Programme Director and Director General of the National Department of Health, Me Precious Matsoso
Ms Virginia Palmer, Deputy Chief of Mission, United States Embassy, representing the US Ambassador, His Excellency Mr Patrick Gaspard
Mr Fritz Lherisson, UNAIDS Country Director
Mr Herve Ludovic-de Lys, UNICEF country representative
Dr Gottfried Hirnschall, Director HIV, WHO/HQ, Geneva
Dr Francis Kasolo, Director, Disease Prevention and Control Cluster, WHO/AFRO, Brazzaville
Development and implementing partners Members of the media
Ladies and Gentlemen
Good morning
I would like to thank the World Health Organisation (WHO) for its leadership in conducting the 5 yearly review of South Africa’s HIV/AIDS, TB and Prevention of Mother to Child Transmission (PMTCT) programmes undertaken in October last year. We welcome the finalisation of the review report, whose hand-over is the primary goal of our coming together today.
We note that this handover is taking place a few weeks before South Africans, will once again, exercise their right to elect a government of their choice, continuing with the tradition started 20 years ago on the advent of the first democratic elections, led by our founding father, Nelson Mandela, himself, a former victim of Tuberculosis, and an advocate for HIV/AIDS.
The principles of our democracy are enshrined in our Constitution, which among other things enjoins the government to provide good quality health care to all citizens, thereby ensuring that citizens live long and healthy lives, even in the face of epidemics such as those caused by TB and HIV/AIDS.
Providing HIV/AIDS, TB and PMTCT services is guided by policies and strategic plans that we develop from time to time, including the current National Strategic Plan for HIV/AIDS, TB and STIs launched by the President of the Republic in December 2011. What is unique about this strategic plan is that, for the first time, it addresses both HIV/AIDS and TB together.
I am informed that this is the first ever integrated review of these three programmes. Historically, like other countries we did separate reviews of the TB, HIV and PMTCT reviews. However, because our policy is to implement these programmes seamlessly – in an integrated fashion at health facility and community levels - we decided in 2013 to conduct an integrated review. We have high TB/HIV co-infection levels which makes integrated programming the only efficient and effective way of dealing decisively with these two diseases.
We believe that this is the right approach to take as it reflects our recognition of the symbiotic and linked relationship of these epidemics. I often describe TB and HIV/AIDS as sides of the same coin, primarily to emphasise the need for joint planning and implementation in addressing the epidemics. It therefore makes sense that performance assessments of the programmes is done jointly as this review has demonstrated.
The recommendations come at an opportune moment as a “half-time” reflection or mid-term assessment of our performance since the current National Strategic Plan (NSP) came into effect in 2012.
This review is also timeous as it coincides with two other events held recently. As you know last week we held a successful regional ministerial meeting on TB in the mines at which 4 ministers signed a framework agreement on harmonised treatment of TB in miners and other 4 ministers signed an intent to sign after in-country consultations. The meeting has added impetus to our efforts by charting a clear course in ensuring harmonised approaches to treatment and referrals in the region. In addition, a surveillance system that will enable us to trace all infected miners, irrespective of their physical location within the region will be installed. This is an important milestone as the prevalence of TB in the mines is second only to TB in correctional facilities. Secondly, two days ago, the Human Sciences Research Council (HSRC) launched the results of the 2012 Household survey which provided data on prevalence, incidence and behavioural aspects of HIV. The issue of TB in mines, the key conclusions of the HSRC survey as well as the recommendations made in the programme review which is being formally handed over to me today will all be used to strengthen our health programmes.
Let me turn now to reflections on the review itself as well as the recommendations made by the team.
Programme Director, let me speak briefly to a few of the suggested interventions that we have identified in response to some of the review recommendations. A detailed document that contains the Department’s responses to the recommendations will be made available today – I am informed that this document was produced with input from many of our partners who coincidently will also be assisting us to implement them.
