The HIV programme & implications for health systems strengthening in

South AfricaYOGAN PILLAYNATIONAL DEPARTMENT OF HEALTH, SOUTH AFRICAJULY 24, 2014

HIV and ART in South Africa 6.4 million people living with HIV and AIDS (total population 54

million) Prevalence amongst pregnant women: 29% Prevalence in the general population: 12.2% Incidence: 1.07% (0.71% in males; 1.46% in females) 50% of maternal mortality and under 5 mortality associated with HIV 2.5 million on ART ART Coverage: 80% of women, 65% of children and men

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PROGRESS•Significant domestic investment in the treatment programme• Investment case done since 2008/09; currently TB/HIV

investment case being completed (used to convince Treasury to fund the programme)•20 million tested in 20 months (campaign); currently 8 million

tested annually•Treatment at PHC level (NIMART) and integrated with TB• Large numbers on treatment (initiation at CD 4>200)

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Progress contd•>90% of pregnant women tested and >80% on treatment•MTCT: <2.6% at 6 weeks•Fixed dose combination since April 2013 (1.2m on FDCs); drug cost declines•Courier service for stable patients piloted•First ever independent integrated TB, HIV and PMTCT programme review conducted in Sept/Oct 2013

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HIV/AIDS deaths cut by >50% since 2006

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Life expectancy is increasing

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Key factors in HIV response success Political leadership & domestic funding Strategic information for steering the response Design of programmes that fit the epidemic Delivering effective services Enabling and sharing innovations

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HIV spending in South Africa

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5 000

10 000

15 000

20 000

25 000

30 000

35 000

R m

illio

nHIV spending in South Africa 2007/8 - 2016/17

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Strategic information for decision-making

Joint Review of HIV, TB and PMTCTProgrammes in South AfricaMain ReportApril 2014

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Political leadershipDeputy President chairs the South African National AIDS Council (with civil society rep as co-chair) President Zuma address World AIDS Day in 2009 and announced new treatment guidelinesPresident Zuma and Deputy President Mothlanthe launch HIV, STI and TB Strategy Plan, 2012-2016 President Zuma launches national HCT Campaign to test 15 m South Africans in 15 monthsPresident Zuma tests and announces his HIV status publicly

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Design programmes that fit the epidemic National Strategic Plan for HIV/AIDS, STIs and TB

2012-2016 Nine provincial strategic plans Costed implementation plans Reprogramming of national grants to align with

these plans One national proposal for grant renewal,

national investment strategy

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Delivering effective services Well managed health services (at all levels) Drug procurement & delivery/availability Task shifting Reducing laboratory costs Involvement of civil society and private sector Strengthening integration Links to social safety nets

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Integrated, independent programme reviews Five yearly individual programme reviews (HIV and TB)2013: joint review to review level of integrated service delivery – TB, HIV and PMTCT (led by WHO)2014: using lessons from the 2013 joint review – midterm review of the maternal, newborn, child and women’s health and nutrition strategy (led by UNICEF)Currently programming the recommendations from these reviews (most relate to the need for health systems strengthening)Must create the conditions and evidence for use in reflecting on successes and challenges in programme implementation

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Progress towards the Millennium Development Goals (SAMJ, Vol 104, No 3 (2014)

Progress towards the Millennium Development Goals in SA Y Pillay, P Barron

Successfully controlling malaria in South Africa L Blumberg, J Frean, D Moonasar, South African Malaria Elimination Committee

Effectiveness of pneumococcal conjugate vaccine and rotavirus vaccine introduction into the South African public immunisation programme S A Madhi, L Bamford, N Ngcobo

Laboratory information system data demonstrate successful implementation of the prevention of mother-to-child transmission programme in South Africa G G Sherman, R R Lilian, S Bhardwaj, S Candy, P Barron

Elimination of mother-to-child transmission of HIV in South Africa: Rapid scale-up using quality improvement S Bhardwaj, P Barron, Y Pillay, L Treger-Slavin, P Robinson, A Goga, G Sherman

Tuberculosis control in South Africa: Successes, challenges and recommendations G J Churchyard, L D Mametja, L Mvusi, N Ndjeka, A C Hesseling, A Reid, S Babatunde, Y Pillay

A brief history of South Africa's response to AIDS N P Simelela, W D F Venter

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Challenges (lets also learn from challenges and what does not work)

Joint planning across the social sector to take into account the social determinants of healthIncreasing inputs and involvement of communitiesImproving quality of care at the same time as we expand coverage rapidlyMoving from pilots and demonstration projects (largely development partner funded) to review and to scaleHow to keep front line health providers motivatedThe list is endless....... Hence the need to learn from each other......

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I THANK YOU FOR YOUR ATTENTION

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