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ACCELERATED IMPLEMENTATION OF THE COMPREHENSIVE PROGRAMME TO FIGHT HIV AND AIDS IN KZN. PROVINCIAL COUNCIL ON AIDS MEETING 25 AUGUST 2010. Umkhanyakude 39.9%. K WA Z ULU – N ATAL - 2008. Amajuba 34.7%%. Zululand 36.2%. Umzinyathi 29.2%. Uthukela 38.6%. Uthungulu 36.1%. Ilembe

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accelerated implementation of the comprehensive programme to fight hiv and aids in kzn

ACCELERATED IMPLEMENTATION OF THE COMPREHENSIVE PROGRAMME TO FIGHT HIV AND AIDS IN KZN

PROVINCIAL COUNCIL ON AIDS MEETING

25 AUGUST 2010

slide2

Umkhanyakude

39.9%

KWAZULU – NATAL

- 2008

Amajuba

34.7%%

Zululand

36.2%

.

Umzinyathi

29.2%

Uthukela

38.6%

Uthungulu

36.1%

Ilembe

35.8%

Umgugundlovu

45.7%

HIV Prevalence range

Sisonke

35.8%

Ethekwini

40.3%

30 – 40%

>40%

<30%

Ugu

40.6%

0

25

50

100

150

200

>40%

Kilometers

empirically we can rapidly reduce hiv incidence if we can
Empirically we can rapidly reduce HIV incidence if we can:
  • ↑ age of sexual debut
  • ↓ sexual frequency
  • ↓ partner change
  • ↓ concurrent partners
  • ↑ condom use
  • Knowledge of HIV status
slide6

HIV Prevention

Methods -2010

ANTI-

RETROVIRAL THERAPY FOR PREVENTION

PrEP

BEHAVIOURAL CHANGE

HCT

MTCT

BARRIER METHODS (Male & Female Condoms)

MICROBICIDES

VACCINES

PEP

MALE

CIRCUMCISION

Under

investigation

Proven HIV

prevention methods

hiv counselling and testing hct
HIV COUNSELLING AND TESTING (HCT)
  • President’s announcement on 1st of December 2009 included the Massive campaign to mobilise all South Africans to get tested
  • Previously known as VCT
  • Objectives of HCT are:
    • Mobilize people to know their status.
    • Support people with key prevention messaging in order to take proactive steps to a healthy lifestyle irrespective of HIV status
    • Increase incidence of health seeking behaviour; and
    • Increase the access to treatment, care and support
  • HCT is moving from voluntary testing, to a service delivery model to offer HCT to all patients at their entry point in the health system
  • Participation by all public health facilities (fixed and mobile), NGOs and other non medical sites (incorporate effective referral systems)
  • Target for country = 15 million people to be tested by JUNE 2011.

PREVENTION

male medical circumcision
MALE MEDICAL CIRCUMCISION
  • Since Launch 18 camps held covering all districts
  • All hospitals now doing circumcisions
  • Part of comprehensive risk reduction strategy
  • Programme manager appointed to lead the programme
  • 144 doctors have been trained on circumcision
surgical intervention
Surgical Intervention
  • Local anesthesia by competent practitioner
  • Practitioners trained on all methods: Sleeve resection, forceps guided method and also use of the Tara clamp
  • Competence in forceps guided method and sleeve resection a prerequisite for training in Tara clamp
phc art initiation
PHC ART INITIATION

279 ART SERVICE POINTS

slide19

KZN ART FIGURES

30 JUNE 2010

Umkhanyakude

14 942

25 933

32 008

Amajuba

Zululand

.

Umzinyathi

Uthukela

Uthungulu

34 642

16 706

22 914

Ilembe

20 812

Umgugundlovu

39 733

Sisonke

Ethekwini

97 995

17 608

TOTAL ACTIVE

PATIENTS:

345 834

Ugu

22 541

0

25

50

100

150

200

>40%

Kilometers

national comprehensive hiv aids plan statistics
NATIONAL COMPREHENSIVE HIV & AIDS PLAN STATISTICS

Uptake of 15 000

Patients per month

In KZN

tenofovir microbicide gel results
TENOFOVIR MICROBICIDE GEL RESULTS

What is a microbicide?

A microbicide is a product that can be applied to the vaginal or rectal mucosa with the intention of preventing the transmission of sexually transmitted infections including HIV

tb hiv integration
TB/HIV INTEGRATION
  • HCT linked with TB testing
  • Isoniazid preventative therapy commenced 1 April 2010 in 291 facilities with 5967 patients benefitting at the end of June 2010
  • All MDR/XDR patients put on ART irrespective of staging
what is a caprisa 004 trial
What is a CAPRISA 004 trial

Proof of concept study of a topical PrEP ARV based strategy using 1% tenofovir

Done at Vulindlela and Durban sites of CAPRISA

First microbicide trial with funding from a developing country as it was co-funded by US & SA governmental agencies (DST)

Started in 2007 and results released in July 2010.

results
RESULTS

CAPRISA 004, showed that women who used a gel containing tenofovir gel 12 hours precoitally and 12 hours post coitally, had a 39 percent lower rate of infection compared to women who used a placebo gel. In addition to HIV, it also prevented Herpes simplex virus transmission

1st ever study showing promising results in this field, internationally

what next now
WHAT NEXT NOW?

An independent study should confirm these results before the product is confirmed as effective (VOICE trial on, results due 2014)

If the confirmation occurs, the product will then have to be registered with the MCC as a drug

Will be part of a comprehensive strategy and not as a stand alone intervention

The process to be followed is still going to take at least 4-5 years before but it all depends on the confirmatory study

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