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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. 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

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  1. ACCELERATED IMPLEMENTATION OF THE COMPREHENSIVE PROGRAMME TO FIGHT HIV AND AIDS IN KZN PROVINCIAL COUNCIL ON AIDS MEETING 25 AUGUST 2010

  2. 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

  3. 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

  4. 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

  5. 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

  6. District Performance April-July 2010

  7. Province by Province Comparison

  8. 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

  9. Implementation Model

  10. 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

  11. MMC Figures as at 31 July 2010

  12. His Majesty, MEC and HOD during MMC launch

  13. The Premier and MEC at Ladysmith camp

  14. Minister and MEC for Health at Ugu camp

  15. KwaNibela-Hluhluwe camp

  16. PHC ART INITIATION 279 ART SERVICE POINTS

  17. 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

  18. NATIONAL COMPREHENSIVE HIV & AIDS PLAN STATISTICS Uptake of 15 000 Patients per month In KZN

  19. 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

  20. 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

  21. 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.

  22. 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

  23. 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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