1. NWDOH HAST PROGRAMMES SABCOHA CONFERENCE JULY 2011 SUNCITY

2. PRESENTATION OUTLINE Background Provincial and District HIV prevalence NSP Key Priority Areas HIV and Aids Management Policy Changes NW’s response to HCT campaign Provincial HCT performance HCT progress PMTCT Challenges Required Action 2

3. Background North West province divided into 4 districts namely, Bojanala, Dr Kenneth Kaunda, Dr Ruth Segomotsi Mompati Ngaka Modiri Molema It is further divided into 21 sub districts Total population of 3 185 799 (Stats SA) Province is predominantly rural (64.4%) with the Black population in majority (91%) Females are slightly more (50.4%) than males 49.6% (Census 2001) 3

4. 4 DISTRICT HIV PREVALENCE 2007 - 2009 DISTRICT200720082009 Bojanala33.331.834.9 Dr Ruth Segomotsi Mompati 26.928.125.7 Ngaka Modiri Molema 27.028.225.1 Dr Kenneth Kaunda 32.435.229.2 Province30.63130

5. Broad NSP Key Priority Areas HIV and AIDS PROGRAMMES STRUCTURED AROUND 4 PRIORITY AEAS AS FF: Prevention Treatment, care and support Research, monitoring and surveillance Human rights and access to justice 5

6. NSP Priority Areas PREVENTION PROGRAMMES STIs management and control HIV counseling and Testing (HCT) Prevention of Mother to Child Transmission of HIV (PMTCT) Post Exposure Prophylaxis for Sexual Assault (PEP) High Transmission Areas Specialized Auxiliary HIV and AIDS Projects Partnerships /Social mobilization TREATMENT CARE AND SUPPORT ART programme (CCMT) Clinical management training Clinical guidelines Home/community based care Palliative care Step down care Community Health Worker programme EPWP Support groups 6

7. NSP Priority Areas cont.. MONITORING, RESEARCH AND SURVEILLANCE Programme monitoring Operational research Surveys Impact assessments HUMAN RIGHTS AND ACCESS TO JUSTICE Advocacy toolkits Paralegal structures HIV and AIDS related material Stigma mitigati on 7

8. NW’s approach to HIV and Aids Management Integrating HIV and Aids, TB and MCWH programmes because: NCCEMD 2002 – 2004 and 2005 to 2007 reflected maternal deaths due to HIV\AIDS were 44.2% to 51% respectively. Saving children (2005-2007) reflected that nationally, 47% children who died were HIV pos eligible for ART. They died of conditions such as TB, diarhoea, malnutrition, pneumonistic carinii. 70% of M/XDR clients on treatment are HIV pos 8

9. POLICY CHANGES 1 st December 2009 (WAD) Government launched a revitalized campaign on HIV and Aids and TB focusing on taking responsibility. All public health facilities (fixed and mobile) must provide HIV testing. All PHC facilities to provide ART Special focus and fast track - TB/HIV co infection, pregnant women and children under 1 year Campaign began on 1 st April 2010

10. Objectives of National HCT Campaign HCT moving from voluntary testing, to a service delivery model to offer HCT to all patients at their entry point in the health system –To mobilize people to know their status and link to treatment, care and support –Encourage people to take proactive steps towards living a healthy lifestyle, irrespective of their HIV and TB status, through key HIV prevention messages –Increase incidence of health seeking behavior for HIV, STI and TB

11. HCT Targets- Provinces TOTAL POPULATION TARGETED POPULATION TARGETED PRETEST COUNS TARGETED TESTS ECAll districts 6,884,4824,117,741 2,219,4622,017,693 FSAll districts 2,972,9831,926,174 1,059,396963,087 GPAll districts 9,859,5436,834,865 3,683,9923,349,084 KZNAll districts 10,077,6206,243,334 3,365,1573,059,234 LPAll districts 5,357,9493,144,090 1,694,6641,540,604 MPAll districts 3,646,1232,236,374 1,205,4051,095,823 NW All districts 3,229,0782,038,488 1,098,745998,859 WCAll districts 4,945,7323,280,801 1,768,3511,607,592 NCAll districts1,108,599689,675371,735337,941 National48,082,10930,511,54216,466,90714,969,917 11

