PROGRESS ON KEY INDICATORS 2012-2014
PROGRESS ON KEY INDICATORS 2012-2014
MPUMALANGA PROVINCIAL STRATEGIC PLAN FOR HIV, TB AND STIS
(2012-2016)
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Introduction
The 2012-2016 Mpumalanga Provincial Strategic Plan (PSP) is aligned to the National
Strategic Plan (NSP) 2012-2016 whose vision is “zero new infections, zero AIDS deaths and
zero discrimination”. The purpose of the PSP is firstly, to provide clear guidance for the
province, the districts, NGOs, and the private sector, to enable them to work in a
collaborative manner in achieving the ultimate goal of eliminating HIV infection and reducing
the impact of AIDS in Mpumalanga Province. Secondly, it is to articulate, disseminate, and
provide education to the public at large on agreed provincial priorities and strategies within
the scope of Vision 2016.
To achieve the identified goals and objectives the PSP put emphasis on the need for a
coordinated approach to implementation and management of the provincial response. To
that end, clearly delineated roles of the AIDS Councils at provincial, district and local levels
were identified. The process through which the 2012-2016 PSP was developed reflects the
importance placed upon the need for a multi-sectoral response to the burden of AIDS. Figure
1 shows that a combined review of the 2007-2011 NSP and the 2009-2011 PSP was
conducted to ensure a synergetic approach to fighting HIV, STIs and TB. Results from the
combined NSP and PSP review inevitably influenced the form and shape that the PSP under
review would ultimately take without losing focus of the provincial needs, priorities and
uniqueness.
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NSP 2012-16
PSP 2012-16
POP2012-16
PSP Review 2009-11
NSP Review2007-11
M&E Plan
Civil Society
District AIDS Councils
M&E Plan
Figure 1: Strategic Framework informing the 2012-2016 PSP
In line with the need for a coordinated multi-sectoral approach to fighting HIV, STIs and TB,
the Mpumalanga province identified the civil society sector, in addition to the AIDS councils,
as an important stakeholder. These are important stakeholders as they provide a
comprehensive infrastructure required to rollout and implement programmes targeted at
impacting the overall PSP goal. The provincial operational plan (POP) developed sought to
operationalize the broader strategy of the province by breaking it into implementable priority
activities. An M&E plan supported by a management information system (MIS) was identified
as a critical piece of the process of monitoring progress towards the achievement of the PSP
goal. Other external instruments and guidelines that influenced the development of the PSP
were the United Nations General Assembly Special Session (UNGASS), the Millennium
Development Goals (MDGs) and the National Service Delivery Agreement (NSDA), inter
alia.
Strategic Objectives
In alignment to the NSP, the Province has decided on the following strategic goals:
1. Acceleration of prevention interventions in order to reduce the rate of new HIV and TB
infections and deaths by 50%
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2. Improvement of access to comprehensive treatment, care and support services to 80% of
all eligible people living with HIV, STIs and TB; 70% of them being alive 5 years following
initiation of treatment
3. Mitigation of the socio-economic impacts of HIV, STIs and TB, especially among the most
vulnerable groups such as orphans and children, PLHIV and their caregivers and/or
families, and guarding against any form of discrimination and stigmatisation
4. Strengthening the capacity of all sectors and the Mpumalanga AIDS Council (MPAC) to
respond effectively to the priority goals that have been established.
These strategic goals were to be achieved through the prioritised implementation of the
following broad activities:
1. Increase HIV awareness throughout all sectors particularly in the high risk populations
such as the youth and farm workers
2. Intensify case finding and follow up through screening for HIV, STIs and TB
3. Intensify HCT campaigns and testing in clinical settings through provider initiated
counselling and testing
4. Maintain the health and wellness of all citizens
5. Utilise combination prevention strategies to maximize HIV prevention
6. Promote the core values of the South African constitution to mitigate stigma,
discrimination and related behaviours
7. Strengthen the MPAC, DACs, and the LACs to promote a multi-sectoral approach to HIV,
STIs and TB prevention, treatment and support.
