The Response to hiv/aids a parliamentary Briefing March 2003 Department of Health

The Response to HIV/AIDS A Parliamentary Briefing March 2003

• Department of Health

Mission and Vision

• Primary goals:

• Reduce the number of new HIV infections, especially among youth; and
• Reduce the impact of HIV/AIDS on individuals, families and communities

Guiding the Response

• Strategic Plan; HIV/AIDS, STI and TB guidelines

• Multisectoral response – working with SANAC

• Operational plans linked to Strategic Plan

Structures in addressing HIV/AIDS

Staff establishment

• National office

• Approximately 93 – including consultants, admin staff

• National office seconds 7 officials per province from the national budget

• 2 x GAAP
• 2 x VCT
• 2 x PMTCT
• 1 x HBC

Programmes in the NDOH

• TB

• STI Prevention

• IDC

• Youth

• GAAP

• NGO Funding

• Care and Support

Priorities for 2003 (General)

• Scaling up of key interventions: PMTCT, VCT, HBC, non-o-pep

• Mid-term review of HIV/AIDS and STI Strategic Plan

• Review of existing policies and guidelines – also identify and address policy gaps

• Implementation of TB Medium-Term Development Plan

TB Control

• Selected achievements in 2002/03

• Medium Term Development Plan launched
• In-patient TB care unit established at NDOH
• District-based reporting in 5 provinces
• MDR-TB surveillance completed
• TB/HIV Training districts in all provinces

• Selected priorities for 2003

• Ensure implementation of MTDP
• Improve performance of hospital based TB services

TB Control

• Selected priorities for 2003 (cont.)

• Implement uniform district-based recording and reporting system
• Increase public awareness
• Reduce treatment interruption rate from 12.7% to 7.5%
• Introduce new treatment regimen
• Implement joint TB/HIV activities
• Monitor management of MDR-TB patients

TB Control

• Challenges

• Inadequate funding for TB, especially TB drugs
• National TB budget – R7.679m in 2002, R8.109m in 2003
• Human resources at district level
• Unequal access to quality lab services
• Poor quality of data
• Poor TB treatment outcomes
• High defaulter rates (12%)
• Sub-optimal care in some SANTA hospitals

Prevention

• Barrier Methods - Achievements

• Increased funding for increased purchase and distribution (350 million male and 1.8 million female) – increase to 400m male condoms in 2003
• Access to female condoms increased from 27 sites in 2000 to 200 sites in 2002
• Virtually no stock-outs of condoms (22m male p/m and 100,000 female p/m)

Prevention

• Barrier Methods - Context

• Public sector condom distribution programme largest in Sub-Saharan Africa (condoms/ population)

• Barrier Methods - Challenges

• Ensure access at community and individual levels
• Public misperception that government condoms are of inferior quality

Prevention

• Barrier Methods - Strategy

• Research shows branding condoms creates a perception of good quality
• Packaging – the more attractive a condom packet is, the more likely it is to be used

• Steps taken

• Research in all provinces to develop an appropriate brand name
• Busy registering brand name as property of DOH
• New specifications for condom tender to include the brand name, and also new packaging

Prevention

• STI Management - Achievements

• National rapid appraisal on STI management
• Patient-ready treatment kits – fieldwork on feasibility study completed
• Traditional healers appointed
• Decrease in syphilis (11.2% in 1997 to 2.8% in 2001)

• STI Management – Priorities

• Conduct STI surveillance
• Strengthen STI syndromic management (public and private)

Prevention

• STI Management - Priorities

• Promote improved health-seeking behaviour (improved condom distribution)
• Identify and review existing provincial traditional healer structures

• STI Management – Challenges

• Moving from awareness to change
• Improving STI management in the private sector
• Strengthen collaboration with traditional healers

Prevention

• PMTCT – Package of care

• Service delivery as part of existing maternal and child care services
• Routine ANC
• Voluntary counselling (pre/post) HIV testing
• Counselling on safe infant feeding practices
• Provision of formula
• Nevirapine (mothers and babies)
• Multivitamins (mothers and babies)
• Treatment for opportunistic infections
• Post delivery follow-up

Prevention

• PMTCT - Achievements

• 600 sites implementing PMTCT
• Guidelines for PMTCT rollout provided
• PMTCT training guides and tools
• Video on PMTCT/IF in 4 languages; Limpopo study to inform communication strategy
• Start of PMTCT resistance studies
• Commencement of PMTCT cohort study

Prevention

• PMTCT – Priorities

• Rollout of PMTCT programme – capacity building
• Additional funding provided as part of conditional grants
• Strengthen and coordinate research
• Communication and advocacy strategy for PMTCT
• Improve data collection
• Monitor PMTCT cohort study

Prevention

• PMTCT - Coverage

• Coverage in June 2002

• Approx. 250 facilities (hospitals CHC, MOUs)
• Approx. number of ANC bookings per month = 7000
• Approximately 8% of annual bookings
• Estimated coverage 12-15%

