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NWDOH HAST PROGRAMMES
SABCOHA CONFERENCEJULY 2011SUNCITY
PRESENTATION OUTLINE
• Background• Provincial and District HIV prevalence• NSP Key Priority Areas• HIV and Aids Management Policy Changes• NW’s response to HCT campaign• Provincial HCT performance• HCT progress• PMTCT• Challenges• Required Action
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Background• North West province divided into 4 districts
namely, Bojanala, Dr Kenneth Kaunda, Dr Ruth Segomotsi Mompati Ngaka Modiri Molema
• It is further divided into 21 sub districts
• Total population of 3 185 799 (Stats SA)
• Province is predominantly rural (64.4%) with the Black population in majority (91%)
• Females are slightly more (50.4%) than males 49.6% (Census 2001)
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DISTRICT HIV PREVALENCE 2007 -DISTRICT HIV PREVALENCE 2007 -20092009
DISTRICTDISTRICT 2007 2007 20082008 20092009
BojanalaBojanala 33.333.3 31.831.8 34.934.9
Dr Ruth Segomotsi Dr Ruth Segomotsi MompatiMompati
26.926.9 28.128.1 25.725.7
Ngaka Modiri Ngaka Modiri MolemaMolema
27.027.0 28.228.2 25.125.1
Dr Kenneth Kaunda Dr Kenneth Kaunda 32.432.4 35.235.2 29.229.2
ProvinceProvince 30.630.6 3131 3030
Broad NSP Key Priority Areas
HIV and AIDS PROGRAMMES STRUCTURED AROUND 4 PRIORITY AEAS AS FF:
• Prevention• Treatment, care and support• Research, monitoring and surveillance• Human rights and access to justice
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NSP Priority AreasPREVENTION PROGRAMMES • STIs management and
control• HIV counseling and Testing
(HCT)• Prevention of Mother to
Child Transmission of HIV (PMTCT)
• Post Exposure Prophylaxis for Sexual Assault (PEP)
• High Transmission Areas• Specialized Auxiliary HIV
and AIDS Projects• Partnerships /Social
mobilization
TREATMENT CARE AND SUPPORT • ART programme (CCMT)• Clinical management
training• Clinical guidelines• Home/community
based care• Palliative care• Step down care• Community Health
Worker programme• EPWP• Support groups
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NSP Priority Areas cont..MONITORING, RESEARCH
AND SURVEILLANCE
• Programme monitoring
• Operational research• Surveys• Impact assessments
HUMAN RIGHTS AND ACCESS TO JUSTICE
• Advocacy toolkits• Paralegal structures• HIV and AIDS
related material• Stigma mitigation
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NW’s approach to HIV and Aids Management
Integrating HIV and Aids, TB and MCWH programmes because:
• NCCEMD 2002 – 2004 and 2005 to 2007 reflected maternal deaths due to HIV\AIDS were 44.2% to 51% respectively.
• Saving children (2005-2007) reflected that
nationally, 47% children who died were HIV pos
eligible for ART. They died of conditions such as TB,
diarhoea, malnutrition, pneumonistic carinii.• 70% of M/XDR clients on treatment are HIV pos
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POLICY CHANGES • 1st December 2009 (WAD) Government launched
a revitalized campaign on HIV and Aids and TB focusing on taking responsibility.
• All public health facilities (fixed and mobile) must provide HIV testing.