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Impact Indicators in Mpumalanga Province
NSP Goals Indicator
Reducing new infections by at least
50% using combination prevention
approaches
MTCT rate (six weeks and 18 months) 2.1%1
HIV prevalence among women and men
aged 15-24
21.8%2
HIV Antenatal Prevalence among
women aged 15-49
36.7%3
HIV Incidence 1.4%4
Total number of New HIV Infections (2 years +) 28,0005
Initiating at least 80% of eligible
patients on ART with 70% alive and
on treatment 5 years after initiation
Total number of patients initiated on
treatment
270 9956
Patients alive and on treatment 243 3747
HIV mortality 5.1%8
Reducing the number of new
infections and deaths from TB by
50%
TB Incidence 9453 new cases9
TB mortality 10.6%10
1 Mpumalanga Departmenet of Health Annual Report 2013/2014. 2 Shisana O, Rehle T, Simbayi LC, et al. South African National HIV Prevalence, Incidence and Behaviour
Survey, 2012. Cape Town: HSRC Press; 2014.
3 The 2012 National Antenatal Sentinel HIV and Herpes Simplex type-2 prevalence Survey, South
Africa, National Department of Health: Pretoria.
4 Spectrum 2013
5 Ibid
6 Mpumalanga Departmenet of Health Annual Report 2013/2014. 7 Ibid
8 Statistics South Africa. Mid-year population estimates 2013. Pretoria: Statistics South Africa; 2013a
9 ETR.NET 2013
10 Statistics South Africa. Mid-year population estimates 2013. Pretoria: Statistics South Africa; 2013a
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Goal 1: Reducing new infections by at least 50% using combination
prevention approaches
National HIV prevalence was estimated at 12.2% in 2012 (95% CI: 11.4-13.1). In 2008
prevalence was estimated at 10.6% indicating an increase of 1.6%. Mpumalanga recorded
the HIV prevalence 35.6%, above the national estimate of 29.5%. The province remains the
second province with the highest HIV prevalence after Kwa-Zulu Natal. The graph below
presents the trends of HIV prevalence in Mpumalanga from 2002 to 2012.
Figure 2: HIV prevalence in Mpumalanga (2 years and older) 2002, 2005, 2008 and 2012.
Source: South African National HIV Survey, 2012
Figure 2 above shows that the HIV prevalence for people 2 years and older in Mpumalanga
took a curvilinear shape from 2002 to 2012. It shows a steady increase from 2002 to 2008
when it reached its high and dropped from 15.4% in 2008 to 14.5% in 2012. The drop could
be attributed to intensified and coordinated efforts to fight HIV, STIs and TB in the province
and nationally. While there is a drop in prevalence among this population, the drop is yet to
reach the level it was estimated to be in 2002. This trend was similar to that observed among
the 2-14 age-group although this group registered a drop as early as 2008. The prevalence
for this group was 3.7% (2002), 5.4% (2005), 3.8% (2008) and 1.7% (2012). This shows
some significant gains and strides made in the prevention-of-mother-to-child transmission as
a result of mother-baby pair tracking from birth to 18 months.
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Percentage distribution of HIV prevalence by district in the Mpumalanga Province
The district level variations in the HIV prevalence over the past three years are depicted in
Table 1 and Figure 3 below. Two districts in the Mpumalanga province: Gert Sibande and
Ehlanzeni recorded the 12th highest HIV prevalence among the 52 health districts in the
country in 2012. Gert Sibande antenatal HIV prevalence has significantly declined from
46.1% in 2011 to 40.5% in 2012, a decrease by 5.6%. On the other hand, Nkangala
antenatal HIV prevalence has increased from 29.6% in 2011 to 32.1% in 2012, though still
the lowest in the province11.
Table 1: HIV prevalence among antenatal women by district, Mpumalanga, 2010 to 2012.
Mpumalanga 2009 (%) 2010 (%) 2011 (%)
Provincial 35.1 36.7 35.6
Ehlanzeni 37.7 35.8 35.1
Gert Sibande 38.2 46.1 40.5
Nkangala 27.2 29.6 32.1
Figure 3: HIV prevalence among antenatal women by district, Mpumalanga, 2010 to 2012.12
11 The 2012 National Antenatal Sentinel HIV and Herpes Simplex type-2 prevalence Survey, South
Africa, National Department of Health: Pretoria
12 Ibid
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A decrease is realised in HIV prevalence among young women in the age group 15 to 19-
year-old group, from 17.4% in 2010 to 14.0% in 2011 to a very slight increase 0.4% in 2012
(Table 2). Data in the table below also shows that HIV prevalence was high among the 30 to
34-years-old age group. The 45 to 49-years-old age group registered a significant decrease
that is consistent from 2010 to 2012, dropping from 37.5% to 20.0%.
