KZN TB AND HIV AND AIDS DISEASE BURDEN DR SM ZUNGU HEAD OF DEPARTMENT PARTNERSHIP CONFERENCE 12 OCTOBER 2010

PRESENTATION OUTLINE Introduction TB/HIV Disease Burden 2009 ANC HIV Prevalence KZN’s Response Partnerships Conclusion

INTRODUCTION KZN is second most populous province after Gauteng with a population of just > 10,4 million which is 20,9% of total SA population KZN has the highest HIV prevalence in South Africa and accounts for 28% of SA HIV infection The province also has the highest TB disease burden.

Introduction cont. TB case load is 1161: population with a TB/HIV co infection rate of about 70% More than 70% of medical admissions are HIV related

HIV PREVALENCE: ANC SURVEY 2009 DistrictPrevalence95% CI AMAJUBA – 41.6 ETHEKWINI – 44.0 ILEMBE – 44.9 SISONKE UGU – 44.6 UMGUNGUNDLOVU – 45.7 UMKHANYAKUDE – 46.6 UMZINYATHI – 35.1 UTHUKELA – 42.6 UTHUNGULU – 51.8 ZULULAND – 43.5 TOTAL – 41.0

KZN HIV ANC PREVALENCE 2009

HIV PREVALENCE 2009 cont

HIV and SYPHYLLIS Prevalence 2009 ….

Trend in Age related prev. from

Source: Abdool Karim Q, Abdool Karim SS, Singh B, Short R, Ngxongo S. AIDS 1992; 6: Age & gender distribution of HIV infection in South Africa 0 < Prevalence (%) Female Male >49

HIV Burden cont There is a higher HIV prevalence amongst the ages yrs with a rising trend amongst the ages of yrs The other represents HIV prevalence for mothers who were the under the age of 10 yrs This is indicative of early sexual debut and The high HIV prevalence amongst young females is indicative of trans-generational sex – younger females having sex with older men as the same age group males have a significantly lower HIV prevalence

Socio-Cultural Factors Driving the Epidemic Some of the socio- cultural factors driving the epidemic include but not limited to: –Poverty –Unemployment –Multiple –sexual partners –Substance abuse –Gender based violence –Gender inequalities

Provincial Response CCMTP –Consolidation of the comprehensive management of patients with HIV and AIDS. Prevention, Treatment, Care and Support –Strengthening of the health system NSP Two primary aims –reduce the number of new HIV infections by 50% by 2011 –reduce the impact of HIV and AIDS on individuals, families, communities and society expanding access to appropriate treatment, care and support to 80% of all people diagnosed with HIV

Provincial Response cont Presidential declaration of 01 December 2009: – to treat HIV and TB under one roof –ART for pregnant women and TB/HIV co infected individuals –Treatment for all the HIV infected infants <1yr HIV Counseling and Testing campaign – Aim to test 15million people in South Africa KZN HCT target is just above 3million people to be tested by end June 2011

FISCAL COMMITMENT (,000) YEARESCGT0TAL 2003R R85.591R R R R R R R R R R R R R R580,483R757,213R1,337, R582,227R1,121,575R1,703, R463,811R1,498,811R2,341,404

HIV COUNSELING and TESTING 100% of all public health facilities providing HCT services Provider Initiated Counseling and Testing approach being promoted to scale up HIV testing HCT also available at non medical sites; tertiary institutions, correctional services Link and Clicks pharmacies have joined forces with DOH in HCT campaign and are now offering free HIV Testing – Commitment from all Link and Clicks pharmacies in the province Other initiative in the pipeline to form partnerships with private hospitals in the HCT and MMC – e.g. MEDI Clinics

HCT Sites DistrictHospitalsClinicsMobilesNon-med Ethekwini Ugu Ilembe43821 Sisonke Umgungundlovu Uthukela33234 Umzinyathi43863 Amajuba31821 Zululand76101 Umkhanyakude Uthungulu Total

HCT Progress HCT targets ambitious but achievable Province has achieved 66% of its target in 5 months Ugu district has achieved 102% so far whilst other districts range between 48 –70 % of their targets Districts are currently doing data mop –up Districts are planning more activities to reach the target

Country 5months Province Pre-testTestedPositivePositivity Rate EC 362,972279,98433,24912% FS 204,596158,77333,81421% GP 566,012525,56885,21416% KZN 878,769710,650150,07921% LP 457,874387,48949,34913% MP 179,122159,55343,62827% NC 57,36854,9976,18311% NW 462,284348,35566,90419% WC 210,410204,18422,36911% TOTAL 3,379,4072,829,553490,78917%

