ACCELERATED IMPLEMENTATION OF THE COMPREHENSIVE PROGRAMME

TO FIGHT HIV AND AIDS IN KZN

PROVINCIAL COUNCIL ON AIDS MEETING25 AUGUST 2010

HIV Prevalence range

30 – 40%

>40%0 50 100 150 20025Kilometers

KWAZULU – NATAL- 2008

.Amajuba34.7%%

Ugu40.6%

Sisonke35.8%

Ethekwini40.3%

Umkhanyakude39.9%

Zululand36.2%

Uthukela38.6%

Ilembe35.8%

Uthungulu36.1%

Umgugundlovu45.7%

>40%

<30%

Umzinyathi29.2%

Empirically we can rapidly reduce HIV incidence if we can:

• ↑ age of sexual debut

• ↓ sexual frequency

• ↓ partner change

• ↓ concurrent partners

• ↑ condom use

• Knowledge of HIV status

BARRIER METHODS

(Male & Female Condoms)

MTCTHCT

BEHAVIOURAL CHANGE

VACCINES

PrEP

MICROBICIDES

ANTI-RETROVIRAL

THERAPY FOR PREVENTION

HIV PreventionMethods - 2010

MALECIRCUMCISION

PEP

Underinvestigation

Proven HIVprevention methods

HIV COUNSELLING AND TESTING (HCT)

• President’s announcement on 1st of December 2009 included the Massive campaign to mobilise all South Africans to get tested

• Previously known as VCT• Objectives of HCT are:

– Mobilize people to know their status.– Support people with key prevention messaging in order to take proactive steps to

a healthy lifestyle irrespective of HIV status– Increase incidence of health seeking behaviour; and– Increase the access to treatment, care and support

• HCT is moving from voluntary testing, to a service delivery model to offer HCT to all patients at their entry point in the health system

• Participation by all public health facilities (fixed and mobile), NGOs and other non medical sites (incorporate effective referral systems)

• Target for country = 15 million people to be tested by JUNE 2011.

PREVENTION

District Performance April-July 2010

DISTRICTSPre test

counselled for HIV

Adult >15 Children

<15Total

Tested15 months'

TargetQuarter One %

AchievedClients tested +

Total Positive

    Male Female           MaleFema

le

Children

<15yrs

 

Ugu 51,665 13,557 35,684 1,677 50,918 208,504   92% 3,632 7,244 244 11,120

Ethekweni 134,248 38,903 71,810 3,647

114,360 1,053,113   41%12,304

22,132 930

35,366

iLembe 31,115 8,206 18,430 1,079 27,715 185,510   56% 1,839 3,217 149 5,205

                         

Amajuba 23,890 7,370 14,864 869 23,103 178,223   49% 1,595 3,360 188 5,143

Uthukela 25,762 6,467 16,567 931 23,965 184,289   49% 1,800 4,299 164 6,263

Umzinyathi 72,021 8,338 19,058 1,128 28,524 128,263   83% 1,682 3,260 144 5,086

Sisonke 27,920 6,281 18,509 1,257 26,047 138,743   70% 1,098 2,746 143 3,987

uMgungundlovu 61,070 15,586 30,604 2,358 48,548 322,101   57% 3,724 7,339 252 11,315

                         

Uthungulu 90,523 21,176 45,459 2,354 68,989 260,112   99% 2,882 5,891 210 8,983

Zululand 32,079 8,299 20,067 1,197 29,563 235,060   47% 1,973 3,892 159 6,024

Umkhanyakude 22,836 6,202 14,457 1,186 21,845 165,315   50% 1,402 2,830 154 4,386

                         

Totals 573,129 140,385 305,509 17,683 463,577 3059233   57%33,93

166210

2737

102878

Province by Province Comparison

Province Districts Pretest Tested4 Months

target % Tested PositivePositivit

yScreene

d TB ReferredCampaign

Target

Eastern Cape 7 227,221 176,316 538,052 33% 20,727 12% 47,308 8,421 2,017,693

Free State 5 87482 81432 256,824 32% 15,010 18% 26,918 6679 963,087

Gauteng 6 340290 340,290 893,088 38% 58,351 17% 142,923 28,010 3,349,084

KwaZulu-Natal 11 573,129 463,577 815,796 57% 102,878 22% 252,062 48,624 3,059,234