Table 2: HIV prevalence among antenatal women by age group, Mpumalanga, 2010 to 2012.
Age Group (Years) 2010 2011 2012
<15 22.2 12.5 0.0
15-19 17.4 14.0 14.4
15-24 25.6 25.0 23.7
20-24 32.0 32.8 30.8
25-29 46.1 48.9 48.4
30-34 53.6 53.8 49.7
35-39 38.7 52.6 48.0
40-44 30.9 34.0 40.0
45-49 37.5 24.0 20.0
>49 ** ** **
HIV Incidence
The 2012 HSRC survey estimates that nationally over the period mid-2011 to mid-2012
there were approximately 469 000 new infections (95% CI: 381 000–557 000) in the
population aged 2 years and older. This translates to 1.1% estimated incidence for that
period. There are no recently published estimates of HIV incidence in adults by province.
However, a number of earlier models have produced estimates of HIV incidence by
province, and these estimates are summarised in Table 3 below. Differences in HIV
incidence trends by province are important in identifying variations in changes in the
epidemic, including potential influence of HIV prevention programmes. The earlier Spectrum
and ASSA 2008 estimates of adult HIV incidence both suggested that incidence was
second-highest in Mpumalanga after KwaZulu Natal. In 2013, spectrum estimated incidence
in Mpumalanga at 1.4% translating to 28 000 actual new infection.
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Table 3: Estimates of HIV Incidence by Province.13
HIV incidence in children
Mother to child HIV transmission is characterised by transmission occurring at or before the
time of birth or after birth through breastfeeding. Reports have shown best performance and
significant strides for PMTCT programme for the two years under review as more babies
were born free from HIV infection. A dramatic decline was shown in the prevention of Mother
to Child transmission between 2012/13 and 2013/14 where the response towards HIV born-
free infants at 6-8weeks was found to be between 2.3% and 3%. This is attributable to the
introduction of Dual Therapy when AZT was commenced from 28 weeks of gestation and
single-dose Nevirapine was given in labour whilst HAART was being provided for women
with CD4 counts of less than 200.
13 South African National AIDS Council. Progress Report on the National Strategic Plan for HIV, TB
AND STIs (2012 – 2016). Pretoria: South African National AIDS Council; November 2014.
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Goal 2: Initiating at least 80% of eligible patients on antiretroviral
treatment (ART), with 70% alive and on treatment five years after
initiation
This indicator is concerned with coverage, effectiveness and impact of the ART programme.
Flowing from the country’s national strategic plan for HIV, STIs and TB 2012-2016, the
Department’s strategic objectives were to scale up combination prevention interventions to
reduce the rate of new infections, and to improve the quality of life of people living with HIV,
by providing a comprehensive package of care, treatment and support services to at least
80% of people living with HIV and AIDS.
Data from the DHIS has shown that in 2012/13 year, antenatal clients initiated on ART were
6,139 tripling to 18,419 in 2013/14 year for the Mpumalanga province. The total number of
clients started on ART for the same periods were 57,186 and 61,228 respectively. The
cumulative total of those currently on treatment for the same periods increased from 209,714
in 2012/13 to 243,374 in 2013/14.
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Goal 3: Reducing the number of new TB infections and deaths from
TB by 50%
The table below indicates that Mpumalanga’s TB cure rate is estimated to be 69.9%. Those
who died as a result of TB were at 6.7% which puts Mpumalanga at fifth position across the
country. While a commendable achievement, the province TB cure rate is below the national
average of 74.2%. About 5.9% were estimated to have been lost to follow-up. This indicates
the need for strengthened efforts for referral and retention of clients in care.
