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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.
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
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
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)