• Coverage December 2002

• Over 600 facilities
• Estimated coverage over 60%

• Coverage March 2003 – all facilities with ANC services

Prevention

• PMTCT numbers: October 2001 - November 2002

• Total # of women visiting ANC first time = 73 680
• Number accepting testing = 46 920
• HIV positive = 13 860
• NVP uptake = 6 720

Prevention

• PMTCT - Challenges

• Improve holistic approach including

• Food security
• Poverty alleviation
• Social grants
• Basic sanitation
• Training
• Community support

• Outcome measurement:

• Babies blood only by doctors
• Loss to follow-up

Prevention

• PMTCT – Cohort Study

• Multi-centre study: HST, UWC, MRC, UND
• Sites: Prince Mshiyeni Hospital (KZN), Paarl MOU (WC), Umzimkulu (EC)
• Mother-baby pairs to be followed up to assess:
• Postnatal vertical transmission (e.g run tests to ascertain if women and babies took NVP)
• Description of infant feeding patterns from birth to 9 months (HIV- & HIV+ mothers
• Influence of PMTCT on infant feeding & assessment of adherence to choice of feeding
• HIV+ women experience in relation to disclosure & health seeking behaviour

Prevention

• PEP (non-occupational) – Package of care

• Counselling
• STI prophylaxis
• HIV testing
• Emergency contraception
• Medico-legal assessment of injuries
• Data management (registers)
• Provision of ARVs
• Follow-up testing of survivors who chose to use ARVs

Prevention

• Non-o-pep – Monitoring

• The following important:
• Number that reports for service
• Number of survivors who return (measure of compliance)
• Number of survivors who stop taking therapy due to side effects or other reasons
• Severity of side effects
• All seroconversions

Prevention

• Non-o-pep – Plans and Challenges

• AZT & 3TC provided at hospitals
• Intensive forensic training planned
• M&E big challenge – not part of routine DHIS
• Also a challenge forging partnerships to:
• Reduce health impact of rape
• Maximize conviction rates
• Reduce incidence of rape

Prevention

• VCT - Achievements

• 982 VCT sites operational
• Materials development – couples counselling manual, counselling directory, posters, pamphlets
• Rapid testing training and tender
• Tender awarded for mentoring (HIVCORE)
• VCT evaluation study

Prevention

• VCT - Priorities

• 80% access by March 2004 (including partnerships with private sector)
• Strengthen provincial capacity – training, counsellor placements
• Accreditation system established
• Strengthen mentorship programme
• Communication strategy

Prevention

• VCT Assessment Recommendations

• Access

• Opening times for VCT services not to be linked to normal working hours to accommodate those who work or attend school

• Infrastructure

• Identify sites that do not have comfortable waiting and reception areas and private rooms for counselling
• Upgrade sites that have been identified

• Quality

• Find mechanisms to measure client satisfaction

Prevention

• VCT Assessment Recommendations

• M&E

• Improve data collection
• Improve supervision and mentoring
• Improve routine data collection

• Marketing

• Develop strong marketing strategy

• Planning

• Integrate VCT into other services at facility level, especially STIs and TB

Prevention

• New VCT Strategy

• Establish PPP for VCT

• Target groups

• Women: ANC, FP, STI clinics, workplace
• Youth: youth and recreational centres, NGOs
• Men: NGOs, mining industry, Department of Transport, hostels
• Rural communities: NGOs, traditional leaders & healers, FBOs 

Prevention

• New VCT Strategy

• Types of VCT sites

• Integrated/stand-alone, e.g. youth organisations, NGOs, FBOs
• Medical integrated sites, e.g. STI, TB and ANC clinics
• Mobile units

• Critical areas

• Mentoring of counsellors
• Accreditation of trained counsellors, trainers etc.
• Marketing of VCT services
• Data management

Treatment

• Package of care

• Treatment of OIs
• TB prophylaxis
• Diflucan partnership Programme

• Expanding the package

• Treasury-Health Task Team

• Priority: training of health workers, especially in clinical management

Care and Support

• HBC – Achievements

• HBC coordinators appointed all provinces
• Rapid appraisal on HBC services in SA
• National HBC Conference + distribution of HBC kits
• Advocacy toolkit
• Palliative care guidelines
• PWA Summit

Care and Support

• HBC numbers (from rapid assessment)

• 466 existing HBC programmes
• 370 172 service beneficiaries (includes children)
• 5 975 traditional healers
• 7 404 child-headed households
• NGOs conduct training
• Human resources
• 9 553 volunteers

Care and Support

• HBC – Priorities

• Develop and review guidelines
• Strengthen existing HBC services and expand new services
• Involvement of PWAs in all programmes
• Support groups at PMTCT and VCT sites
• Capacity building – palliative care, clinical management, project management
• Address nutrition for PLWHA

