KZN TB AND HIV AND AIDS DISEASE BURDEN
DR SM ZUNGUHEAD OF DEPARTMENT
PARTNERSHIP CONFERENCE12 OCTOBER 2010
PRESENTATION OUTLINE
• Introduction
• TB/HIV Disease Burden
• 2009 ANC HIV Prevalence
• KZN’s Response
• Partnerships
• Conclusion
INTRODUCTION
• KZN is second most populous province after Gauteng with a population of just > 10,4 million which is 20,9% of total SA population
• KZN has the highest HIV prevalence in South Africa and accounts for 28% of SA HIV infection
• The province also has the highest TB disease burden.
Introduction cont.
• TB case load is 1161:100 000 population with a TB/HIV co infection rate of about 70%
• More than 70% of medical admissions are HIV related
TB INCIDENCE RATE - 2008 AS AT: 1 JULY 2009
1161
1518
1406 14051354
12931243
1143
1002950
905
741
0
200
400
600
800
1000
1200
1400
1600
KZN DC 27 DC 20 DC 21 DC 28 DC 43 DC 22 DC 24 DC 23 DC 26 DC 29 DC 25
DISTRICTS
NO
. OF
CA
SE
S
HIV PREVALENCE: ANC SURVEY 2009 District Prevalence 95% CI
AMAJUBA 37.3 33.3 – 41.6
ETHEKWINI 41.5 38.9 – 44.0
ILEMBE 40.6 36.5 – 44.9
SISONKE 35.2 29.3 - 41.6
UGU 40.2 36.0 – 44.6
UMGUNGUNDLOVU 40.9 36.2 – 45.7
UMKHANYAKUDE 39.7 33.1 – 46.6
UMZINYATHI 28.2 22.2 – 35.1
UTHUKELA 37.7 33.0 – 42.6
UTHUNGULU 46.4 41.1 – 51.8
ZULULAND 36.7 30.4 – 43.5
TOTAL 39.5 38.1 – 41.0
KZN HIV ANC PREVALENCE 2009
0
10
20
30
40
50
HIV PREVALENCE 2009 cont KZN-HIV Prevalance by district
0
10
20
30
40
50
Pre
vala
nce
2007 38.7 39.3 34.1 37.3 39.8 31.6 36.2 35.9 34.6 41.6 41.4 40.8
2008 38.7 34.7 35.8 40.6 39.9 29.2 38.6 36.1 36.1 40.3 35.8 45.7
2009 39.5 37.3 35.2 40.2 39.7 28.2 46.4 37.7 36.7 41.5 40.6 40.9
Prov. ma Sis Ugu Umk Umz UTh Utk Zul eTh ILe uMg
HIV and SYPHYLLIS Prevalence 2009….
KZN HIV & Syphilis Prevalence From 1990-2009
15.8
32.4
32.5
36.536.2
33.5
37.5
40.7
39.1
39
38.7
38.7
13.5
18.3
9.6
4.82.9
1.6
20
26.8
39.5
2.6
4.41.3 1.5 1.4 0.8 1.2 1.1 0.6
0.6 0.8
0
5
10
15
20
25
30
35
40
45
1985 1990 1995 2000 2005 2010
Year
Prev
alen
ce
% HIV Prev. % RPR Syph
Trend in Age related prev. from 2007 - 2009
0
5
10
15
20
25
30
35
40
Age Category
Pre
vale
nce
2007 2008 2009
2007 10.2 33.7 29.1 17.6 7.8 1.2 0.1 0
2008 11.8 30.8 30.1 17 8.7 1.5 0.1 0
2009 12.9 31.9 28.1 17.6 7.5 1.7 0.1 0.2
15-19 20-24 25-29 30-34 35-39 40-44 45-49 other
Source: Abdool Karim Q, Abdool Karim SS, Singh B, Short R, Ngxongo S. AIDS 1992; 6: 1535-9
Age & gender distribution ofHIV infection in South Africa
00
<9<9 10-1410-14
Pre
vale
nce
(%
)P
reva
len
ce (
%)
15-1915-19 20-2420-24 25-2925-29 30-3930-39 40-4940-49
22
44
66
88
1010
FemaleFemaleMaleMale
>49>49
HIV Burden cont• There is a higher HIV prevalence amongst the ages 15-
29 yrs with a rising trend amongst the ages of 10 -14yrs• The other represents HIV prevalence for mothers who
were the under the age of 10 yrs• This is indicative of early sexual debut and • The high HIV prevalence amongst young females is
indicative of trans-generational sex – younger females having sex with older men as the same age group males have a significantly lower HIV prevalence
Socio-Cultural Factors Driving the Epidemic
• Some of the socio- cultural factors driving the epidemic include but not limited to:– Poverty– Unemployment– Multiple –sexual partners– Substance abuse– Gender based violence – Gender inequalities
Provincial ResponseCCMTP
– Consolidation of the comprehensive management of patients with HIV and AIDS.
