North West Department of Health has been a leading province in the HIV Counselling and Testing (HCT) campaign, nationally. The national department has a national target of testing 15 million people by June 2011 and 998,859 of the target were to be tested in the North West Province alone. The department is proud to announce that it has already achieved a 99% (892 000) of its share of the target.
In 2009, the Honourable President Jacob Zuma announced a new approach in the fight against HIV and AIDS during his World AIDS Day speech, which is in line with the 2007/11 National HIV and AIDS Strategic Plan (NSP). The HIV Counselling and testing (HCT) campaign calls upon all South Africans to know their HIV status, in order to access treatment early and reduce new HIV infection by promoting healthy lifestyles in all clients who have tested and know their status. This is regarded as the largest campaign ever of its kind.
The announcement was influenced by HIV prevalence in Sub Sahara and South Africa itself, whereby 22.4 million (17%) of the population were affected by HIV in 2008. We are 0.7% of the population of the world and yet present 17% of the HIV and AIDS prevalence. In 2008 national HIV prevalence among pregnant women attending antenatal (ANC) was 29.3%. In North West Province the prevalence was 31%, with Dr Kenneth Kaunda District being the highest at 35%. We have, however, as the Province seen changes in HIV prevalence. According to 2009 figures the HIV prevalence in pregnant women is 30%.
The objectives of the current HIV campaign will further strengthen the health systems as other resources will be channelled to it. It is, however, important to note that the campaign did not come with a separate budget and provinces were expected to implement the campaign within available funds.
Condom distribution and use is an important strategy in the fight against HIV and AIDS. The North-West Department of Health has been distributing condoms through different mechanisms throughout the province. Apart from public health facilities, condoms are also made available to the public at entertainment social outlets within the communities. It is envisaged that condom distribution will double in all provinces to meet the Minister’s target of two billion condoms per year by the end of the HCT Campaign. The department is currently strengthening the marketing of Choice condoms as a quality brand, and working to improve consistent and correct condom usage.
The department has also registered a remarkable progress with the High Transmission Area (HTA) programme, aimed at truck drivers and commercial sex workers and other high risk groups. This project is part of the province’s response to the national strategy on HIV and AIDS, aimed at preventing the spread of STI, HIV and AIDS in areas that cannot be reached through standard awareness campaigns and day-to-day primary health care services. Currently there are two formal intervention sites in Zeerust and Vryburg and some informal intervention sites referred to as "hot spots". Plans are underway to open an additional five intervention sites.
In order to successfully implement the project, the numbers of peer educators deployed at intervention sites, Hot Spots as well as in communities, have been increased from fifty two (52) to eighty three (83).
HIV-related conditions and hypertension are still the leading causes of maternal deaths. The Prevention of Mother to Child Transmission (PMTCT) strategy is implemented by the department to address maternal, neonatal and under-five mortality. There has been a marked decrease in mother to child HIV transmission, from 15.5% in 2009/10 down to 5% in 2010/11. Strategies have been put in place to continuously improve the PMTCT Programme, and further reduce mother to child HIV transmission.
Despite the fact that the province is leading in the HCT campaign, the department is still confronted with infrastructural challenges, and a shortage of professionals with scarce skills such as doctors, pharmacists, dieticians, psychologists. The programme has shifted from being doctor-driven to nurse-driven, and professional nurses are trained to initiate eligible clients on ARV’s.
Infrastructural challenges in the HCT program will be addressed through the purchasing of park homes as temporary structures. The plan is to increase space with permanent physical structures through upgrading of hospitals, in the future.
The department will also continue to engage accredited service providers to train more care givers, increase the use of community counsellors, provide alternative space for counselling, and contract non-governmental organisations (NGOs) specialising in counselling to train counsellors.
To date, 51 health care facilities have been accredited to offer ARV’s, making an increase in ARV sites from 29 to 80.
