City Health:Khayelitsha

Virginia Azevedo

July, 2007

Death Data & IMR

Khayelitsha: IMR, 2001-2006(Deaths of babies under 1 yr of age, out of 1,000 live births)

43 43 4237

3431

2001 2002 2003 2004 2005 2006

Cape Town: IMR 2003 - 2006

42

25

37

24

32 31

25

2221

12

18

14

2122

35

Eastern Khayelitsha Klipfontein M/Plain Northern Southern Tygerberg Western City

2003 2004 2005 2006

Deaths in children <1 yr: Khayelitsha 2001-2006

50

27

49

34

59

3439

52

37

48

32 32

AIDS Gastro.

2001 2002 2003 2004 2005 2006

Khayelitsha: Top causes of deathAll Ages, 2001-2006 (as per death certificates)

369

513460

558494

553

693616

321

670 626

330

693598

365

705645

398

AIDS TB Crime

2001 2002 2003 2004 2005 2006

HIV CARE

ENROLLMENT ON ARVS TO DATE: 5,301Adults = 4,881Children = 420

Site BAdults: 1,989 Children: 168

Michael MAdults: 1,725 Children: 131

NolungileAdults: 1,161 Children: 121

KuyasaAdults: 33 Children: 0

Matthew GAdults: 35 Children: 0

PMTCT

HIV Testing - Service Utilisation

35,853 36,027

41,139 41,62344,699

42,13145,557 46,595

54,397 55,573

63,201

Jul-Sept'04

Oct-Dec04

Jan-Mar'05

Apr-Jun'05

Jul-Sept'05

Oct-Dec'05

Jan-Mar'06

April-Jun '06

Jul-Sept'06

Oct-Dec'06

Jan-Mar'07

HIV Testing Q4 '06 vs Q1 '07

7370

4,729

13,975

6,946

5,010

2,481

6,8436,606

8,419

4,789

16,483

8,147

5936

7,1668,209

4,818

Eastern Khayelitsha Klipfontein M/Plain Northern Southern Tygerberg Western

Q4 06 Q1 07

% Adult Population Tested for HIV (Jan-Mar '07, Annualised)

9.8%

6.5%

10.7% 10.6%

19%

8%9%

7.2%

13%

10.7%

7.5%

5.3%5.2%6.3%

7.7% 8%

6%

12.7%

East Khay Klip M Plain North South Tyg West City

% Tested Target

% Female Tested (Jan-Mar '07)

64%71% 71% 68%

49%

69%74%

52%

29%

63%

East Khay Klip M/Plain North South Tyg West Wkplc City

HIV Positivity Rates Jan-Mar '07

20%

18%

31%

22%

15%

11%

22%

18%

13%

10%

17%

29%

14%

12% 12%

10%

17.2%

23%

Eastern Khay Klip M Plain Nrthrn Sthrn Tyg Wstrn City

PMTCT Babies - Offer of PCRApril-June '06 vs July-Sep '06

0%

20%

40%

60%

80%

100%

Q2 '06 70% 74% 87% 88% 79% 85% 77% 84% 79%

Q3 '06 69% 74% 78% 89% 75% 86% 80% 79% 78%

Estrn Khay Klip M Plain Nrthrn Sthrn Tyg Wstrn City

PMTCT Babies - HIV Positivity Rates (April-June'06 vs July-Sep '06 Cohorts)

0%

5%

10%

15%

HIV+ (Q2 '06) 8.6% 3.9% 5.1% 3.6% 5.9% 8.3% 1.9% 5.6% 5.0%

HIV+ (Q3 '06) 7.0% 3.7% 4.3% 5.7% 11.8% 9.0% 9.1% 3.3% 5.6%

EasternKhayelits

haKlipfontei

nMitchells

PlainNorthern Southern

Tygerberg

Western City

PMTCT - good formula compliance (July-Sep '06 Cohort)

0%10%20%30%40%50%60%70%80%90%

100%

%gd comp 47% 51% 74% 81% 93% 75% 91% 82% 67%

Eastn Khaye Klip M Plain Nthrn Sthrn Tygbg Westn City

STIs

Cape Town Metro - 2006: STIs-New (68,033)

3,3425,407 6,348

11,848

19,270

5,049

10,986

5,783

STI-New MUS-New

CT Metro - 2006: STI-New Caseburden (68,348)

