Health Minister’s speaker notes for SA satellite on 90-90-90 progress and recovery from Covid-19
SANAC CEO: Dr Thembi Xulu who is also the Programme Director
Chairperson of the SANAC Civil Society Forum: Ms Steve Letsike
National Director: National Association of People Living with HIV and AIDS (NAPWA): Mr M Zazini
Deputy, Private Sector Forum: Dr T Gopane
Representatives of Civil Society Organisations with us today
Colleagues from different Government Departments
Colleagues from the UN Family, PEPFAR and Global Fund and other Donor and implementing partners
Good Morning
It gives me great pleasure to be with you today at this 24th International AIDS Conference and particularly to showcase our progress as a country on the 90-90-90 targets, and plans as we transition to the new 95-95-95 targets. The past 2 years have been very difficult for the whole world as we all grappled to respond to the COVID-19 Pandemic.
However, through collective global commitment, we have proven that together work, we can achieve remarkable success even against the world’s most deadly infectious diseases. In our case as SA, I would say against all odds, as we struggled not only with the COVID-19 Pandemic and natural disasters to mention but a few.
Like in many parts of the world, COVID-19 further strained our health systems which in turn has worsened human rights-related barriers to accessing health services, deepened gender inequities, spiralled poverty, and led to increased rates of gender-based violence.
Indeed we suffered major setbacks, lost the loved ones and lived in fear, but we have also seen extraordinary resilience and innovations, as countries adapt to the new normal and leveraging the synergies between existing investments to fight HIV, TB and Malaria, and new interventions to combat COVID-19.
We have learned lessons out of COVID-19 and we should work hard to ensure that new pandemics do not undo/reverse the gains made against HIV/AIDS, TB and STIs.
In terms of the 90-90-90 targets, we are currently at 94-78-89. The country-wide interventions to accelerate progress towards targets are prioritised and monitored. These include, but are not limited to:
- The 10-Point Plan which focuses on 10 key interventions to be implemented in all health facilities
- Treatment and Retention Acceleration Plan
- Provincial and District Implementation Plans
- The Surge, which is a partnership with PEPFAR at high burden facilities,
- Operation Phuthuma which is an acceleration plan which addresses Quality Improvement, paired with a Nerve Centre Approach.
While COVID-19 has slowed progress toward the 90-90-90 targets, the trend does seem to be shifting and we are starting to see some improvement, which proves that our interventions have yielded results within the context of the COVID-19 pandemic. Results for each of the sub-populations vary (with adult females at 95-81-90, adult males at 92-72-90, and children under 15 years at 80-69-640).
Progress also vary by province, and these results show that we need to place special focus on the second and third 90s of the cascade as well as the children’s cascade.
We need to continue to ensure that clients are initiated and retained in care as there is a growing number of adults who have been previously diagnosed, but are not on ART. This includes those who had started ART and defaulted, and those who were never initiated. This process is referred to as “The Welcome Back Campaign”.
In order to support provinces and accelerate progress, the National Department has established an acceleration and project management room called Operation Phuthuma which monitors data daily and works with provinces to take action when targets are being missed. This includes working, in conjunction with
Department of Health at all levels, as well as external funders, to ensure that facility-level targets are set up and actioned.
Provinces have also strengthened their operation rooms to replicate this function at the provincial level.
To date five districts, have achieved the 90-90-90 targets and many more are gradually moving towards the same as we track the progress monthly.
The COVID-19 restrictions have negatively impacted programme performance and improvement in many districts, while in some provinces natural disasters such as floods exacerbated the challenges, but we soldiered on.
As the pandemic restrictions were gradually eased, we focused on case finding innovations that included HIV Self-screening and other self-care interventions delivered through communities integrated into COVID-19 response, we initiated community pharmacy distribution for self-care (as pharmacies remained essential and open), online distribution of screening test kits packaged with condoms and information material for PreP.
We strengthened 3 monthly multiple dispensing of ARVs to ensure that stable clients did not have to frequent facilities. We further expanded our external pick-up points for all chronic medication beyond the health care facilities and brought these services closer to communities.
Our detailed accelerated catch up plans include, but not limited to the following key interventions:
1. Accelerate HIV case finding through Index testing, HIV Self Screening, Targeted testing at key entry points, and consistent linkage to treatment for diagnosed patients
2. Increase and maintain patients on treatment by supporting the transition of stable patients onto TLD, enrolling clients into the CCMDD (Central Chronic Medicine Dispensing and Distribution) program and decanting patients to differentiated models of care.
3. Support pharmaceutical services to manage drug availability in a climate of global shortages. This would also assist with maintaining the multi-month dispensing of treatment to at least 3 months (a process referred to as MMD3).
4. Return defaulting patients to care by tracking and tracing any clients who do not attend scheduled appointments, or who are due for laboratory tests to support clinical management.
Let me conclude by mentioning that we are now currently transitioning to the 95-95-95 targets like the rest of the world, with the upcoming National Strategic Plan for HIV, TB and STIs: 2023-2028, the country will shift all targets towards 95-95-95 objectives as follows:
1st 95 - we are sitting at 93% - 7,436,628 against target of 7,576,953
2nd 95 - we are at 76% - 5,645,120 against target of 7,198,105
3rd 95 - we are at 90% - 3,716,736 against a target of 6,838,200
The HIV/AIDS and STI Cath-Up Plans have been developed for the current financial year (April 2022 – March 2023) and focused strategies have been developed and will continue to be central to the acceleration towards 95-95-95.
These strategies include:
- The Pediatric and Adolescent HIV Matrix of Interventions
- A Comprehensive Youth Prevention Campaign Strategy
- Differentiated Models of Care for eligible PLHIV
- Quality Improvement and Nerve Centre Approaches at all levels through Operation Phuthuma
- Continued focus on improving performance at the lowest level whilst defining strategies that create an enabling environment, is expected to get the country back on track towards 95-95-95
With regards to Tuberculosis, we have noted that the gains made in the recent past have been reversed. Using the 90-90-90 cascade on TB indicates that during the year 2020, only 72% of the estimated number of people living with this disease were diagnosed, and 88 % of them were initiated on treatment.
Of those diagnosed only 65 % were successfully treated, so we have not attained any 90 hence the justification for our TB Recovery Plan which uses a target-driven programmatic approach and also evidence- based.
Our goals are to find TB, to treat TB, to retain TB patients in care and to prevent the disease. We recently approved guidelines on treatment of latent TB that includes 3HP (3 months of weekly rifapentine and isoniazid oral treatment). We are committed to implement these guidelines.
The TB Recovery Plan is a transitional plan that will inform the 5th generation of National Strategic Plan for HIV, TB and STIs 2023 to 2028.
COVID-19 pandemic has contributed to 20% decline in TB case finding, although case finding started improving with introduction of TB catch-up plans that partially informed our TB Recovery Plan.
The effects of COVID-19 have been severe but the South African health system is steadily recovering. The country will continue to progress towards the 95-95-95 targets and epidemic control.
At this point, I would like to thank our donor funders PEPFAR and Global Fund for the continuous support through our Country Operational Plans and Memorandum of Understanding.
And last but not least, I would once again like to thank our health care workers for their contribution and commitment to the continuous expansion of primary health care in the country.
I THANK YOU