The North-West Department of Health remains committed to empowering its HIV care and support programme. By the end of January 2011, there were 414 organisations rendering these services throughout the province, 325 of which offered comprehensive home-community based care services. Attached to these organisations are 5 330 caregivers. Step-down care (SDC) operates under the management and supervision of hospitals. HIV and AIDS management supports these facilities by facilitating training for professional nurses and caregivers, procurement of equipment and payment of stipends to caregivers, who form the majority of human resources in these facilities. By the end of June 2010, five (5) step-down facilities in Mafikeng, Gelukspan, Nic Bodenstein, Taung and Potchefstroom were operational.
Hundred and thirty (130) support groups exist throughout the province, focusing not only on persons living with HIV but also on other HIV issues, such as nutrition, chronic conditions and breastfeeding support. The main objective of the programme is to maximise the involvement of People Living with HIV through capacity-building using support group guidelines and advocacy toolkits for people living with HIV and AIDS.
In order to uphold human rights and fulfil its legislative mandate on health and rights, the department has forged a partnership with the local University of the North West AIDS Law Clinic and paralegal cluster. They assist the department in implementing human rights and access to justice programme in the province. Care givers and traditional health practitioners have been trained on human rights in relation to health care service delivery, especially in mitigating stigma and discrimination around HIV and AIDS.
Case finding of tuberculosis (TB) has increased, from 33 000 last year, to 34 000 this financial year through TB screening due to an increased number of patients diagnosed during HCT campaign, conducted in all districts.
For TB control a courier service is available in all facilities on a daily basis which improves collecting specimen and delivering the results.In addition, the National Health Laboratory Services (NHLS) have installed 60 SMS printers covering all remote areas. This minimises the turnaround time as patients can be put on treatment immediately, which in turn, will reduce the spread of infection within communities. Facilities have been trained on how to collect quality sputum specimens, with 75% of facilities receiving results within 48hours.
In our effort to improve turnaround time on TB diagnosis results, we have acquired the GeneXpert machine at Tshepong Hospital. GeneXpert machines can diagnose patients with tuberculosis within two hours. The GeneXpert tests for TB much faster and more accurate than microscopic tests that are used to diagnose the disease, which could take between three to five months to produce results.Now the department will be able to diagnose TB within two (2) hours and start patients on treatment immediately.
The TB turnaround strategy has enabled the province to improve the cure rate from 56.1% at the end of 2009/10, to 63.3% at the third quarter of 2010. Staff members have been trained on basic TB management and managers trained on supervision, reporting and recording. Five hundred and fifty (550) community health workers were trained on Directly Observed Treatment (DOT) short course in 2010 alone. The Department will continue to improve the TB cure rate as a priority.
As a result of these TB initiatives, the number of cases of TB patients that default from TB treatment has been reduced from 9% of cases, to 8%. This has been enhanced by improved training of facility heath worker, distribution of the new TB guidelines and the use of defaulter tracer teams that are functioning in districts with particularly high TB case loads, namely Bojanala and Dr Kenneth Kaunda.
All patients diagnosed and confirmed with Multi-Drug Resistant TB are admitted to Tshepong hospital, and the waiting period has decreased because of the new systems implemented by the National Health Laboratory Services (NHLS).Taung Hospital has been assessed for MDR treatment and is now initiating treatment for patients living in the Dr Ruth Segomotsi Mompati District.
The five year anniversary of partnership programme against TB was celebrated between Klerksdorp/Tshepong Complex, local GP's and Broadreach Healthcare. This programme has successfully sustained a project whereby patients who are stable on ARV's are down referred to local general practitioners in the Matlosana Sub-District.
The national Department of Health TB directorate has confirmed that the Klerksdorp/Tshepong Complex is the only hospital in the country which has successfully cured an XDR TB patient. The 2nd Phase of the MDR TB Unit at Tshepong Hospital is now complete and functional. The MDR/XDR TB Complex behind Tshepong Hospital boasts 20 XDR TB beds and 76 MDR TB beds.
Enquiries:
Tebogo Lekgethwane
Cell: 082 929 9958
E-mail: tlekgethwane@nwpg.gov.za