Limpopo 5 246,508 207,939 410,828 51% 27,544 14% 34,772 5,176 1,540,604

Mpumalanga 3 113,272 100,045 292,220 34% 27,506 28% 44,841 6,800 1,095,823

Northern Cape 5 39201 27,532 90,116 31% 3,187 11% 5,701 1,972 337,941

North West 4 186,222 141,399 266,364 53% 26,299 20% 65,873 9,577 998,859

Western Cape 6     426,692 0%         1,607,592

Grand Total  

1,745,087

1,484,509 3,989,980 37% 269,282   586,671 109,545 14,969,917

MALE MEDICAL CIRCUMCISION

• Since Launch 18 camps held covering all districts

• All hospitals now doing circumcisions• Part of comprehensive risk reduction

strategy • Programme manager appointed to lead

the programme• 144 doctors have been trained on

circumcision

Implementation Model

Mixed method approach to cover targets

•1.8- 2million in 5 years•94 000 neonates annually

Health facilities•Routine daily circumcisions for adults

•Routine daily circumcisions for neonates•Facility readiness done and targets set

CAMPS

•Catch up for mass circumcision•2 day camps

•Arranged per district•More than 150 per camp

•Mainly younger groups (15-25)

Surgical Intervention

• Local anesthesia by competent practitioner

• Practitioners trained on all methods: Sleeve resection, forceps guided method and also use of the Tara clamp

• Competence in forceps guided method and sleeve resection a prerequisite for training in Tara clamp

MMC Figures as at 31 July 2010 District No of circumcisions

Ethekwini 606

Umgungundlovu 2067

Ilembe 332

Ugu 369

Sisonke 167

Umkhanyakude 150

Zululand 717

Uthungulu 534

Amajuba 437

Uthukela 141

Umzinyathi 320

Total 5840

His Majesty, MEC and HOD during MMC launch

The Premier and MEC at Ladysmith camp

Minister and MEC for Health at Ugu camp

KwaNibela-Hluhluwe camp

PHC ART INITIATIONDistrict No of clinics initiating ART

Ethekwini 14Umgungundlovu 10

Ilembe 17Ugu 29Sisonke 5

Umkhanyakude 48

Zululand 21

Uthungulu 14

Amajuba 10

Uthukela 20Umzinyathi 2Total 90

279 ART SERVICE POINTS

>40%0 50 100 150 20025Kilometers

.Amajuba

Ugu

Sisonke Ethekwini

Umzinyathi

Umkhanyakude

Zululand

Uthukela

Ilembe

Uthungulu

Umgugundlovu

22 914

97 995

39 733

22 541

17 608

20 812

34 642

32 008

25 933

16 706

14 942

KZN ART FIGURES30 JUNE 2010

TOTAL ACTIVE PATIENTS:

345 834

NATIONAL COMPREHENSIVE HIV & AIDS PLAN STATISTICS

113927

55874

219952

330897

68792

74743

94000

13579 77990

0

50000

100000

150000

200000

250000

300000

350000

NO OF PATIENTS ON ART AS AT

31/05/2010

EC FS GP KZN LP MP NW NC WC

PROVINCESUptake of 15 000

Patients per monthIn KZN

TENOFOVIR MICROBICIDE GEL RESULTS

What is a microbicide? A microbicide is a product that can be

applied to the vaginal or rectal mucosa with the intention of preventing the transmission of sexually transmitted infections including HIV

TB/HIV INTEGRATION• HCT linked with TB testing

• Isoniazid preventative therapy commenced 1 April 2010 in 291 facilities with 5967 patients benefitting at the end of June 2010

• All MDR/XDR patients put on ART irrespective of staging

What is a CAPRISA 004 trial• Proof of concept study of a topical PrEP

ARV based strategy using 1% tenofovir• Done at Vulindlela and Durban sites of

CAPRISA• First microbicide trial with funding from a

developing country as it was co-funded by US & SA governmental agencies (DST)

• Started in 2007 and results released in July 2010.

RESULTS• CAPRISA 004, showed that women who used a

gel containing tenofovir gel 12 hours precoitally and 12 hours post coitally, had a 39 percent lower rate of infection compared to women who used a placebo gel. In addition to HIV, it also prevented Herpes simplex virus transmission

• 1st ever study showing promising results in this field, internationally

WHAT NEXT NOW?• An independent study should confirm these

results before the product is confirmed as effective (VOICE trial on, results due 2014)

• If the confirmation occurs, the product will then have to be registered with the MCC as a drug

• Will be part of a comprehensive strategy and not as a stand alone intervention

• The process to be followed is still going to take at least 4-5 years before but it all depends on the confirmatory study