TB AND HIV: “THE STRATEGIC VISION FOR THE COUNTRY” Dr Lindiwe Mvusi 18 May 2012 MMPA Congress 2012

PRESENTATION OUTLINE  Background  Vision and Goal  Strategic objectives  Priority TB interventions  Conclusion

1997 Phased implementation of DOTS, establishment of DTDs 1999 Introduction of fixed dose combination drugs Establishment of TB and HIV pilot districts 2000 MDR-TB guidelines endorsed, establishment of MDR-TB treatment facilities 2002 Launch of the MTDP Launch of the ACSM Plan Scale up of TB/ HIV Collaborative activities 2005 Declaration of TB as an emergency in AFRO region Launch of the National TB Crisis Plan 2006 Development of MDR and XDR Action Plan 2007 Launch of the National TB Strategic Plan Development of Infection control guidelines for TB 2010 Framework for decentralisation of MDR-TB treatment 2011 National HIV, AIDS, STI and TB Strategic Plan

GLOBAL BURDEN OF TB WHO REORT ON GLOBAL TB CONTROL 2011 Estimated TB Incidence rate, 2010HIV prevalence in TB patients, 2010

TB PREVALENCE RATE PER  Baseline 1990 –431/  Target for 2015 –215/  Current (2010) –795/ WHO REORT ON GLOBAL TB CONTROL 2011

TB INCIDENCE RATE PER  Baseline 1990 –301/  Target for 2015 –150/  Current (2010) –981/ WHO REORT ON GLOBAL TB CONTROL 2011

TB MORTALITY RATE PER  Baseline 1990 –38/  Target for 2015 –19/  Current (2010) –50/ WHO REORT ON GLOBAL TB CONTROL 2011

PROPORTION ON MDR-TB AMONG NEW CASES GLOBALLY WHO GLOBAL DRUG RESISTANT TB REPORT 2010

DRUG RESISTANT TB LABORATORY NOTIFICATIONS:  Prevalence MDR-TB among new: 1.6%  Prevalence MDR-TB among ret: 6.7%  Prevalence of XDR- TB among MDR-TB: 9%

VISION  Zero new TB and HIV infections  Zero vertical transmission of infection  Zero preventable deaths associated with TB, HIV and AIDS  Zero discrimination

GOALS  Reducing new HIV infections by at least 50%  Reducing new TB infections by 50%  Initiating at least 80% of eligible clients on ART, with 70% on treatment after 5 years  Reducing TB deaths by 50%  Reducing self reported stigma related to TB and HIV by at least 50%  Promote human rights through an enabling and accessible legal framework

STRATEGIC OBJECTIVES  Address social and structural barriers –Social, cultural norms and behaviours –Socio-economic factors –Access to basic services –Gender inequities –vulnerability  Prevention of new infections –Combination interventions Biomedical, behavioural, social and structural

 Sustain health and wellness –Access to diagnostic, treatment, care and support services  Protection of human rights and improving access to justice –Stigma, discrimination, human rights violations, gender inequalities

STRATEGIC ENABLERS  Governance and institutional arrangements –Coordination of multi-sectoral approach –Increased responsibility and accountability  Effective communication –Social and behavioural change  Monitoring and evaluation –Focussing on impact – incidence, prevalence, morbidity and mortality  Research –Surveillance and vital statistics –Health systems and operations research –Research for innovation –Policy, social and public health research

TB KEY POPULATIONS  Household contacts  Health care workers  Mine workers  Inmates and correctional services staff  Mobile, migrant and refugee populations  People living in informal settlements  Smokers, drug and alcohol abusers  People with diabetes and those who are malnourished

SOCIAL, ECONOMIC AND BEHAVIOURAL DRIVERS  Improving living conditions  Hard to reach areas, populations –Access to services –Rural including farming communities  Alcohol and substance abuse  Poverty alleviation and food security  Education and job opportunities  Gender based violence

PREVENTION  Early diagnosis and treatment –Regular symptomatic screening of high risk groups –Contact/ source investigation –Outbreak investigations  Airborne infection control –Cough hygiene –Adequate ventilation –Risk assessments of high risk areas  Preventive treatment –Isoniazid –ART –Vaccines

HEALTH AND WELLNESS  Rapid diagnostic tests –GeneXpert, LPA  HIV testing  Age appropriate quality TB drugs (FDCs)  ART irrespective of CD4 count  Appropriate treatment of opportunistic infections and diseases  Treatment literacy to improve compliance

 Referral, community follow up and support systems –Including MDR-TB care  Systems for delivery of chronic medication  Integrated service delivery

HUMAN RIGHTS AND ACCESS TO JUSTICE  Rights violation –Systems for monitoring abuses  Workplace discrimination  Unfair discrimination in access to services

CONCLUSION For this plan to be a success it requires a combination of interventions to address TB and HIV as well as a multi sectoral approach

“STOP TB …….. BECAUSE YOU CAN ” Thank you