• All PHC facilities to provide ART
• Special focus and fast track - TB/HIV co infection, pregnant women and children under 1 year
• Campaign began on 1st April 2010
Objectives of National HCT Campaign
HCT moving from voluntary testing, to a service delivery model to offer HCT to all patients at their entry point in the health system
– To mobilize people to know their status and link to treatment, care and support
– Encourage people to take proactive steps towards living a healthy lifestyle, irrespective of their HIV and TB status, through key HIV prevention messages
– Increase incidence of health seeking behavior for HIV, STI and TB
HCT Targets- Provinces
TOTAL
POPULATIONTARGETED
POPULATION
TARGETED PRETEST COUNS
TARGETED TESTS
EC All districts 6,884,482 4,117,741 2,219,462 2,017,693
FS All districts 2,972,983 1,926,174 1,059,396 963,087
GP All districts 9,859,543 6,834,865 3,683,992 3,349,084
KZN All districts10,077,620 6,243,334
3,365,157 3,059,234
LP All districts 5,357,949 3,144,090 1,694,664 1,540,604
MP All districts3,646,123 2,236,374
1,205,405 1,095,823
NWAll districts
3,229,078 2,038,4881,098,745 998,859
WC All districts 4,945,732 3,280,801 1,768,351 1,607,592
NC All districts 1,108,599 689,675 371,735 337,941
National 48,082,109 30,511,542 16,466,907 14,969,917
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HCT TARGETS PER DISTRICT
DISTRICT EST. TOTAL POPULATION
EST. HCT TARGET POPULATION
HCT TARGET TO BE TESTED OVER 15 MONTHS
HCT TARGET PER DISTRICT PER MONTH
BOJANALA 1 282 466 833 702 408 514 27 234
DR. K. K. 708 193 466 495 228 583 15 238
NMM 770 960 466 795 228 730 15 248
DR. R.S.M. 467 459 271 496 133 033 8 868
TOTAL 3 229 078 2 038 488 998 820 66 588
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PROVINCIAL HCT STATUS Source: DHIS; 12 June 2011
Indicator Bojanala Dr. K. K. NMM Dr. RSM Province
Pre- Test Counseled 554,897 217,764 258,659 186,780 1,218,100
Tested 435,482 181,519 239,933 139,286 996,220Tested Positive for HIV 80,029 36,503 31,446 16,193 164,171HIV Positivity Rate
18.3 20.1 13.1 11.6 16.4Screened for TB
425,226 172,889 241,724 265,544 1,105,383Referred for clinical diag. TB
34,426 27,978 19,368 28,555 110,327TB Screening rate
76.7 79.4 93.5 142.2 90.8Target 394,487 220,964 221,106 128,599 965,526
Target achieved 110 82 108 108 103
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ANALYSIS As at 12 June 2011 the NW province exceeded its HIV testing target
by 3% i.e. testing 996,220 clients against a target of 965,526 • The district s have tested as follows:
Bojanala = 110% (435,482 against a target of 394,487 ) Dr. K. K= 82% (181,519 against a target of 220,964 ) NMM = 108% (239,933 against a target of 221,106 ) Dr. RSM= 108% (139,286 against a target of 128,599 )
• The Provincial HIV testing rate is 81.8% With districts performing as follows:
Bojanala = 78.4% Dr. K. K= 83.4% NMM = 92.8% Dr. RSM= 74.6%
(norm is - 90% of all pretest counseled for HIV should be tested for HIV)
• NWP only province exceeded HCT target set. Progressively improved, reached and exceeded set target. 14
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Treatment Expansion - Summary
Before campaign
After campaign
No. of ART sites 31 124
Patients on ART 78 238 127 301
Total number of nurses trained and qualifying to initiate patients on ART
Nil 1397
No. of nurses trained on NIMART initiating patient on ART
Nil 147
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PMTCTIndicator Target Bojanala Dr K K NMM Dr RSM Province
ANC coverage >95 90 88 77 88 94
ANC visits before 20wks rate
>70 35 42 45 39 40
Delivery rate at facility
>95 65 71 71 76 76
BBA rate <4 6 4 6 7 5
ANC HIV 1st test rate
>95 125 92 121 102 111
ANC HIV 1st test pos rate
<15 28 25 22 18 24
ANC CD4 1st test rate
>95 63 73 58 58 67
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PMTCTIndicator Target Bojanala Dr K K NMM Dr RSM Province
ANC initiated on AZT during ANC
>95 57 75 68 68 59
ANC client initiated on HAART rate
>70 72 62 68 49 67
ANC NVP uptake rate
>95 59 63 79 69 64
Baby NVP uptake rate
>95 93 99 97 98 95
Baby PCR around 6wks uptake rate
>80 99 81 93 127 97
Baby PCR positive around 6wks rate
<5 9 5 7 6 6
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Challenges • Low ANC booking below 20wks • Low delivery rate in facilities• Low uptake of AZT and NVP initiation for
pregnant women• ARV programme is still doctor driven –
nurses not confident to initiate patients• Limited TB/HIV integration (Late diagnosis and
initiation of both TB and ART treatment)
• Infrastructural challenge- old clinics not designed to cater for high case load of clients- impacts negatively on site readiness
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Challenges (contd..)
• Lack of tracking system for clients tested positive at outreach events to health facilities
• Shortage of nurses and doctors – inappropriate placements
• Health Information management (Recording, reporting, and use)
• Non compliance with treatment by MDR TB patients - Salaries stopped when the patient is admitted in hospital (55% of patients admitted in Tshepong specialised unit from Bojanala) 20
Required Action • Refurbishment and improvement of existing infra
structure to fast track site assessments• Human resources provision (attract and retain)• Provision of personnel and transport for defaulter
tracing• Strengthening of Health Information Management
Systems (Provision of IT equipment and IT support) • Strengthening and funding community outreach
programmes and social mobilization • Strategies to secure jobs of workers diagnosed with
MDR TB until the worker is discharged from hospital• Employer support with adherence to treatment and
follow up appointment. (reduce transport costs)21
THANK YOU
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