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BRIEFING: JOINT COMMITTEE ON HIV AND AIDS. Department of Correctional Services’ (DCS’) HIV and AIDS programme for inmates. 14 June 2013. INTRODUCTION.
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BRIEFING: JOINT COMMITTEE ON HIV AND AIDS Department of Correctional Services’ (DCS’) HIV and AIDS programme for inmates 14 June 2013
INTRODUCTION • According to international norms and standards, “inmates must have access to the same quality and range of health care services as the general public receives from the National Health System”. A person’s capacity to access these services should not be compromised by reasons of incarceration since all people have a basic right to health, nutrition, clean and safe environment as obliged by the Constitution of the Republic of South Africa. • Incarcerated persons represent a small proportion of the total South African population, who are also at risk of developing health and social problems. • In terms of the Correctional Services Act, 1998 (Act 111 of 1998), the department provides primary health care services and refers patients to external health facilities, mainly those of the Department of Health (DoH) where secondary and tertiary levels of health care are accessed. • Health care delivery in the Department of Correctional Services (DCS) is however rendered in accordance with DoH’s legislation, policies and guidelines in an effort to contribute to the key outputs which are consistent with the Millennium Development Goals (MDGs).
BACKGROUND • The department is comprised of six Regions (Eastern Cape, Free State/Northern Cape, Gauteng, KwaZulu-Natal, Limpopo/Mpumalanga/North West and Western Cape). • 48 Management Areas (similar to Districts in the Department of Health). • 241 Correctional Centers. • There is at least one Primary Health Care (PHC) facility per Correctional Centre and one in-patient facility / sickbay with beds ranging from 5 – 120 per management area. • An in-patient facility is defined as a facility that has been established for the purpose of accommodating inmates that are ill or recovering from post-operative procedures and cannot be accommodated in the general cells whilst on treatment. This facility does not meet the requirements for being classified as a hospital. • The Department recruits health care professionals (professional nurses, pharmacist, medical practitioners, psychologists).
SERVICES AND PROGRAMMES The Department ensures access to and provides primary health care services on a 24 hour basis which include: • Promotive and preventive health services (health education). • Curative services for acute minor ailments, injuries, communicable and non- communicable diseases. • Pharmaceutical services. • Mental health care. • Facilitates access to supplementary health services i.e. laboratory, physiotherapy, radiography, speech, hearing and occupational health services. • Referral depending on need • within Correctional environment; • public health sector at local / district and provincial level; • Private health care providers.
HIV AND TB MANAGEMENT HIV and TB management is rendered in accordance with the National Strategic Plan (NSP) for HIV, Sexually Transmitted Infections (STIs) and TB 2012 - 2016 as well as the DCS TB Management Guidelines (2013). HIV and AIDS Programmes and Services: PREVENTION • Offer HIV counseling, testing and linking inmates to treatment. • Conduct HIV education and information sessions (individual or group). • Screening HIV positive inmates for TB. • Provide IPT to HIV positive inmates to prevent the likelihood of developing TB. • Distribution of condoms. • Ensure access to Voluntary Medical Male Circumcision. CARE • Implementing palliative care with the support of partners. SUPPORT GROUPS • Established and maintained within correctional centres by health care professionals and custodial staff as well as offenders.
HIV AND TB MANAGEMENT HIV and AIDS Programmes and Services: PREVENTION … • Provide HIV Post Exposure Prophylaxis (PEP) for injuries and sexual assaults. • Refer pregnant women for Prevention of Mother to Child Transmission (PMTCT) of HIV (Eradication). CARE • Implementing palliative care with the support of partners. SUPPORT GROUPS • Established and maintained within correctional centres by health care professionals and custodial staff as well as offenders.
HIV and TB MANAGEMENT TREATMENT • Ensure access to Antiretroviral Treatment (ART) internally and through referrals to external public health facilities. • Department has commenced with the provision of Fixed Dose Combination (FDC).
HIV AND TB MANAGEMENT TB management: • Screening on admission. • Comprehensive assessment within 24 hours of admission. • Development and implementation of individualized nursing care plans. • Recording and monitoring. • Health education on TB. • All TB positive inmates are offered HIV Counseling and Testing (HCT). • HIV infected TB patients are initiated on CPT unless contra-indicated to prevent opportunistic infections.
GUIDELINES FOR THE MANAGEMENT OF TB, HIV AND STIS IN CORRECTIONAL FACILITIES 2013 • Developed in collaboration with NDoH and partners. • Launched by the Minister of Health on World TB Day. The guidelines requires the following: Prevention • HIV Counselling and Testing must be offered to all inmates at entry, exit, upon self-presentation and during campaigns. • Symptom-based TB screening must be done on all inmates at entry, exit, upon self-presentation, bi-annually or during campaigns. • Screening must be extended to internal and external TB contacts.
GUIDELINES FOR THE MANAGEMENT OF TB, HIV AND STIS IN CORRECTIONAL CENTRES 2013 Prevention…… • Inmates with pulmonary TB must be isolated for two weeks. • Provision of Isoniazid preventive therapy (IPT). • GeneXpert MTB/RIF on symptomatic cases. • Chest X-ray (digital). Treatment • According to National Guidelines. • GeneXpert MTB/RIF-positive, rifampicin-resistant patients are referred to a multidrug-resistant TB unit for further management.
GUIDELINES FOR THE MANAGEMENT OF TB, HIV AND STIS IN CORRECTIONAL CENTRES 2013…… • Inmates with pulmonary TB should be isolated for two weeks. • All HIV-positive inmates require repeat CD4 testing every 6 months, monthly TB symptom screening and regular STI screening. • All HIV-positive inmates require repeat CD4 testing every 6 months, monthly TB symptom screening and regular STI screening.
HIV & AIDS AND TB MANAGEMENT HIGHLIGTHS Political commitment • DCS is actively involved in all South African National AIDS Council (SANAC) activities. Integration of DCS health care services into the National Health System • The department participated in the development of the National Strategic Plan (NSP) for HIV, STIs and TB: 2012-2016 and its Operational Plan. • This assisted the department to focus on issues that are specific to inmates as a key population vulnerable to the dual epidemics of TB and HIV. • NDoH provides leadership/support with the development of health care policies. • DCS is also involved in various DoH activities at National, Provincial and District levels. • DCS participates in the Government Community Service programme for pharmacists.
HIV & AIDS AND TB MANAGEMENT HIGHLIGTHS Partnership and co-operation established with external partners [Government departments (DoH) and NGOs]. MoUs signed with the following partners: • Population Council to strengthen HIV Post Exposure Prophylaxis services for injuries and sexual assault survivors in all Regions. • The International Training and Education Centre for Health (I-TECH) for the training of health care professionals in comprehensive HIV and TB management. • Hospice Palliative Care Association to strengthen capacity to implement palliative care. Training of non-health care staff • 1186 Offenders are trained as peer educators in HIV & AIDS and TB to assist in health promotion and disease prevention.
CONCLUSION Correctional Health must form part of the National Health System as good “prison health is good public health”. Partnerships and cooperation between the DCS and DoH as well as all relevant partners must be maintained for the optimum delivery of health care programmes and services to the inmate population.