Table 4: TB treatment outcomes
Treatment Outcomes: 2011 - New Smear Positive TB cases (Source: ETR.Net 2013)
Prov. SS +
Cases
Cured Success Failed Died Lost to follow
up
Transferred Not
Evaluated
No. % No. % No. % No. % No. % No. % No. %
EC 21,541 14,575 67.7% 16,818 78.1% 344 1.6% 1,459 6.8% 1,651 7.7% 1,195 5.5% 74 0.3%
FS 8,966 6,491 72.4% 6,964 77.7% 215 2.4% 884 9.9% 424 4.7% 441 4.9% 38 0.4%
GP 22,495 18,233 81.1% 18,421 81.9% 343 1.5% 1,241 5.5% 1,149 5.1% 975 4.3% 366 1.6%
KZN 34,078 25,249 74.1% 27,274 80.0% 649 1.9% 1,810 5.3% 1,970 5.8% 1,645 4.8% 730 2.1%
LP 8,648 6,513 75.3% 6,697 77.4% 175 2.0% 739 8.5% 406 4.7% 592 6.8% 39 0.5%
MP 9,453 6,608 69.9% 7,511 79.5% 185 2.0% 637 6.7% 555 5.9% 554 5.9% 11 0.1%
NW 9,668 6,662 68.9% 7,329 75.8% 159 1.6% 780 8.1% 742 7.7% 560 5.8% 98 1.0%
NC 3,610 2,469 68.4% 2,803 77.6% 96 2.7% 247 6.8% 262 7.3% 125 3.5% 77 2.1%
WC 14,790 12,038 81.4% 12,518 84.6% 265 1.8% 449 3.0% 1,015 6.9% 424 2.9% 119 0.8%
SA 133,249 98,838 74.2% 106,335 79.8% 2,431 1.8% 8,246 6.2% 8,174 6.1% 6,511 4.9% 1,552 1.2%
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Goal 4: Ensuring an enabling and accessible legal framework that
protects and promotes human rights in order to support
implementation of the NSP.
Chapter 2 of the South African Constitution makes provision for the protection and promotion
of human rights and obliges the state to ensure the realisation of such rights particularly for
specific vulnerable groups. These rights include amongst others, the rights to equality,
dignity, life, freedom, privacy and security of the person, irrespective of sexual orientation. In
line with this provision, the Mpumalanga province emphasised the need for programming
that is sensitive and targeted at such groups of people as women (pregnant, with child-
bearing potential or post-menopausal), men, adolescents, children, sex workers, LGBT,
MSM and persons with disabilities.
Goal 5: Reducing self-reported stigma related to HIV and TB by at
least 50%.
The stigma index is the indicator for measuring this goal; the index is currently not measured
in the DHIS. SANAC is driving efforts to implement the stigma index to monitor efforts to
reduce stigma and discrimination and meet this fifth goal of the NSP. Local government
departments continue to deliver stigma and discriminating reduction programmes in line with
the NSP goals and objectives.
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Strategic objective 1: Addressing social and structural drivers of
HIV, STI and TB prevention, care and impact
Social and structural approaches address the social, economic, political, cultural and
environmental factors that lead to increased vulnerability. As pointed out in the NSP, every
government department — at national, provincial and municipal levels — has a critical role to
play in addressing the structural factors driving HIV and TB. There was a high proportion of
women who have experienced physical or sexual violence in both financial years 2012/13
(60.3%) and 2013/14 (62.4%) as shown in the table below based on data from the district
health information system (DHIS). While the proportion is high, it may be an indication of the
progress and successes of community mobilisation efforts in the province resulting in more
people aware of their rights and not afraid to report cases of violence to the police.
Indicator Baseline Values Provincial
Target
Values
Data Source Achieved
2012/13
Achieved
2013/14
Delivery rates under 18 – NIDS To be determined
in 2012
10.5
(2012/13) <
10.51%
(2013/14)
Mpumalanga
Department of
Health Annual
Report(2013/14)
8.9 % 9.1%
Number of women and children reporting gender-
based violence (GBV) to the police in the last year
To be determined
in 2012
…………
(2012/13)
……….
(2013/14)
Crime Research
and Statistics -
South African
Police Service
4267 3953
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Strategic Objective 2: Preventing new HIV, STI and TB infections
"Targeted, evidence-based combination prevention is needed to achieve the long-term goal
of zero new HIV, STI and TB infections. Focusing prevention efforts in high transmission
areas and on key populations is likely to have the greatest impact, whilst simultaneously
sustaining efforts in the general population." (SANAC, 2011a: 39). A Combination Prevention
approach (ibid.) acknowledges that no prevention intervention on its own can adequately
address the HIV and TB epidemics at the population and individual levels. Combination
prevention uses a mix of structural, social, behavioural and biomedical interventions that,
when implemented simultaneously, will have the greatest power to reduce transmission, as
well as mitigate individuals’ susceptibility and vulnerability to infection.
