Recommendations for policy in the Western Cape Province regarding the prevention of Major Infectious Diseases including hiv/AI

April 2005 to March 2006:

The key considerations for policy change are the following:

1. 
   Integration of pMTCT services into Maternal and Women’s Health and Child Health services;
   
2. 
   Review of ART regimen
   

3. 
   Explore Feeding options – the transmission through mixed feeding remains a problem
   
4. 
   Follow-up of mother infant pairs up to the age of 2 years of age
   

Implementation strategy:

1. 
   Review anti-retroviral treatment regimen for pMTCT (dual therapy from 28 weeks gestation);
   
2. 
   Review feeding option counselling;
   
3. 
   Implement follow-up systems.
   

5. 
   Other strategies:
   

Appendix 3. Draft Surveillance, Monitoring and Evaluation Strategy

6. 
   CONCLUSION
   

The HIV epidemic in the Western Cape is relatively less mature than the rest of the country and this province has a unique opportunity to intervene. However, within the province is also evident that there are sub-epidemics which are maturing at various rates and therefore the prevention strategies will have to be tailored to the local context. This prevention strategy aims to pursue a “combination prevention approach” that focuses on improving the coverage, scale, intensity of proven interventions. It is imperative that this be reinforced with clear and non-ambiguous messages aimed at the community level as well as at the individual level.

References

ASSA. Actuarial Society of South Africa. ASSA 2003 AIDS and Demographic Model, provincial version. http://www.assa.org.za. 2005.

Bradshaw D, Nannan N, Joubert J, Laubscher R, Nojilana B, Norman R, Pieterse D, Schneider M. l. Provincial mortality in South Africa, priority-setting for now and a benchmark for the future. S Af Med J. 2005; 95: 496-503.

Department of Health. National HIV Sero–Prevalence Survey of Women Attending Public Health Antenatal Clinics in South Africa 2005.

Department of Health. National HIV Sero–Prevalence Survey of Women Attending Public Health Antenatal Clinics in South Africa 2002, ISBN 0-620-2611307.

Flisher AJ, Mathews C, Mukoma W, Ahmed N, Lombard C.J. Secular trends in risk behaviour of Cape Town grade 8 students. Manuscript under review.

iKapa Elihlumayo 2006. The Provincial Growth and Development Strategy of the Western Cape, May 2006.

Kelly JA, Murphy DA, Sikkema KJ, McAuliffe TL, Roffman RA, Soloman LJ, Winett RA, Kalichman SC, and the Community HIV Prevention Research Collaborative. Randomized, controlled, community-level HIV-prevention intervention for sexual-risk behavior among homosexual men in US cities. Lancet, 350. 1997:1500-1504.

Pettifor AE, Rees HV, Steffenson A, et al. HIV and sexual behaviour among young South Africans: a national survey of 15-24 year olds. Johannesburg: Reproductive Health Research Unit, Univ.of Witwaterstrand, 2004. Health Systems Trust Publication 2004.

Shaikh, N. Abdullah, F., Lombard, C.J., Smit, L., Bradshaw, D. & Makubalo, L. (2006). Masking through averages – intra-provincial heterogeneity in HIV prevalence within the Western Cape. South African Medical Journal, 96, 538-543).

Shaikh & Abdullah. The Provincial and Health District Survey Report; Western Cape 2002; ISBN 1-875017-87-9.

Shisana O, Simbayi L. Nelson Mandela/ HSRC Study of HIV/AIDS. South African National HIV prevalence, Behavioral Risks and Mass Media. Human Sciences Research Council. 2002. ISBN 0-7969-2007-9; 58-59.

Shisana O, Rehle T, Simbayi LC et al. South African National HIV prevalence, Incidence, Behavior and Communication survey, 2005. Human Sciences Research Council press, Cape Town.

Reddy P, Panday S, Swart D, Jinabhai C, et al. Umthenthe Uhlaba Usamile-The South African youth risk behaviour Survey 2002. Cape Town :South African Medical Research Council.

UNAIDS. 2005. AIDS epidemic Update: December 2005. UNAIDS/WHO, UNAIDS /05.19E.

