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TREATMENT AND PREVENTION SCALE-UP:

THE SOUTH AFRICAN EXPERIENCE

By Dr MoolmanTeam South Africa

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The State of the South Africa HIV and AIDS Epidemic

12%=5.7 million people are infected with HIV

28% of pregnant women were HIV+ in 2007

46.2% of maternal mortality is HIV related

57% of deaths of children under the age 5 during 2007 were as a result of HIV

73% TB-HIV co-infection rate

28% of infected people were receiving treatment for HIV, at the end of 2007.

Largest antiretroviral treatment programme in the world, But low access to treatment.

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So what is the plan to address this challenge?Plan for Universal Access: the National Strategic Plan (NPS) 5-year (2007-2011)NSP for HIV and AIDS and STIs2 main objectives to be achieved by 2011:

To reduce the number of new HIV infections by half (50%),To provide comprehensive treatment, care and support to 80% of those who need it.

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The HIV Counselling and Testing campaign (HCT)

April 2010: launch massive HCT campaign

Ambitious target: testing 15 million people by June 2011enrolment of an additional 500,000 patients onto ART by March 2011.

Response: large numbers of people coming forward to be tested

TB screening and CD4, to fast-track onto the treatment programme

Results so far: 1million tested voluntarily for HIV and 70,605 enrolled onto ART.

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The expanded treatment programme

Treatment available at more health facilities

Decentralized access to treatment: facilities, other than ARV clinics to initiate treatment

By end of 2011 all health facilities must be able to initiate patients on ART.

Train health workers and shift tasks from:

physicians to nurses, pharmacists to pharmacy assistantsnurses to lay counselors.

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Nurse initiated and managed ART

(NIMART)Authorisation for professional nurses to manage patients with HIV/AIDS

Nurses are trained to:Screen for TB and other OI Place patients on ARV (Children, Adults & pregnant woman) using predetermined national regimens;Re-prescribe using same regimens

Manage stable patients Refer to Doctor, complicated cases or CD4 < 100

Not new, e.g. Nurse driven programme: TB, HTA, Diabetes,…Using national guidelines and protocols.

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New Treatment Guidelines

In line with WHO recommendations.

1 April 2010: Eligibility Criteria reviewedPregnant women: CD4 ≤ 350 or less, PMTCT to start at 14 weeks (non-HAART)Co-infected with TB and HIV: CD4≤350 or lessMDR/XDR-TB irrespective of CD4Children < 1 year irrespective of CD4.

TDF in 1st line regimen, to reduce the use of Stavudine

PMTCT and children regimens reviewed.

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Funding treatment and care Scaling up definitely needs additional resources R3 billion (US $400million): additional, to fund the ART expansion from 01/04/2010.

R5.4billion (US $715million): to further expand the treatment programme over the next 3 years.

This provides for 2.1million patients to be enrolled onto the programme by 2012/2013.

Investing in health is investing in development. Investing in HIV and AIDS programmes is investing in health

Additional funds needed.

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References

UNAIDS 2008 Report on the Global AIDS epidemic.Speech by Aaron Motsoaledi at the 18th Annual International AIDS Conference, 20 July 2010, Vienna The South African Department of Health Study, 2007National Antenatal Sentinel HIV and Syphilis Prevalence Survey, 2008South African National HIV Prevalence, Incidence, & Behaviour and Communication Survey, 2008http://www.avert.org/safricastats.htm

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“The people who get on in this world are the people who get up and look for the circumstances they want and if they can’t find them make them”

George Bernard Shaw