Progress made in diseases plan
Life expectancy up, HIV and TB infection down nationally, write Yogan Pillay and Nono Simelela
ON March 31, Deputy President Cyril Ramaphosa launched the National Strategic Plan (NSP) for HIV, tuberculosis and sexually transmitted infections 2017-2022.
The NSP is the product of a yearlong thorough consultative process led by the SA National Aids Council (Sanac) in which all sectors of society are represented. Lessons from our collective experiences in implementing the NSP 2012-2016 and the latest scientific evidence were used to craft it.
The review of achievements over the past few years suggests that significant progress in the country’s responses to the HIV and TB epidemics has been made. With the introduction of anti-retroviral treatment, life expectancy has increased from 58.3 years in 2011 to 62.8 years, mother-to-child transmission rates have declined from 3.6% in 2011 to 1.5% in 2016. The annual number of new HIV infections has declined from an estimated 360 000 in 2012 to 270 000 in 2016.
This data shows that investing resources in combating these diseases is paying dividends – people are living longer even when HIV positive. As the prevalence of HIV in particular is greatest in people in their most productive years, ensuring that they live longer creates the conditions for a more productive society.
During the past five years a number of government departments have strengthened their programmes – examples include screening and testing of all inmates for TB and HIV by Correctional Services; screening and testing students for HIV and TB in universities and training and vocational education institutions. The Higher Education and Training HIV/Aids Programme is reaching more young people across the country; and the government launched a plan with the sexworker community to provide services to those who experience high levels of HIV infection.
Notwithstanding these achievements, a large number of challenges persist. These include: the high number of new HIV infections among adolescent girls and young women; high levels of HIV among sexworkers, men who have sex with men, migrant workers; significantly high levels of TB infection, including among specific groups such as mineworkers, people living in informal settlements and health workers; and high levels of HIV/TB co-infection – which means that we cannot deal with HIV without a similar level of effort dedicated to TB prevention and control.
The NSP 2017-2022 adopts a data-driven, evidence-based approach with emphasis on a geographic focus as well as on specific key and vulnerable sections of the popu- lation. The geographic focus means that interventions will be intensified in 27 districts which have the highest burden of HIV as well as 20 high-burden districts for TB.
Prioritising the districts with the highest burden of HIV, TB and STIs, will enable us to maximise impact and efficiency. This approach does not exclude the districts with a lower burden of disease though the level of intensity of activities will be lower. A comprehensive package of services for HIV,TB and STIs will continue to be provided to those in need across the country.
In addition, customised, combination prevention interventions for key populations and vulnerable groups will be designed with representatives of these populations and implemented in partnership between government and civil society organisations.
By focusing on the districts with the highest burden of disease as well as key and vulnerable populations, we hope to achieve epidemic control sooner than if we focus with equal intensity in all areas and on every individual regardless of the burden of disease.
The new NSP is comprehensive, with eight goals: preventing new HIV, TB and STI infections; providing treatment, care and support to all infected; focusing on those most vulnerable to these diseases with customised and targeted services; addressing the social and structural drivers of these epidemics; ensuring that our interventions are guided by human rights principles and approaches; promoting leadership and shared accountability; ensuring that we have the necessary resources to achieve our goals and targets; and using information to monitor progress and supporting research that will accelerate progress towards our goals.
The plan sets ambitious targets to be reached by 2022. We must reduce the number of new HIV infections to less than 100 000 per year, including reducing the number of new HIV infections in adolescent girls and young women from 2 000 per week to less than 800. We must reduce the number of people with new TB infections from 834 per 100 000 population to less than 584/100 000. We must reach the 90-90-90 targets for HIV and TB by 2020 and work towards the 95-95-95 targets. This means that people with HIV and TB must know their status (that is, get tested), be on treatment, and be virally suppressed (HIV) and successfully treated for TB.
The NSP recognises that there are a number of key enablers, or necessary ingredients for its successful implementation. These include: the importance of partnerships between government and civil society, especially people living with HIV as well as TB; the importance of strengthening community systems as well as service delivery systems (health, education and social services for example); the importance of increasing the efficiency of interventions as well as sustainability of interventions.
This NSP is a plan for the entire country. Every South African must take responsibility, personally and collectively, to ensure that this plan is fully implemented. The gains we have made in the past five years will be eroded and these epidemics are likely to rebound if we take our collect feet off the proverbial pedal.
As emphasised by the deputy president during the launch of the NSP, key to the implementation of the plan is to ensure that every leader in South African society plays her/his role to ensure its implementation. This means ensuring that every leader prioritises the implementation of the key strategies in the plan in their everyday work, whether it is allocating resources, increasing awareness of these diseases through their speeches and holding people to account for the achievement of the targets.
Local political leaders (mayors, mayoral committees, and councillors) as well as traditional leaders, business leaders and leaders of worker organisations must prioritise interventions listed in the plan and ensure that they are fully accountable.
The next step must focus on the rapid implementation of the NSP based on provincial and district implementation plans for which provincial and district Aids councils will be responsible with support from the SA National Council.
We propose that in the implementation of the plan we prioritise the following: developing and implementing a national testing and screening campaign with linkage to HIV, TB and STI treatment and care; finding the missing 150 000 people with TB and starting them on treatment; and fast tracking the She Conquers Campaign especially in the 22 high burden sub-districts in the country.
We have the tools we need, the strategic approach is sound, we have a common vision. It is in our hands to end these epidemics as public health threats and to achieve our objective of a generation of under 20s free from HIV by 2030. Dr Yogan Pillay is deputy director-general: HIV/AIDS, TB and maternal, child and women’s health in the national Department of Health, Dr Nono Simelela is special adviser to the deputy president. They write in their personal capacities.