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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