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