Eastern5%

Northern8%

Khayelitsha29%

Klipfontein7% Western

18%

Southern9%

M/Plain16%

Tygerberg8%

1

2

3

STIs-New 2004 2005 2006Eastern 3,792 3,793 3,342Northern 5,124 4,467 5,407Southern 6,084 5,727 6,348Western 14,623 12,922 11,848Khayelitsha 28,061 23,522 19,270Klipfontein 6,036 6,455 5,049M/Plain 8,334 8,682 10,986Tygerberg 8,517 6,938 5,783CT Metro 80,571 72,506 68,033

Cape Town Metro: STIs-New 2004-2006

05,000

10,00015,00020,00025,00030,000

2004 2005 2006

Condoms

Cape Town Metro: Distribution of Male Condoms2004-2006 (Millions)

21.926.2

47.3

2004 2005 2006

Cape Town Metro: Male condom distribution -2004-2006 (Millions)

4.32.8

5.07.2

10.3

5.18.0

4.6

2004 2005 2006

Khayelitsha: Male condom distribution - Jul/06 - May/07=79 male condoms per male per year

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

Jul 06 Aug 06 Sep 06 Oct 06 Nov 06 Dec 06 Jan 07 Feb 07 Mar 07 Apr 07 May 07 June 07

Target:2condoms /week per per male

Average sexual intercourse: = 2Xs per week

Requirements for Khayelitsha:2 x 4weeks= 8 condoms/male/month8 x12 months = 96 condoms/male/year96 x 120,000 males (>14y) =

+-12,000,000 condoms PER YEAR for Khay+-1million condoms PER MONTH for Khay

Khayelitsha: Condom requirements

Cape Town Metro: Condoms issuedper male > 15 yrs, per year

19 14 1422 23

17

2820 2020

1016

23

43

2732

1923

3425 28

53

85

4055

2742

East North South West Khay Klipf M/Plain Tygerb CTMetro

2004 2005 2006

Cape Town Metro - 2006: Female Condoms Distributed (137,966)

9,285

23,28418,509

16,015

26,515

12,931

28,788

2,639

KHAY: Live Births vs TOPs @ Michael M

6,668 7,049 6,685

7,812 7,916

268 439 188765

1,434

2001 2002 2003 2004 2005

Live Births TOPs @ MM

Total Births & Births to Mothers < 18yrs: 2001 - 2005

6,668 7,049 6,8867,811 7,920

352 436 375 479 469

2001 2002 2003 2004 2005

Total Births Births to mothers <18yrs

Khayelitsha: Teenage Pregnancy Rates 2001 - 2006

5.28

6.19

5.45

6.13 6.235.9

2001 2002 2003 2004 2005 2006

VCT

51545517

6482 6567

7747 7515

8258 8364

9120

8365 8209

6547

13701688

2142 21862439 2318 2638 2426 2568

2113 23671784

Q3 04 Q4 04 Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07

Total District VCT Total District HIV+

Khayelitsha : Total HIV Testing

Khayelitsha: Total HIV testing

28,311

9,085

34,107

9,745

VCT total HIV+

2005 2006

Cape Town: HIV TestingQ4 '06 vs Q1 '07

68437370

4,729

5936

8,147

16,483

6606

13975

5010

6946

2481

8419

4789

7,1668,209

4,818

Eastern Khayelitsha Klipfontein M/Plain Northern Southern Tygerberg Western

VCT Q4 '06 VCT Q1 '07

% Adult Population Tested (Q4 2006)

7.2%

8.7% 8.5%9.1%

15.6%

9.2%

5.2%

13.4%

5.4%

4.0%

8.0%

10.7%

7.5%

5.3%6.3%

7.7%

12.7%

6.0%

East Khay Klip M Plain North South Tyg West City

% Tested Target

27722940

2497 23732664

1616

Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07

Khayelitsha: HIV testing Jan - Jun 07

Khayelitsha: HIV testing Q1 vs Q2 07

459

201

495

142

626

1041915

497

974

1390

760

225 206130

355

556420

592

1160

206

422

740

177

451

856

120

Ku

yasa

Lu

vuyo

MG

on

iwe

M Z

eke

Mic

hae

lM

CH

C

Mic

ahel

M M

OU

No

lun

gile

No

l.Y

ou

th

Site

BC

HC

Site

BM

OU

Site

BY

ou

th

To

wn

II

Zak

hel

e

Q1 07 Q2 07

VCT for STI (Oct-Dec '06 vs Jan-Mar '07)