• Social Development support: food parcels

NGO Funding

• Achievements

• National consultative workshop (December 2002)
• Rapid assessment tool developed
• Permanent staff appointed
• 63 NGOs funded (R18.5 million)

• Priorities

• Policy guidelines on NGO funding
• Establish National Funding Cycle
• Develop criteria for financial auditing
• NGO mentoring programme

NGO Funding

• Challenges

• Absence of clear policy framework
• Fraudulent use of funds – poor financial management
• Provincial NGO Funding coordinators – multiple tasks

National Integrated Plan

• Achievements for 2002/3

• Conditional grant funding for an extended year until 2005/6
• Consistent, coordinated reporting established from provinces to national
• NDoE taking up role to shift focus to prevention
• Development of two-day workshop module on Gender & HIV/AIDS Education

National Integrated Plan

• Objectives for 2003/4

• Consolidation of financial management systems
• Facilitate strengthening of links between departments for collaboration in poverty alleviation programmes
• Broader implementation of Gender Education & HIV/AIDS programmes
• NIP objectives shared at district level for all three departments

IDC

• Achievements for 2002/3

• IDC programme (with internal programmes)
• Capacity building – 7 workshops
• 3 Reports to Social Cluster
• Collaboration with DPSA on Action & Impact Project
• Assistance to specific Departments
• Revival of Master Training Programme for LG

IDC

• Objectives for 2003/4

• Support and resources to national government departments to strengthen internal and external programmes
• Strengthen response to HIV/AIDS at Local Government level – support and advocacy
• Integrated and coordinated response to HIV/AIDS of government departments at all levels

Partnership Support

• Achievements

• Traditional Leaders AIDS Programme in 7 provinces
• HTA project – working in high-risk environments (bars, taverns, shebeens)
• Awareness campaign with commuters and drivers in trains, taxis and buses
• Women in Partnership Against AIDS programme in all provinces
• Men’s imbizo

Partnership Support

• Priorities

• Support sectors – migrant and agricultural workers, mobile populations, traditional leaders, transport sector, SACMA, women
• Technical support to Danish funded project on Violence against Women, and Poverty and HIV/AIDS
• Project management training to women in managerial position in NGOs and CBOs
• Training – unions, organisations etc.

GAAP

• Achievements in 2002/3

• Developed at least three advertisements per campaign for TV and radio
• All campaigns have new materials
• High visibility of advertisements
• Care and support component in campaign with a hotline
• World AIDS Day 2002
• Faith-based evaluation report

GAAP

• Objectives for 2003/4

• HIV/AIDS and TB promotional material – STIs, TB, Care and Support, PMTCT, VCT
• Social mobilisation – main events (e.g. World AIDS Day)
• 24-hour counselling service
• Expand sectoral involvement in HIV/AIDS, STIs and TB – Men, FBOs, entertainment, people with disabilities

Khomanani Campaigns

• Positive Living - Wellness and Anti stigma

• Cirles of Support - Promote support for orphans and vulnerable children

• Our time, Our Choice, Our Future - Youth prevention

• Sexually Transmitted Infections - Symptom recognition and treatment

• Stop Tuberculoses - Early diagnosis and treatment

• Health Worker Excellece - Promote professional best practice

POSITIVE LIVING

Youth - Our time, our choice, our future

CIRCLES OF SUPPORT

Advertising – Below the Line

• Positive Living: R704,234

• Circles of Support: R3,066,518

• Khethimphilo: R8,021,466

• STI: R10,499,068

• TB: R9,483,153

• WAD: R3,490,729

• (BMI SponsorWatch report, January to December 2002)

Billboards

Small Media

Research

• Achievements

• Start of PMTCT resistance studies
• Commencement of PMTCT cohort study
• Youth Risk Behaviour Survey – results due first half of 2003

• Research agenda

• Resistance:
• Assess resistance to Nevirapine in mothers and babies
• Enrolment complete (King Edward & Bara)
• Analysis underway
• First results expected July 2003

Research

• Social Science Research

• Aims to understand social dynamics that will inform communication strategy
• Completed in one province (Limpopo)
• Underway in 2 provinces (KZN, Free State)

• Demographic and Health Survey due in 2003

• Continue participation in Microbicide research

• Funding for SAAVI (increased)

Strategic Issues

• TB

• Communication

• Monitoring and evaluation

• Integration

• Stipends for lay workers

Challenges

• Lack of human resources, and skills base of resource base in place

• Integrated planning at district level

• Monitoring and evaluation frameworks

• Financial and human resources for TB

• Increase in MDR-TB

• Integration of services – STI, VCT, TB

Budget for HIV/AIDS and TB

• National: R668 668 000

• R333 556 000 in conditional grants to provinces
• HBC * VCT
• Step down care * PMTCT
• Management * Non-o-Pep
• Training * CSW

• R500m to provinces - equitable share

• Conditional grant & ES is in addition to MTEF