Reach of HCT Programme and TB Screening in the province
Following the launch of the HCT campaign in 2010 and the subsequent annual efforts at
national level to ensure a wider reach and coverage with HCT services, the Mpumalanga
province has made good progress for the period 2012/13 and 2013/14. During 2012/13,
566 696 people were reached with HIV counselling and testing services. Although a slight
decrease was recorded in the 2013/14 financial year with 556 782 people reached, the
provinces is already over achieved its cumulative target (900,000) for the PSP period 2012-
2016. The multi-sectoral approach in reaching people with HCT services should be
maintained for the rest of the PSP period. In terms of population coverage of TB screening,
data obtained from the DHIS indicate that the province screened an estimated 112 842
people representing 84% of the financial year 2012/13 target. Continued efforts should be
put on screening for TB all health facility clients.
Reach of male condom distribution
In terms of male condom distribution, the province achieved about 86% of its 2012/13
financial year target. This is a commendable achievement. Based on the 2012/13
performance, the target for 2013/14 financial year was increased to 60,000,000 condoms
distributed. This was a 25% increase from 48,000,000. In 2013/14, the province fell short of
the target by 33%.
Reach of Male medical circumcision
In accordance with Voluntary Male Medical Circumcision (VMMC) policy of South Africa
there is a need to upscale this programme and reach more men as this is regarded as one of
the effective strategies to reduce HIV transmission amongst men. In line with the national
proposal of reaching more men in 2015, the Mpumalanga Province achieved over 99% of its
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target for male medical circumcision in both financial year 2012/13 and 2013/14. The
province reported 49 609 males medically circumcised in financial year 2012/13 and 42,604
in financial year 2013/14.
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Indicator Baseline Values Provincial Target
Value
Data Source Achieved
2012/13
Achieved
2013/14
Number (and percentage) of men
and women 15–49 counselled and
tested for HIV
13 million (HCT Review
Report); 62% ever tested,
37% tested in the past 12
months (2008 NCS)
900 000 (2012-
2016)
90% (2012-
2016)
Mpumalanga PSP (2012-
2016)
Mpumalanga Department of
Health Annual Report
(2013/14)
566 696 556 782
Number and percentage of people
screened for TB
Eight million(2011 HCT
Review)
DHIS 112 842
84%
Number of newly diagnosed HIV
positive people started on IPT for
latent TB infection
53%(2011 HCT Review) 50%(2012/13)
60% (2013/14)
DHIS
Mpumalanga Department of
Health Annual Report
(2013/14)
38 214
28,4%
43 947
95,8%
% men and women aged 15–24
reporting the use of a condom
with their sexual partner at last
sex
40% (NCS 2008) HSRC,2012 39.4%
% young women and men aged
15–24 who had sexual intercourse
before age 15 (age at sexual
debut)
10% (UNGASS Report
2010)
HSRC,2012 7.7%
% women and men aged15–49
years who have had sexual
intercourse with more than one
partner in the last 12 months
7% (UNGASS Report 2010) HSRC,2012 13.7
Male condom distribution 492 million(2010/11) 48, 000, 000
APP(2012/13)
60 000 000 APP
(2013/14)
APP (2012/13 to 2014/15)
Mpumalanga Department of
Health Annual Report
(2012/13 & 2013/14)
41 149
000
40 317
964
(29.3%)
Female condom distribution 5,1 million(2010/11) 100,000
APP(2012/13)
50,000
APP(2013/14)
APP (2012/13 to 2014/15)
Mpumalanga Department of
Health Annual Report
(2012/13 & 2013/14)
600 918 1 194 475
(0.8%)
Number of men medically
circumcised
143 000 (2010/11) 50 000 (2012/13)
10 000 (2013/14)
APP(2013/2014)
Mpumalanga Department of
Health Annual Report
(2012/13 & 2013/14)
DHIS
49 609 42 604
Number of people reached by
prevention communication at
least twice a year
To be determined in 2012 NCS 84%
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Strategic objective 3: Sustaining health and well being
Morbidity and Mortality
As part of their contribution to the work of Health Data Advisory and Co-ordination
Committee (HDACC), the Medical Research Council (MRC) of South Africa and the School
of Actuarial Sciences at the University of Cape Town (UCT), released data from the Rapid
Mortality Surveillance (RMS) system on four key outcome indicators for South Africa in
August 2012. The data reflected that the life expectancy of South Africans has increased
from 56.5 years in 2009 to 60 years in 2011. The Infant Mortality Rate (IMR) decreased from
40 deaths per 1000 live births in 2009 to 30 deaths per 1000 live births in 2011; and the
Under-5 Mortality Rate decreased from 56 deaths per 1000 live births in 2009 to 42 deaths
per 1000 live births in 2011. These achievements far exceeded the targets set for 2014 in
the NSDA of the Health Sector for 2010 to 2014. Undoubtedly, more work still needs to be
done to fight maternal and infant mortality, however, the NDoH report points to the fact that
South Africa should recognise and leverage these profound achievements as a celebration
of the unity of purpose and the high value our nation places on the wellbeing and
productivity of its children, mothers, workers and society at large.
