The National Strategic Plan for HIV, TB and STIs

• The plan for the country’s response to HIV, TB and STIs

• Covers five year periods

• New NSP: 1 April 2017 to 31 March 2022.

• Set the scene for reaching the NDP goals in 2030

• Focus for impact

• Multi-sectoral and inter-sectoral

• Optimise Implementation at provincial level

• Game changers: old and new

Progress against the goals of current NSP

Goal Status1 Reducing new HIV infections by at

least 50% using combination

prevention approaches

Sexual Transmission (15-49 years) has declined but the target

has not been achieved

PMTCT (at 6 weeks) target reached. This is a major

achievement2 Initiating at least 80% of eligible

patients on ART, with 70% alive and

on treatment five years after

initiation

ART Initiation target has been reached. This is a major

achievement

Survival on treatment low

3 Reducing the number of new TB

infections, as well as the number of

TB deaths by 50%

Rate beginning to decline but target not reached.

Beginning to decline but target not reached

4 Ensuring an enabling and accessible

legal framework that protects and

promotes human rights in order to

support implementation of the NSP

Country has comprehensive legal framework in place

5 Reducing self-reported stigma and

discrimination related to HIV and TB

by 50%

Relatively low stigma level though unanticipated high

internalised stigma found in survey.

3

Number of PLHIV in SA receiving ARTbetween 2009 and 2014

616337

933621

1611430

2350180

2760620

3078570

0

500000

1000000

1500000

2000000

2500000

3000000

3500000

12009 2010 2011 2012 2013 2014

Mother to Child Transmission

Antenatal Prevalence Trends

Estimated annual new HIV infections among young women (15 -24 years) by Province, South Africa - 2015

[Source: Calculation based on Spectrum 2015 estimates]

1,730

5,939

7,489

8,264

8,780

12,137

15,494

17,302

25,565

102,700

2,478

8,694

10,584

11,760

12,180

17,220

231

24,360

36,120

146,496

Northern Cape

Free State

Western Cape

Limpopo

North West

Mpumalanga

Eastern Cape

Gauteng

KwaZulu-Natal

SOUTH AFRICA

New HIV Infections 15 -24 yrs, 2015

New Infections Females 15 -24

Infection PathwayAfrica Centre identified phylogenetically linked HIV transmission

networks in Hlabisa

High HIV incidence men mean age 27 years (range

23-35 years)

High HIV risk women Mean age 18 years (range 16-23 years)

High HIV prevalence women

Mean age 26 years

(range 24-29 years)

Very young women

acquire HIV from

men, on average,

8 years older

Men and women > 24

years usually acquire

HIV from similarly

aged partners

When teen women

reach mid-20s they

continue the cycle Source: Dellar R, Tanser F, Abdool Karim Q, et al.

Manuscript in preparation

8

3,997,530

3,400,781

1,758,204 1,457,551

6,670,360

6,003,324

5,402,992 5,402,992

4,862,692

-

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

PLHIV PLHIV who knowtheir status

Total On ART Viral loads done ViralogicallySuppressed

HIV Care and Treatment Cascade (March 2016 - National)

Actuals 90-90-90 Target (Test and Offer)

60% 85% 52% 83%

43%

% Progress against 90-90-90

Loss to Follow Up

TB Treatment Success

Performance

Indicator

Achieved

2012/13

Target

2013/14

Achieved

2013/14

Target

2014/15

Achieved

2014/15

TB new client

treatment

success rate

73.8% 85% 75.9% 82% 82.5%

TB defaulter rate

(new pulmonary

TB)

6.1% < 5% 6.2% 6% 5.7%

Evolution of the epidemic and the evolution of the response

• Evolution of the epidemic: – Importance of young women and girls– Need to identify hotspots with targeted responses– key populations identified for HIV and TB– 90/90/90 targeting for HIV and TB in District Implementation Plans

• Identify, acknowledge and build on the many successes to date, for example– Rollout of ART– Multi-stakeholder engagement and multi-government response– Specific strategies for key populations

• What does the baseline need to be in 2022 to be able to reach the 2030 National Development Plan goals and targets?– AIDS free generation– Concomitant decrease in TB incidence and mortality

• What are the game-changers to take us to this baseline?

HIV treatment (2)

2014: 59.6% of active patients on ART had a viral load done at 96

months, 81.0% were virally suppressed.

Source: NDoH, 2014

14

Male and Female Condom Distribution, 2010-2014

Performance

Indicator

2010

(Baseline)

2011 2012 2013 2014 2015 2016 NSP

Target

Number of

male condoms

distributed

492,000,000 230,011,096

(53% <

baseline)

251,419,268

(49% <

baseline)

352,065,256

(29% <

baseline)

506,431,299

(51% of

2016 NSP

target

723 799 877

(72% of 2016

NSP target)

1 billion

(51% ↑ from

baseline)

Number of

female

condoms

distributed

5,100,000 4,325,196

(16% <

baseline)

4,309,146

(16% <

baseline)

7,686,231

(51% >

baseline)

13,254,328

53% of 2016

NSP target

20 700 161

(83% of 2016

NSP target)

25,000,000

(400% ↑

from

baseline)

Key Questions

• What are the Key epidemiological findings for HIV and TB?

• What are the current successes that need to be scaled up?

• What are the current policy directives that need different implementation for improved reach?

• What are the game-changers to set the scene for the NDP in 2030?