0%10%20%30%40%50%60%70%80%

Oct-Dec '06

Jan-Mar '07

Khayelitsha: HIV testing Jan - Jun 06 vs 07

380

1202

2075

1839

1226

125 34

6

1955 2034

406

364

227

824

378

946

262

1046

1897

1471

919

101 31

2

1566

2550

1500

431

336

2504

43563

0

54

1060

HW

W

Kuy

asa

Luvu

yo

Mat

thew

G

May

enze

ke

MM

CH

C

MM

MO

U

Nol

ungi

le

Site

C Y

PPA

SA

Sim

elel

a

SB C

HC

SB M

OU

SB Y

outh

Tow

n II

Zakh

ele

Jan-Jun 06 Jan-Jun 07

Khayelitsha: Pre-test counselling / dayQ1 vs Q2 07

5.2

4.33.8 4

5.7

2.11.9

3.42.5 2.7 2.3

4.1

6.3

3.73.3

6.1

3.4

4.8

2.4

3.5

2.3

3.53.5

22.5

2.9

Q1 07 Q2 07

Last year target=5

Current target=8

TB

KHAYELITSHA SUB-DISTRICT

72

44

865

1103

12031274 1296

1071

40

50

60

70

80

90

100

Q1'02

Q2'02

Q3'02

Q4'02

Q1'03

Q2'03

Q3'03

Q4'03

Q1'04

Q2'04

Q3'04

Q4'04

Q1'05

Q2'05

Q3'05

Q4'05

Q1'06

Q2'06

Q3'06

Q4'06

Q1'07

Q2'07

Cu

re R

ate

Ne

w S

m+

[%]

200

400

600

800

1000

1200

1400

1600

TB

ca

se

s r

eg

iste

red

fo

r tr

ea

tme

nt

Cure New Sm+ Case Load

Cape Town Metro: Case Finding 2006

Khayelitsha5,880=21%

Eastern3,602=13%

Western2,668=9%Tygerberg

3,453=13%

Southern2,064=8%

Northern2,290=9% M/Plain

3,375=13%

Klipfontein4,078=14%

Khayelitsha: Smear conversion @ 3 months (All smear+) 2005-2007

65%57% 57% 56%

65%

80% 82% 81% 81%

5% 7% 4% 6% 3% 5% 5% 3% 4%

27%30%

35% 32%29%

9%5%

9% 9%

Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07

Converted Remained positive Sputa not available

Khayelitsha: TB Treatment OutcomesNew Smear Positive Jul 05 - Sep 06

21%

2.9% 4.5% 2.9%

72%78%

11%4.8% 3.8% 2.6% 0.2%

44%

67%

2%

Cure Success Interruption Death Transfer/out Failure Not/Evaluated

Q3 04 Q4 04 Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06

The improvement in cure rate last quarter was maintainedThe gap reduced from 23% to 6%!

Cape Town Q1 2006: Cure Rate New Smear+

77%72%

82% 85%

59%

74%80% 77% 76%

1607

910

845

564

545

826

711

6707

1045

Khayelitsha: TB Treatment Outcomes Re-Rx Smear Positive Q3 04 - Q2 06

30%

53%

28%

10.4%

19%

4.1% 2.7%5.0%

67%

58%

Cure Success Interruption Death Transfer/Out Failure Not/EvaluatedQ3 04 Q4 04 Q1 05 Q2 05 Q3 05 Q4 05 Q1 06

PROGRESS AT SITE B CLINIC (New Smear+)

60

73

31

16

68

54

26

59

68

75

Q3 04 Q4 04 Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06

Cure Success Failure Died Interruption Transferred Not evaluated

Khayelitsha: Total MDR Registered (216)

14 1320

30

10

32

63

16 18

KHAYELITSHA: VCT for TBQ3 05 - Q4 06

99 95

6882

19

95

Counselled Accepted Positive Bactrim Haart % CD4

Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07

Not yet updated!

Adult VCT for TB (Q3 06)

0

300

600

900

1200

1500

Unknown 82 11 16 34 42 35 68 33

HIV- 453 414 354 317 192 217 554 264

HIV+ 284 860 360 374 201 178 181 230

Eastern Khay Klipfont M/Plain North South Tygerb West

Positivity Rates TB Clients (Q3 2006)

39%

68%

50% 54% 51%45%

25%

47% 49%

Prevention is critical to make treatment affordable & sustainable

Conclusion

Let us work togetherfor a better city