Control and management of Tuberculosis in the province
Based on data obtained from the ETR.Net system, the Mpumalanga TB programme has
been largely successful. Inter-sectoral collaboration is very crucial towards winning the battle
against the scourge of HIV and AIDS, TB and STI. At sub-national level this needs to be
elevated for the purpose of monitoring and evaluation of HIV and TB programmatic activities
as well as reducing infection rates and the related burden of diseases affecting our
communities. Against a target of 80%, the province achieved 90% TB case detection rate in
financial year 2012/13. While the province increased its smear positive TB case treatment
rate in financial year 2013/14 to 80%, it fell short of the >85% target for that year.
Consistently, the TB case fatality rate has been declining from a baseline of 7.1% to 6.7% in
financial year 2012/13 and 6% in financial year 2013/1414.
14 Mpumalanga Departmenet of Health Annual Report 2013/2014.
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Indicator Baseline
Values
Provincial
Target
Values
Data Source Achieved
2012/13
Achieved
2013/14
% people per year becoming eligible who
receive ART
58% DHIS 100,5%
TB case registration rate 708/100 000 Mpumalanga
Department of
Health Annual
Report,
(2012/13)
ETR.net
676/100 000 570/100 000
TB case detection rate 72%
(2010,WHO)
80% ETR.net 90 %
% smear positive TB cases that are
successfully treated
73% smear
positive
78.5%
(2012/13)
>85%
(2013/14)
Mpumalanga
Department of
Health Annual
Report
(2012/13 &
2013/14)
ETR.net
79.2% 80%
TB case fatality rate (CFR) 7,1% Mpumalanga
Department of
Health Annual
Report,
(2012/13 &
2013/14)
ETR.net
6.7% 6.0 %
Number and percentage of registered TB
patients who tested for HIV
54% (2010
WHO)
DHB
(2013/14)
Mpumalanga
Department of
Health Annual
Report,
(2013/14)
ETR.net
10 991 (85%)
Number of all newly registered TB patients
who are , expressed as a proportion of all
newly registered TB patients
60% (WHO) ETR.net 60.5% Not available
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Indicators to be reported on by Mpumalanga AIDS Council
Strategic Objective 1
Number of women and children reporting gender-based violence (GBV) to the police
in the last year
Proportion of women who have experienced physical or sexual violence in the last
year
Current school attendance among orphans and among non-orphans aged 10-14
(UNGASS and MDG indicator)
% municipalities with at least one informal settlement where targeted comprehensive
HIV, STI and TB services are implemented
% government departments and sectors with operational plans with HIV, TB and
related gender- and rights-based dimensions integrated
Strategic Objective 2
% men and women aged 15–24 reporting the use of a condom with their sexual
partner at last sex
% young women and men aged 15–24 who had sexual intercourse before age 15
(age at sexual debut)
% women and men aged15–49 years who have had sexual intercourse with more
than one partner in the last 12 months
Number of people reached by prevention communication at least twice a year
Strategic Objective 3
% people per year becoming eligible who receive ART
Substance abuse.
Implementing interventions to address gender norms and gender-based violence.
Mitigating the impact of HIV, STIs and TB on orphans, vulnerable children and
youths.
Reducing the vulnerability of young people to HIV infection by retaining them in
schools, and increasing access to post-school education and work opportunities.
Reducing HIV- and TB-related stigma and discrimination.
Strengthening community systems to expand access to services.
Supporting efforts aimed at poverty alleviation and enhancing food-security
programmes.