GEYODI BUDGET 2009 /10

GAUTENG PROVINCE RESPONSE

NTOMBIZODWA MNTAMBO

16 AUGUST 2015

80% of estimated incident cases in 22 high-

burden countries

lat

-40

-20

0

20

40

60

-150 -100 -50 0 50 100 150

log10(Inc)

0.5

1.0

1.5

2.0

2.5

3.0

2

HIV prevalence among TB cases, 2008

lat

-40

-20

0

20

40

60

-150 -100 -50 0 50 100 150

HIV in TB

(%)

[0,0.576]

(0.576,3.3]

(3.3,9.9]

(9.9,22.6]

(22.6,100]

NA

Global estimate: about 1.4 million TB/HIV cases and half a million TB/HIV deaths a year

3

Almost 50% of MDR-TB burden in China

and India

lat

-40

-20

0

20

40

60

-150 -100 -50 0 50 100 150

MDR-TB

cases

0

10

100

1000

10000

50000

4

Our Response

POLICY

5

STOP TB STRATEGY

STOP TB STRATEGY

(The initial)

VISIONA WORLD FREE OF TB

GOALDramatically reduce the global burden of TB by 2015 in line with the Millennium Development Goals (MDG) and the Stop TB Partnership targets© WHO 2006

6

STOP TB STRATEGY OBJECTIVES

•Achieve universal access to high-quality diagnosis

and patient-centred treatment

•Reduce the human suffering and socioeconomic

burden associated TB

•Protect poor and vulnerable populations from TB,

TB/HIV and multidrug-resistant TB

•Support development of new tools and enable their

timely and effective use © WHO 2006

7

STOP TB STRATEGY cont.

•MDG 6, Target 8: ...halted by 2015 and begun to

reverse the incidence...

•Targets: linked to the MDGs and endorsed by Stop TB

Partnership: By

– 2005: Detect at least 70% of new sputum smear-positive TB

cases and cure at least 85% of these cases

– 2015: Reduce prevalence of and deaths due to TB by 50%

relative to 1990

– 2050: Eliminate TB as a public health problem ( <1 case

per million population)

© WHO 2006 8

STOP TB STRATEGY COMPONENTS

Pursue high-quality dots expansion and enhancement:

a. Political commitment with increased and sustainedfinancing

b. Case detection through quality-assured bacteriology

c. Standardized treatment with supervision and patientsupport

d. An effective drug supply and management system

e. Monitoring and evaluation system, and impactmeasurement

© WHO 20069

Address TB/HIV, MDR-TB And Other

Challenges

• Implement collaborative TB/HIV activities

• Prevent and control multidrug-resistant TB

•Address prisoners, refugees and other high-riskgroups and special situations

© WHO 2006 10

Contribute to health system strengthening

• Actively participate in efforts to improve system-wide

policy, human resources, financing, management, service

delivery, and information systems

• Share innovations that strengthen systems, including

the Practical Approach to Lung Health (PAL)

• Adapt innovations from other fields

© WHO 200611

Engage all care providers

• Public-Public, and Public-Private Mix (PPM)

approaches

• International Standards for TB Care (ISTC)

© WHO 006

12

Empower people with TB, and

communities

• Advocacy, communication and social mobilization

• Community participation in TB care

•Patients’ Charter for Tuberculosis Care

©WHO 2006 13

Enable and promote research

• Programme -based operational research

• Research to develop new diagnostics, drugs and

vaccines

©WHO 2006

14

COMBATING HIV AND AIDS AND REDUCING TB � Improved access to Antiretroviral treatment (ART)

� Access to ART has slightly improved by xxxxxx.

� A tracking and tracing system for Defaulters and loss to follow has been developed by WBOT

� Number of ART facilities has increased from 364 in the 1st quarter to 380 in the 4th quarter.

15

Q1 Q2 Q3 Q4

Preliminary 2013/2014 468 301 560 382 588168 591 848

Target (2013/2014) 793 250 843 500 893 750 944 000

100 000

200 000

300 000

400 000

500 000

600 000

700 000

800 000

900 000

1 000 000

Num

ber

Total clients remaining on ART (TROA) at end of the month, Gauteng province

2013/2014 Financial year

15

COMBATING HIV AND AIDS AND REDUCING TB Good progress made in improving HIV/TB treatment collaboration

• There is a slight decline in the number of HIV/TB co-infected clients enrolled on ARV

treatment

– Instability amongst Community Health Workers affected performance 16

Q1 Q2 Q3 Q4

Actual 2012/2013 66.0% 66.4% 48.0% 54.8%

Target (2012/2013) 45.0% 45.0% 45.0% 45%

Preliminary 2013/2014 64.90% 52.4% 60.7% 58%

Target (2013/2014) 60.0% 60.0% 60.0% 60.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

%Percentage of HIV-TB co-infected patients placed on ART, Gauteng province

Comparison of 2012/13 & 2013/14

16

World Health Assembly (UN) - Paradigm

shift (The new)

• End TB strategy (20 year) 2016 – 2020

• Incidence of 10/100 000

• Theme “zero deaths, disease and suffering due to TB”

WHO 2014

17

90, 90, 90 Strategy

• 90% screening

• 90% diagnosis

• 90% treatment

• 90% success rate

18

90,90,90,Strategy cont.

• Find at least 90% of all TB people with TB in the population that require treatment and place them appropriate therapy (first line, second line as well as preventive therapy;

• As a part of the effort to reach 90% of all people with TB, make a special effort to reach 90% of the key population groups - the most vulnerable, underserved, at risk populations in countries; and

• Reach 90% treatment success through affordable treatment services, promoting adherence and social support.

19

Barriers to TB and HIV successes• Service provider related

• Client/ community related

• Environment related

• Programmatic issues:

– Decrease of Drug-susceptible TB case notification

– Increase of MDR-TB cases

– MDR-TB is a public health crisis globally

– Number of MDR-TB cases initiated on treatment

diagnosed increasing (Over 10,000 during the year 2013)

– community-based expansion including nurse-initiated

MDR-TB Dr Ndjeka : National Department of Health20

Intervention1. Technology• New GXP type – the MTB ultra

• Smart spot

• New algorithm

• New INH cartridge

• Confirmations of lab GXP results

• 2 smears vs 1 for provinces - ? Consistency

• Pediatric stool prototype

• Expansion of EMOCHA

• ??? Private sector 21

Intervention cont.2. Program Strengthening

• Implement all policies:– Susceptible TB

– Decentralized mx of TB

– pediatric TB management

– Infection Control Prevention/ prophylaxis

– M & E

– 90,90,90 Strategy

– ACSM

– Capacity building

3. Research

4. Policy implementation– Involvement of other stakeholders

22

THANK YOU

23