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ANTIRETROVIRAL TREATMENT IN RESOURCE-LIMITED SETTINGS: PROGRESS & CHALLENGES IN SOUTH AFRICA

ANTIRETROVIRAL TREATMENT IN RESOURCE-LIMITED SETTINGS: PROGRESS & CHALLENGES IN SOUTH AFRICA. YOGAN PILLAY DEPARTMENT OF HEALTH, SOUTH AFRICA IAS, 2014. CONTEXT OF HIV IN SOUTH AFRICA. Population - 52 million 6.4 million people living with HIV Prevalence amongst pregnant women: 29%

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ANTIRETROVIRAL TREATMENT IN RESOURCE-LIMITED SETTINGS: PROGRESS & CHALLENGES IN SOUTH AFRICA

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  1. ANTIRETROVIRAL TREATMENT IN RESOURCE-LIMITED SETTINGS: PROGRESS & CHALLENGES IN SOUTH AFRICA YOGAN PILLAY DEPARTMENT OF HEALTH, SOUTH AFRICA IAS, 2014

  2. CONTEXT OF HIV IN SOUTH AFRICA • Population - 52 million • 6.4 million people living with HIV • Prevalence amongst pregnant women: 29% • Prevalence in the general population: 12.2% • Incidence: 1.07% (0.71% in males; 1.46% in females) • Current eligibility: • CD 4<350 • PMTCT: B • Under 5 eligible regardless of CD4 and staging • TB/HIV co-infected regardless of CD4

  3. HSRC, 2014

  4. HSRC 2014

  5. HSRC 2014

  6. PROGRESS • 20 million tested in 20 months (campaign); currently 8 million tested annually • Treatment at PHC level (NIMART) and integrated with TB • Large numbers on treatment (initiation at CD 4>200) • >90% of pregnant women tested and >80% on treatment • Fixed dose combination since April 2013 (1.2m on FDCs); drug cost declines • Courier service for stable patients piloted

  7. Progress contd • Significant domestic investment in the treatment programme • MTCT: <2.6% at 6 weeks • First ever independent integrated TB, HIV and PMTCT programme review conducted in Sept/Oct 2013 • Investment case done since 2008/09; currently TB/HIV investment case being completed (used to convince Treasury to fund the programme)

  8. Challenges • Need to double patients on treatment by end 2016 (4.3 million) • Overworked health facilities • Need new models of service delivery • Testing rate (especially children and men) needs to increase and linkage to treatment and care to be strengthened • % of adolescents and young people on treatment needs to increase

  9. Challenge: retention in care (HERO, 2014)

  10. Next steps • Consider full implementation of WHO 2013 guidelines • Consider Prep for Sex workers • Implement recommendations from the TB, HIV and PMTCT review • Review service delivery platform for testing, initiation and retention in care • Expand other prevention initiatives to reduce new infections by 50%

  11. I THANK YOU FOR YOUR ATTENTION

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