Transcript TB and HIV - The Strategic Vision for SA

TB AND HIV:
“THE STRATEGIC VISION
FOR THE COUNTRY”
Dr Lindiwe Mvusi
18 May 2012
MMPA Congress 2012
PRESENTATION OUTLINE
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Background
Vision and Goal
Strategic objectives
Priority TB interventions
Conclusion
1997
Phased implementation of DOTS, establishment of DTDs
1999
Introduction of fixed dose combination drugs
Establishment of TB and HIV pilot districts
2000
MDR-TB guidelines endorsed, establishment of MDR-TB treatment
facilities
2002
Launch of the MTDP 2002-2005
2003
Launch of the ACSM Plan
Scale up of TB/ HIV Collaborative activities
2005
Declaration of TB as an emergency in AFRO region
Launch of the National TB Crisis Plan
2006
Development of MDR and XDR Action Plan
2007
Launch of the National TB Strategic Plan 2007-2011
Development of Infection control guidelines for TB
2010
Framework for decentralisation of MDR-TB treatment
2011
National HIV, AIDS, STI and TB Strategic Plan 2012-2016
GLOBAL BURDEN OF TB
Estimated TB Incidence rate, 2010
WHO REORT ON GLOBAL TB CONTROL 2011
HIV prevalence in TB patients, 2010
TB PREVALENCE RATE PER 100 000
 Baseline 1990
– 431/ 100 000
 Target for 2015
– 215/ 100 000
 Current (2010)
– 795/ 100 000
WHO REORT ON GLOBAL TB CONTROL 2011
TB INCIDENCE RATE PER 100 000
 Baseline 1990
– 301/ 100 000
 Target for 2015
– 150/ 100 000
 Current (2010)
– 981/ 100 000
WHO REORT ON GLOBAL TB CONTROL 2011
TB MORTALITY RATE PER 100 000
 Baseline 1990
– 38/ 100 000
 Target for 2015
– 19/ 100 000
 Current (2010)
– 50/ 100 000
WHO REORT ON GLOBAL TB CONTROL 2011
PROPORTION ON MDR-TB
AMONG NEW CASES GLOBALLY 2010
WHO GLOBAL DRUG RESISTANT TB REPORT 2010
DRUG RESISTANT TB LABORATORY
NOTIFICATIONS: 2004-2010
 Prevalence MDR-TB
among new: 1.6%
 Prevalence MDR-TB
among ret: 6.7%
 Prevalence of XDRTB among MDR-TB:
9%
VISION
 Zero new TB and HIV infections
 Zero vertical transmission of
infection
 Zero preventable deaths
associated with TB, HIV and AIDS
 Zero discrimination
GOALS
 Reducing new HIV infections by at least
50%
 Reducing new TB infections by 50%
 Initiating at least 80% of eligible clients on
ART, with 70% on treatment after 5 years
 Reducing TB deaths by 50%
 Reducing self reported stigma related to
TB and HIV by at least 50%
 Promote human rights through an
enabling and accessible legal framework
STRATEGIC OBJECTIVES
 Address social and structural barriers
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Social, cultural norms and behaviours
Socio-economic factors
Access to basic services
Gender inequities
vulnerability
 Prevention of new infections
– Combination interventions
• Biomedical, behavioural, social and structural
 Sustain health and wellness
– Access to diagnostic, treatment, care
and support services
 Protection of human rights and
improving access to justice
– Stigma, discrimination, human rights
violations, gender inequalities
STRATEGIC ENABLERS
 Governance and institutional
arrangements
– Coordination of multi-sectoral approach
– Increased responsibility and accountability
 Effective communication
– Social and behavioural change
 Monitoring and evaluation
– Focussing on impact – incidence, prevalence, morbidity
and mortality
 Research
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Surveillance and vital statistics
Health systems and operations research
Research for innovation
Policy, social and public health research
TB KEY POPULATIONS
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Household contacts
Health care workers
Mine workers
Inmates and correctional services staff
Mobile, migrant and refugee populations
People living in informal settlements
Smokers, drug and alcohol abusers
People with diabetes and those who are
malnourished
SOCIAL, ECONOMIC AND
BEHAVIOURAL DRIVERS
 Improving living conditions
 Hard to reach areas, populations
– Access to services
– Rural including farming communities
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Alcohol and substance abuse
Poverty alleviation and food security
Education and job opportunities
Gender based violence
PREVENTION
 Early diagnosis and treatment
– Regular symptomatic screening of high risk groups
– Contact/ source investigation
– Outbreak investigations
 Airborne infection control
– Cough hygiene
– Adequate ventilation
– Risk assessments of high risk areas
 Preventive treatment
– Isoniazid
– ART
– Vaccines
HEALTH AND WELLNESS
 Rapid diagnostic tests
– GeneXpert, LPA
HIV testing
Age appropriate quality TB drugs (FDCs)
ART irrespective of CD4 count
Appropriate treatment of opportunistic
infections and diseases
 Treatment literacy to improve
compliance
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 Referral, community follow up and
support systems
– Including MDR-TB care
 Systems for delivery of chronic
medication
 Integrated service delivery
HUMAN RIGHTS AND ACCESS TO
JUSTICE
 Rights violation
– Systems for monitoring abuses
 Workplace discrimination
 Unfair discrimination in access to
services
CONCLUSION
For this plan to be a success it
requires a combination of
interventions to address TB and
HIV as well as a multi sectoral
approach
Thank you
“STOP TB …….. BECAUSE YOU CAN”