12. HCT TARGETS PER DISTRICT DISTRICTEST. TOTAL POPULATION EST. HCT TARGET POPULATION HCT TARGET TO BE TESTED OVER 15 MONTHS HCT TARGET PER DISTRICT PER MONTH BOJANALA1 282 466833 702408 51427 234 DR. K. K.708 193466 495228 58315 238 NMM770 960466 795228 73015 248 DR. R.S.M.467 459271 496133 0338 868 TOTAL3 229 0782 038 488998 82066 588 12

13. PROVINCIAL HCT STATUS Source: DHIS; 12 June 2011 IndicatorBojanalaDr. K. K.NMMDr. RSMProvince Pre- Test Counseled 554,897217,764258,659186,7801,218,100 Tested 435,482181,519239,933139,286996,220 Tested Positive for HIV 80,02936,50331,44616,193164,171 HIV Positivity Rate 18.320.113.111.616.4 Screened for TB 425,226172,889241,724265,5441,105,383 Referred for clinical diag. TB 34,42627,97819,36828,555110,327 TB Screening rate 76.779.493.5142.290.8 Target394,487220,964221,106128,599965,526 Target achieved11082108 103 13

14. ANALYSIS As at 12 June 2011 the NW province exceeded its HIV testing target by 3% i.e. testing 996,220 clients against a target of 965,526 The district s have tested as follows:  Bojanala = 110% (435,482 against a target of 394,487 )  Dr. K. K= 82% (181,519 against a target of 220,964 )  NMM = 108% (239,933 against a target of 221,106 )  Dr. RSM= 108% (139,286 against a target of 128,599 ) The Provincial HIV testing rate is 81.8% With districts performing as follows:  Bojanala = 78.4%  Dr. K. K= 83.4%  NMM = 92.8%  Dr. RSM= 74.6% (norm is - 90% of all pretest counseled for HIV should be tested for HIV) NWP only province exceeded HCT target set. Progressively improved, reached and exceeded set target. 14

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16. Treatment Expansion - Summary Before campaignAfter campaign No. of ART sites31124 Patients on ART78 238127 301 Total number of nurses trained and qualifying to initiate patients on ART Nil1397 No. of nurses trained on NIMART initiating patient on ART Nil147 16

17. PMTCT IndicatorTargetBojanalaDr K KNMMDr RSMProvince ANC coverage>959088778894 ANC visits before 20wks rate >703542453940 Delivery rate at facility >956571 76 BBA rate<464675 ANC HIV 1 st test rate >9512592121102111 ANC HIV 1 st test pos rate <152825221824 ANC CD4 1 st test rate >95637358 67 17

18. PMTCT IndicatorTargetBojanalaDr K KNMMDr RSMProvince ANC initiated on AZT during ANC >95577568 59 ANC client initiated on HAART rate >707262684967 ANC NVP uptake rate >955963796964 Baby NVP uptake rate >959399979895 Baby PCR around 6wks uptake rate >8099819312797 Baby PCR positive around 6wks rate <595766 18

19. Challenges Low ANC booking below 20wks Low delivery rate in facilities Low uptake of AZT and NVP initiation for pregnant women ARV programme is still doctor driven – nurses not confident to initiate patients Limited TB/HIV integration (Late diagnosis and initiation of both TB and ART treatment) Infrastructural challenge- old clinics not designed to cater for high case load of clients- impacts negatively on site readiness 19

20. Challenges (contd..) Lack of tracking system for clients tested positive at outreach events to health facilities Shortage of nurses and doctors – inappropriate placements Health Information management (Recording, reporting, and use) Non compliance with treatment by MDR TB patients - Salaries stopped when the patient is admitted in hospital (55% of patients admitted in Tshepong specialised unit from Bojanala) 20

21. Required Action Refurbishment and improvement of existing infra structure to fast track site assessments Human resources provision (attract and retain) Provision of personnel and transport for defaulter tracing Strengthening of Health Information Management Systems (Provision of IT equipment and IT support) Strengthening and funding community outreach programmes and social mobilization Strategies to secure jobs of workers diagnosed with MDR TB until the worker is discharged from hospital Employer support with adherence to treatment and follow up appointment. (reduce transport costs) 21

22. THANK YOU 22