Whilst we are testing a large number of people for HIV and screening them for TB we must ensure that those needing treatment are linked to treatment and care. Secondly, whilst South Africa has the largest ART programme in the world we must also ensure that patients initiated on antiretrovirals (ARVs) remain on treatment and that they are virally suppressed.
We therefore welcome the “cascade approach” suggested by the review to ensure that we have a full understanding of the extent of populations at risk to be targeted and to ensure effective interventions through the various stages of care, including screening, counselling, diagnosis, treatment, retention and outcomes.
In our view, the entire South African population is our broad target. All persons who present in our facilities, irrespective of how many times they do so, should be provided with screening and counselling services so that they may be tested for TB and HIV. Those who get confirmed to have contracted any of the diseases, should be immediately initiated on treatment, and retained for the full period that is required. In this regard, we will pay particular attention to pregnant mothers and children, whom, as you know, are most vulnerable.
The national HIV Counselling and Testing Campaign (HCT) which we launched in 2010 has provided an excellent platform for early testing for HIV and screening for TB, and through it, we have managed to reach millions of South Africans. The Deputy President re-launched the campaign on World AIDS Day on 1 December 2013 in an effort to encourage all South Africans to test at least once a year, as envisioned in the National Strategic Plan, to ensure those that are HIV infected and those that screen positive for TB are linked to care and provided with treatment. Equally we will intensify our prevention programmes including condom distribution and medical male circumcision to ensure the HIV negative people remain uninfected and improved airborne infection control and cough hygiene amongst others to reduce TB transmission.
As indicated, we need to give more attention to pregnant mothers and children as among “key populations” at risk of infection. We have already seen some successes, especially with the transmission of HIV from mothers to children, which now is well below 3% but needs to get as close to 1% as possible by 2016.
We know that women aged 20-39 are at high risk for HIV acquisition – these are also the women in the reproductive age. A combination of access to contraception and family planning, early access to HCT and screening for TB and un-interrupted treatment are the keys to success in this cohort. Hence the focus on the provision of an integrated package of services. This must be our game plan.
In addition, the introduction of a fixed dose combination antiretroviral drug, now accessible to all HIV positive pregnant women, regardless of CD4 count, will move us significantly closer to eliminating HIV transmission from mother to child. Furthermore, February being reproductive health month, saw the launch of national family planning campaign, with a focus on dual protection (i.e. condom plus another contraceptive method), as protection against both unwanted and unintended pregnancies and as well as HIV and STIs. In an effort to expand the choice provided to women, the sub-dermal contraceptive implant has been introduced for the first time in public sector facilities. The aim is to try and more effectively address the first prong of PMTCT, namely prevention, by not only providing women with a wider choice of contraceptive methods, but to also improve access to,and ultimately uptake of contraceptives, among women of childbearing age, especially the youth.
With the Genexpert technology now widely available in South Africa, we are now able to diagnose TB among children much better than was the case previously. In addition, it allows us to diagnose Rif resistant TB rapidly as well – this means that we can initiate patients on TB treatment earlier and thus decrease infection rates.
As you know, we are undertaking a major health systems reform that will ultimately improve the quality of health care and expand access to services. The National Health Insurance (NHI) is central to our reform efforts. Once fully implemented, South Africans will be able to access health care, irrespective of the socio-economic circumstances they may find themselves in. Integral to our reforms is the return to a more preventive approach to health care, based on the Primary Health Care (PHC) approach. The current re-engineering of PHC will strengthen our capacity at community and household levels. The combined effect of the NHI and re-engineering of PHC solidifies what to date has been a soft-belly in the provision of HIV/AIDS and TB services: proactive engagement with citizens at service points close to them in their households and communities, to protect them against disease infection, and also ensure proper management in instances where they fall victims to these diseases.
In conclusion, I wish to welcome the findings and recommendations of the review and reiterate our commitment and determination to ensure that the recommendations are implemented to the extent that our resources enable us to do so. I also want to thank the technical and development partners for their continued support to strengthening our health programmes and welcome the pledges made today to continue working with government as we respond to the recommendations of the review.
I thank you.