• Prevention, Treatment, Care and Support
– Strengthening of the health system
NSP 2007-2011• Two primary aims
– reduce the number of new HIV infections by 50% by 2011– reduce the impact of HIV and AIDS on individuals, families,
communities and society• expanding access to appropriate treatment, care and support to
80% of all people diagnosed with HIV
Provincial Response cont
• Presidential declaration of 01 December 2009: – to treat HIV and TB under one roof – ART for pregnant women and TB/HIV co infected
individuals– Treatment for all the HIV infected infants <1yr
• HIV Counseling and Testing campaign – Aim to test 15million people in South Africa
• KZN HCT target is just above 3million people to be tested by end June 2011
FISCAL COMMITMENT (,000)YEAR ES CG T0TAL
2003 R160.932 R85.591 R246.523
2004 R152.373 R186.348 R338.721
2005 R291.836 R251.468 R543.304
2006 R464.304 R344.304 R808.390
2007 R434.086 R344.304 R778.390
2008 R580,483 R757,213 R1,337,696
2009 R582,227 R1,121,575 R1,703,802
2010 R463,811 R1,498,811 R2,341,404
Uninfected People
Exposed People
People Living with HIV
People Living with AIDS
Terminally Ill
Prevention STI Services, Behavior Change Communication, Education, universal precautions . . .
VCT
Prevention of Mother to Child Transmission
Post Exposure Prophylaxis
Pyscho-Social, & Spiritual Support: Individual & Family . . . Care providers . . . Bereavement . . . Orphans
Opportunistic Infections and Related Illnesses Diagnosis, Treatments, Preventive Therapies,
Palliative Care
Home-based Care
Antiretroviral Therapy
STANDARD PACKAGE CARE OF SERVICES FOR HIV/AIDS*
HIV COUNSELING and TESTING • 100% of all public health facilities providing HCT services • Provider Initiated Counseling and Testing approach being promoted
to scale up HIV testing• HCT also available at non medical sites; tertiary institutions,
correctional services • Link and Clicks pharmacies have joined forces with DOH in HCT
campaign and are now offering free HIV Testing – Commitment from all Link and Clicks pharmacies in the province
• Other initiative in the pipeline to form partnerships with private hospitals in the HCT and MMC – e.g. MEDI Clinics
HCT SitesDistrict Hospitals Clinics Mobiles Non-med
Ethekwini 13 163 29 19
Ugu 5 47 14 1
Ilembe 4 38 2 1
Sisonke 4 33 13 5
Umgungundlovu 6 49 12 8
Uthukela 3 32 3 4
Umzinyathi 4 38 6 3
Amajuba 3 18 2 1
Zululand 7 61 0 1
Umkhanyakude 5 60 13 1
Uthungulu 8 49 16 5
Total 62 590 110 53
HCT Progress
• HCT targets ambitious but achievable• Province has achieved 66% of its target in 5
months• Ugu district has achieved 102% so far whilst
other districts range between 48 –70 % of their targets
• Districts are currently doing data mop –up• Districts are planning more activities to reach the
target
Country Performance @ 5months
Province Pre-test Tested Positive Positivity Rate
EC 362,972 279,984 33,249 12%
FS 204,596 158,773 33,814 21%
GP 566,012 525,568 85,214 16%
KZN 878,769 710,650 150,079 21%
LP 457,874 387,489 49,349 13%
MP 179,122 159,553 43,628 27%
NC 57,368 54,997 6,183 11%
NW 462,284 348,355 66,904 19%
WC 210,410 204,184 22,369 11%
TOTAL 3,379,407 2,829,553 490,789 17%
HCT Targets and progress
DISTRICT Campaign Target
Target per Q
# Tested in 5 months
Sisonke 138 743 34 685 39 357
Umgungundlovu
322 101 80 525 63 506
Uthukela 184 289 46 072 28 708
Umzinyathi 128 263 32 065 39 133
Amajuba 178 223 44 555 36 734
HCT Targets and progress
District Campaign Target
Target per Q
#Tested in 5 months
Zululand 235 060 58 765 68 215
Umkhanyakude
165 315 41 328 37 536
Uthungulu 260 112 65 028 102 088
Ilembe 185 510 46 377 40 764
Ugu 208 504 52 126 75 940
Ethekwini 1 053 113 263 278 178 669
High Transmission Area (HTA) Intervention
• Targeting high transmission areas • There are currently:
– 6 Truck Stops – 16 Correctional Services – 13 Tertiary Institutions – 3 Taxi Ranks– 11 Hostels – 3 Farm areas
HTA SitesEthekwini
Umgungundlove
Umzinyathi
Uthukela
Ilembe
Uthungulu
Sisonke
Ugu Zululand
Umkhanyakude
Amajuba
