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HIV, TB and access to healthcare

HIV, TB and access to healthcare. Treatment Action Campaign. TAC was founded in December 1998 advocates for increased access to treatment, care and support services for people living with HIV, TB and related illnesses

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HIV, TB and access to healthcare

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  1. HIV, TB and access to healthcare

  2. Treatment Action Campaign • TAC was founded in December 1998 • advocates for increased access to treatment, care and support services for people living with HIV, TB and related illnesses • implementation of country-wide mother-to-child transmission prevention and roll-out of antiretroviral treatment programmes • Dudley Lee versus the Minister of Correctional Services

  3. HIV and Tuberculosis • Prisons are highly conducive to infectious diseases like HIV and TB (large number of people in a small space) • HIV prevalence in South Africa’s prisons is estimated to be between 20% and 41% (versus 12.2% in the general population) • The prevalence of TB is estimated to be between 3 to 7 times higher than in the general population

  4. TB is leading cause of death in SA’s prisons, followed by pneumonia and HIV-related illnesses (JICS annual report) • Access to healthcare is crucial to prevent prisons from becoming breeding grounds of infectious diseases! • What happens in prison does not stay in prison • Overcrowding and a lack of ventilation is fuelling the spread of TB in prisons

  5. Pollsmoor prison • Pollsmoor remand section has a 90% TB transmission risk (R.Wood study) • September 2014: • Overcrowded with 265% (3791/1427) • more than 200 people are sleeping on a wet floor without matrass • = Ideal breeding ground for TB!

  6. DCS annual report • Inclusion of TB indicator “TB cure rate” • mass screening campaign in all 246 correctional centres • Initiation of inmates on treatment is however not following at the same rate • Without treatment, an individual with active TB can infect up to 20 people in his direct environment • Limited access to healthcare services, the inability of nurses to initiate treatment, and inadequate healthcare services prevent access to treatment

  7. TB cure rate is not sufficient as indicator: does not include those that haven’t been tested, those tested but not on treatment and all remand detainees • To effectively monitor progress made on curbing the TB epidemic, it is essential to know the following numbers for both sentenced and remand detainees: • The number of detainees that tested for TB • The number of detainees that tested positive for TB • The number of detainees initiated on TB treatment • The number of TB cases that were successfully treated

  8. Access to healthcare JICS annual report: • 255% increase in healthcare complaints between 2007-2010 • Further 54% increase between 2011-2014 Top 3 complaints: • failure to provide medical treatment • inadequate medical treatment and • ARV –HIV/TB related treatment.

  9. With the rate of transmission of infectious diseases like HIV and TB at levels higher than anywhere else in the world, poor access to and inadequate provision of healthcare services is exceedingly concerning!

  10. Barriers to access healthcare services • Lack of security staff on the floor • Lack of healthcare staff (only 8 of 48 doctor’s posts are filled) • Nurses not authorised to initiate HIV or TB treatment • Understaffing in overcrowded centres: number of staff is calculated on accommodation, not on population

  11. Pollsmoor – Jan 2014 (TB/HIV Care) • only 68% of inmates that tested positive obtained their CD4 results • less than 57% of inmates eligible for ART were initiatedon ART => These numbers are reason for concern!

  12. We recommend the Committee to request the DJCS to undertake a baseline survey on the prevalence of TB in prisons, and to provide on an annual basis an incidence report to evaluate the current TB strategy and monitor the extent of the TB epidemic within South Africa’s correctional facilities.

  13. We recommend the Committee to request the DJCS As a matter of urgency, to convene a joint sitting with the DOH and Department of Public Works to develop an emergency response plan that targets ventilation and overcrowding in the most overcrowded prisons. To curb the TB epidemic in South Africa it is crucial that there is a coherent plan in place to address the main factors that are fuelling the transmission of this infectious disease in South Africa’s prisons.

  14. We recommend the Committee to request the DJCS To collaborate with the Department of Health and the JICS to identify the main barriers to access healthcare services and develop an appropriate strategy for ensuring sufficient health care personnel and security officials to ensure inmate’s right to health

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