The Response to HIV/AIDS A Parliamentary Briefing March 2003

1. The Response to HIV/AIDSA Parliamentary BriefingMarch 2003 Department of Health

2. 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

3. Guiding the Response • Strategic Plan; HIV/AIDS, STI and TB guidelines • Multisectoral response – working with SANAC • Operational plans linked to Strategic Plan

4. Structures in addressing HIV/AIDS

5. 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

6. TB STI Prevention IDC Youth GAAP NGO Funding Care and Support Partnership Support PMTCT and Research VCT NIP Programmes in the NDOH

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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)

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

25. Infant feeding *NB Data up to May 2002 at pilots

26. 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

27. 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

28. 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

29. Rape Statistics - 2000

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. Care and Support • HBC – Achievements • HBC coordinators appointedall provinces • Rapid appraisal on HBC services in SA • National HBC Conference + distribution of HBC kits • Advocacy toolkit • Palliative care guidelines • PWA Summit

40. 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

41. 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

42. 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

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

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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.

50. 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