Truck stop
1 1 0 1 0 0 1 1 1 0 0
Tertiary institutions
6 3 0 1 0 1 0 1 1 0 1
Farms
Areas0 1 2 0 0 0 0 0 0 0 0
Taxi
Ranks0 0 1 1 1 1 0 0 0 0 1
Hostels
11 0 0 0 0 0 0 0 0 0 0
Condom Distribution
• Condoms (male and female) are distributed at medical and non medical sites
• Distribution at taverns, malls, community gathering areas
• However condom distribution continue to be a challenge – low distribution rates
• Challenge in meeting targets set during the HCT campaign
Condom Distribution cont
• Condom distribution reports only on CHOICE condoms
• Need to interrogate possible reasons for low distribution and also ascertain the extent of preference of other brands of condoms e.g. Lovers Plus over CHOICE condoms
Prevention of Mother to Child Transmission
• PMTCT offered in 100% facilities• PMTCT integrated into MCWH programme• Improve package of care implemented as per
presidential mandate• Emphasis is on early booking before 14 weeks
and HIV testing in order to facilitate early access to HIV prophylaxis and treatment
• Mother to child transmission rate reduce to 8,8%
Medical Male Circumcision (MMC)• HIV Prevention strategies targeting males• Evidence that MMC reduces the risk of HIV acquisition • It is community driven strategy announced by His Majesty King
Zwelithini• Clinical strategy which is aligned to traditional approach• Comprehensive package for youth including life skills coaching
and nation building approach• MMC Campaigns running in all districts • MMC provided in district hospitals• Target for 2010/11 is 372,754 • A total of 10 229 MMC have been conducted since April 2010.
Antiretroviral Therapy
• KZN has the largest ART programme in SA • ART initiations expanded to PHC level • Approach changing from Dr driven to nurse
driven approach - Nurse Initiated and Managed antiretroviral Therapy (NIMART)
• There are currently 300 initiating facilities including PHC facilities
ART Pts & INITIATING PHC’s District PHC INTIATING ART by end Q2 Total Pts by end Q1
Ethekwini 23 97,995
Sisonke 15 17,068
Ilembe 17 20,812
Uthungulu 14 34,642
Umkhanyakude 48 32,008
Zululand 21 25,933
Amajuba 10 14,942
Umzinyathi 2 16,706
Uthukela 20 24,091
Umgungundlovu 11 40,846
Ugu 30 33,362
TOTAL 211 345, 604
Active ART PTS
0
20000
40000
60000
80000
100000
120000
ART cont.
• PHC ART expansion is bringing HIV and AIDS services closer to the communities thus increasing access
• Great commitment from municipalities – aiming at 100% coverage of their facilities
Health Systems strengthening
• In order to provide an efficient and effective TB, HIV and AIDS program the DOH together with partners its is implementing following:– Human resource provisioning – integrated TB/HIV
teams – Capacity development training for health care workers
including community care givers– Infrastructure development and improvement – Monitoring and evaluation of programmes
Partnerships
• TB, HIV and AIDS requires a multi-pronged collaborative response from all sectors of society e.g. NGOs, CBOs, FBOs, Civil Society, Political leaders, traditional leaders, business sector, traditional practitioners, and other government departments
• This collaborative response is coordinated through the Provincial Council on AIDS
Conclusion
• The road ahead of us demands that we work together in an aggressive and integrated manner in the fight against TB HIV and AIDS
• This can only be achieved through the Flagship Programme which is pioneered by our Honorable Premier Dr Zweli Mkhize
• The emphasis is on : – Household Food Security – “ONE HOME ONE GARDEN”– Ward based Intergovernmental programmes of action – Strong volunteer programme
Conclusion
• It is important that all sectors rally around all efforts aimed at combating TB, HIV and AIDS including poverty alleviation to improve the livelihood of the people of KZN
• As we celebrate our partnership let us remember that HIV and TB is one of the factors that continue to cement and strengthen our partnership as warriors against TB, HIV and AIDS
THANK YOU