HCT Targets and progress DISTRICTCampaign Target Target per Q # Tested in 5 months Sisonke Umgungundl ovu Uthukela Umzinyathi Amajuba

HCT Targets and progress District Campaign Target Target per Q #Tested in 5 months Zululand Umkhanyaku de Uthungulu Ilembe Ugu Ethekwini

High Transmission Area (HTA) Intervention Targeting high transmission areas There are currently: –6 Truck Stops –16 Correctional Services –13 Tertiary Institutions –3 Taxi Ranks –11 Hostels –3 Farm areas

HTA Sites Ethek wini Umgu ngun dlove Umzi nyathi Uthuk ela Ilemb e Uthun gulu Sison ke UguZulula nd Umkh anyak ude Amaj uba Truck stop Tertiar y institut ions Farms Areas Taxi Ranks Hostel s

Condom Distribution Condoms (male and female) are distributed at medical and non medical sites Distribution at taverns, malls, community gathering areas However condom distribution continue to be a challenge – low distribution rates Challenge in meeting targets set during the HCT campaign

Condom Distribution cont Condom distribution reports only on CHOICE condoms Need to interrogate possible reasons for low distribution and also ascertain the extent of preference of other brands of condoms e.g. Lovers Plus over CHOICE condoms

Prevention of Mother to Child Transmission PMTCT offered in 100% facilities PMTCT integrated into MCWH programme Improve package of care implemented as per presidential mandate Emphasis is on early booking before 14 weeks and HIV testing in order to facilitate early access to HIV prophylaxis and treatment Mother to child transmission rate reduce to 8,8%

Medical Male Circumcision (MMC) HIV Prevention strategies targeting males Evidence that MMC reduces the risk of HIV acquisition It is community driven strategy announced by His Majesty King Zwelithini Clinical strategy which is aligned to traditional approach Comprehensive package for youth including life skills coaching and nation building approach MMC Campaigns running in all districts MMC provided in district hospitals Target for 2010/11 is 372,754 A total of MMC have been conducted since April 2010.

Antiretroviral Therapy KZN has the largest ART programme in SA ART initiations expanded to PHC level Approach changing from Dr driven to nurse driven approach - Nurse Initiated and Managed antiretroviral Therapy (NIMART) There are currently 300 initiating facilities including PHC facilities

ART Pts & INITIATING PHC’s DistrictPHC INTIATING ART by end Q2Total Pts by end Q1 Ethekwini2397,995 Sisonke1517,068 Ilembe1720,812 Uthungulu1434,642 Umkhanyakude4832,008 Zululand2125,933 Amajuba1014,942 Umzinyathi216,706 Uthukela2024,091 Umgungundlovu1140,846 Ugu3033,362 TOTAL211345, 604

ART cont. PHC ART expansion is bringing HIV and AIDS services closer to the communities thus increasing access Great commitment from municipalities – aiming at 100% coverage of their facilities

Health Systems strengthening In order to provide an efficient and effective TB, HIV and AIDS program the DOH together with partners its is implementing following: –Human resource provisioning – integrated TB/HIV teams –Capacity development training for health care workers including community care givers –Infrastructure development and improvement –Monitoring and evaluation of programmes

Partnerships TB, HIV and AIDS requires a multi-pronged collaborative response from all sectors of society e.g. NGOs, CBOs, FBOs, Civil Society, Political leaders, traditional leaders, business sector, traditional practitioners, and other government departments This collaborative response is coordinated through the Provincial Council on AIDS

Conclusion The road ahead of us demands that we work together in an aggressive and integrated manner in the fight against TB HIV and AIDS This can only be achieved through the Flagship Programme which is pioneered by our Honorable Premier Dr Zweli Mkhize The emphasis is on : –Household Food Security – “ONE HOME ONE GARDEN” –Ward based Intergovernmental programmes of action –Strong volunteer programme

Conclusion It is important that all sectors rally around all efforts aimed at combating TB, HIV and AIDS including poverty alleviation to improve the livelihood of the people of KZN As we celebrate our partnership let us remember that HIV and TB is one of the factors that continue to cement and strengthen our partnership as warriors against TB, HIV and AIDS

THANK YOU