Appendix 1: HIV Prevalence Trends by Area:

Western Cape Province, 2000-2005

District	Area	HIV Prevalence (95% Confidence Interval)
		2000	2001	2002	2003	2004	2005
Cape Metropole	Blaauwberg		0.61.1	8.2±6*	4.4±3.0	1.2±1	7.3±3.6
	Cape Town Central		3.73.6	11.9±6*	11.6±5*	13.7 ±4.7	11.5±3.3
	Greater Athlone		6.84.6	8.9±4	10.1±4.4	16.4 ±3.6	17.7±3.5
	Helderberg		196	19.1±4.5	19.1±4.2	18.8 ±3.3	12.8±3.0
	Khayelitsha		225	24.9±4.2	27.2±4.2	33.0 ±3.5	32.6±3.2
	Mitchells Plain	5.4 0.1	0.71.3	4± 4.0	6.3±4	12.9 ±3.5	5.1±2.0
	Gugulethu/ Nyanga		16.16.5	27.8±5.2	28.1±4.2	29.1 ±2.8	29.1±3.9
	Oostenberg		5.73.3	14.5± 6.	16.1±4.3	14.8 ±3.3	16.2±3.5
	South Peninsula		5.9 3.9	6± 4.1	9.3±3.8	10.8 ±3.2	12.4±3.2
	Tygerberg Eastern	5.1 3.7	6.13.4	10.4±5	8.0±3.9	12.7 ±3.6	15.2±3.5
	Tygerberg Western		7.93.9	12.7±5	8.1±3.3	15.1 ±4	15.0±3.15
Overberg	Bredasdorp/ Swellendam		1.42.7	3.2±4.5	1.1±2.1	10.0±5*	4.5±3.2
	Caledon/ Hermanus		135	10.8±4	14.4±4.6	12.5±3.2	15.4±3.2
Cape Winelands	Ceres/Tulbagh		6.25.3	9.4±5.6*	7.5±5.1	10.5±3.7	13.8±4.6
	Worcester/ Robertson	3.22.7	5.73.9	4.5±3.2	3.9±2.6	8.4 ±3.3	8.1±2.4
	Paarl	4.53.2	8.33.6	11.4±4.4	10.1±4.2	8.9 ±3.0	11.4±3.2
	Stellenbosch		7.13.7	8.5±5*	8.5±4.9	17.8±6.1*	15.5±4.8
West Coast	Vredenburg		8.95.6	9.0±4.7	10.0±4.5	13.0 ±4.1	8.9±3.5
	Malmesbury		2.73	6.7±5.3	10.7±4.8	6.2 ±3.7	6.9±3.2
	Vredendal		1.32.4	10.2±7.6*	3.9±3.4	5.8±4.0	9.9±4.0
Central Karoo / Eden	Knysna/Plettenberg Bay		13.36.7	15.9±5.2*	15.6±4.0	17.4 ± 3.6	21.1±4.5
	Klein Karoo		0.81.4	7.8±6.1	5.4±3.2	6.5 ±4.4	5.3±3.0
	Mossel Bay/ Hessequa		74.7	6.8± 4	13.3±4.8	12.5 ±3.2	8.9±4.5
	George	5.6 5.3	106*	10±4.2	11.6±3.7	13.3 ±3.4	13.8±3.5
	Central Karoo		5.54.5	7.4±5.1*	6.5±4.4	8.9 ±4.6	8.9±5.5
Western Cape

• 
  Results to be treated with caution given the wide confidence intervals
  

Source: HIV Antenatal Surveys, DoH

Appendix 2: Multiple Index of Deprivation by Ward (Map)¹²

1 School of Public Health and Family Medicine, University of Cape Town

2 Centre for AIDS Development, Research and Evaluation (CADRE)

3 Human Sciences Research Council

4 Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, UCT

5 HIV/TB and STI Directorate, Provincial Government of the Western Cape

6 Independent Research Consultant

7 Specialist Scientist, Medical Research Council

8 Senior Investigator, Desmond Tutu Centre

9 Cochrane HIV/AIDS Review Group, Medical Research Council

10 Director, HIV/AIDS Programme of the University of the Western Cape

11

12 The Provincial Indices of Multiple Deprivation for South Africa 2001, Noble, M et al, University of Oxford, HSRC, Statistics South Africa, 2006.

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