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PROGRESS ON KEY INDICATORS 2012-2014

PROGRESS ON KEY INDICATORS 2012-2014

LIMPOPO PROVINCIAL STRATEGIC PLAN FOR HIV, TB AND STIS

(2012 – 2016)

PROGRESS ON KEY INDICATORS MARCH 2015

Page 1 of 19

Introduction

The Limpopo Provincial AIDS Council (LPAC) which is tasked to coordinate all HIV

and TB interventions in the Province took the guidance from South African National

AIDS Council (SANAC) to develop a Provincial HIV, STIs and TB Provincial Strategic

Plan aligned to the NSP. The plan is meant to direct the provincial HIV and TB

response, assist in fulfilling the mandate of the LPAC in reporting to SANAC as well

as assist in costing the response. The LPAC developed this Provincial Strategic Plan

(PSP) in consultation with all relevant stakeholders and this plan has been endorsed

after all the necessary crucial steps. The vision of the plan as well as the strategic

objectives has all been adopted from the global and national vision 2030.

The development of the PSP was heavily influenced and imbedded within the

broader national and international development instruments like the South African

National AIDS Council (SANAC) emphasis on a multi-sectoral approach, the Joint

United Nations Programme on AIDS (UNAIDS) which advocates for Zero new

infections, Zero deaths associated with HIV and TB and Zero Stigma Discrimination

and the United Nations General Assembly Special Session on HIV and AIDS has

responded to HIV and AIDS by involving all stakeholders. The developmental

approach recognised that HIV, TB and STIs is not just a health problem but a cross-

cutting challenge for all sectors including the socio-structural, economic and politico-

legal determinants of health as causes of the causes of disease vulnerability.

From the outset the PSP acknowledges the health challenges that the country and

the province is faced with. It also acknowledges the various efforts by the South

African Government (SAG) at national and provincial level to address those

challenges. Some of the challenges include the quadruple burden of diseases

(Communicable, Non-Communicable, Violence and Injury and HIV/AIDS and TB).

Some of the efforts to address these challenges include the HIV counselling and

Testing (HCT) Campaign launched by government in 2010, the introduction of the

Nurse Initiated Management of ART (NIMART), the National Service Delivery

Agreement (NSDA) and the changes in the eligibility criteria for ART initiation (CD4

below 350), among others. Such an acknowledgment sets the tone and direction

towards which efforts should be directed in order to arrest the epidemic.


Page 2 of 19

The purpose of the strategic plan is:

To guide the development of an implementation plan for the response in the

Province with clear timeframes and indicators to measure progress

To provide strategic direction in identifying practical interventions and the

roles of the stakeholders that forms part of the multi-sectoral response

To guide costing and budgeting for HIV and AIDS, STI and TB interventions to

ensure availability of resources and efforts for resource mobilization

To mainstream HIV and AIDS, STI s and TB services in all sectors in the

Province.

To strengthen multi-sectoral collaboration with greater emphasis on

implementation.

To solicit support and commitment of all stakeholders involved in HIV and

AIDS programmes.

The following is an outline of the strategic priorities for Limpopo as identified during

the consultative process culminating in the PSP:

Strategic Objective 1: Address Social and Structural drivers of HIV and TB

Prevention, Care and Impact

Strategic Objective 3: Sustain Health and Wellness

Strategic Objective 2: Prevention of new HIV and TB Infections

Strategic Objective 4: Protection of Human Rights and Promotion of Access to

Justice

Under each of these strategic objectives are sub-objectives that focus on specific

areas of interest and prioritised in the PSP development process based on the

epidemiological profiling of the province. Additionally, each strategic objective has a

summary of indicators against which the province is obliged to report routinely. Such

an arrangement makes the collection, collation, analysis, reporting and usage of data

much easier. It also makes it easy to track progress on specific soft issues that do

not easily lend themselves to quantitative deductions and conclusion.


Page 3 of 19

IMPACT INDICATORS IN LIMPOMPO Province

NSP Goals Indicator

Reducing new infections by at least 50% using combination prevention approaches

MTCT rate (six weeks and 18 months) 2.6% (6 weeks)1 3.4% (18 months)2

HIV prevalence among women and men aged 15-24

9.2% (2012)3

HIV Antenatal Prevalence among women aged 15-49

22.3% (2012)4

HIV Incidence 1.3%5

Total number of New HIV Infections 35 0006

Initiating at least 80% of eligible patients on ART with 70% alive and on treatment 5 years after initiation

Total number of patients initiated on treatment

49 276 (2012/13) + 47 612 (2013/14) =96,8887

Patients alive and on treatment 2012/13= 197 7198 2013/14= 175 275

HIV mortality 5.1% (2013)9

Reducing the number of new infections and deaths from TB by 50%

TB Incidence 2012/13= 137/100,00010 2013/14= 140/100,000

TB mortality 8.8% (2013)11

1 DHIS, program progress report and District Health Barometer 2012/2013. 2 Ibid

3 Shisana O, Rehle T, Simbayi LC, et al. South African National HIV Prevalence, Incidence and Behaviour

Survey, 2012. Cape Town: HSRC Press; 2014.

4 The 2012 National Antenatal Sentinel HIV and Herpes Simplex type-2 prevalence Survey, South

Africa, National Department of Health: Pretoria

5 Spectrum, 203 6 Ibid

7 Limpopo Provincial AIDS Council Annual Report. 2012/2013 – 2013/2014.

8 Ibid

9 Statistics South Africa. Mid-year population estimates 2013. Pretoria: Statistics South Africa; 2013a

10 Limpopo Provincial AIDS Council Annual Report. 2012/2013 – 2013/2014.

11 Statistics South Africa. Mid-year population estimates 2013. Pretoria: Statistics South Africa; 2013a


Page 4 of 19

Goal 1: Reducing new infections by at least 50% using combination

prevention approaches

National HIV prevalence is estimated at 12.2% (95% CI: 11.4-13.1) in 2102. In 2008

prevalence was estimated at 10.6% indicating an increase of 1.6%. Limpopo

recorded HIV prevalence estimate (9.4%) of below the national estimate of 12.2%12.

The province is the third with a low HIV prevalence after Northern Cape and Western

Cape. The graph below presents the trends of HIV prevalence in Limpopo from 2002

to 2012.

Figure 1: HIV prevalence in Limpopo (2 years and older) 2002, 2005, 2008 and 2012

Source: Shisane et al., 2014

Figure 1 above shows that the HIV prevalence for people 2 years and older in

Limpopo decreased from 2002 to 2005 before it started to increase in 2008 and

2012. An increase in prevalence can either be caused by increased number of newly

positives or an improved retention in care meaning that most people are living longer

with the virus. Another explanation to the increase in prevalence from 2008 onwards

could be a result of increased efforts by government and Non-Governmental

Organisations of educating people about HIV resulting in most people testing and

receiving their HIV results. The province needs to identify the causes of an increase

in prevalence and develop programmes to halt it in the case of increased number of

newly positives.

12 Shisana, O, Rehle, T, Simbayi LC, et al. South African National HIV Prevalence, Incidence and Behaviour



Page 5 of 19

Percentage distribution of HIV prevalence by district in the Limpopo Province

The district level variations in the HIV prevalence over the past three years are

depicted in Table 1 and Figure 2 below. Most of the districts in Limpopo recorded an

HIV prevalence rate above 20% as well as above the provincial average of 22.3%

except for Vhembe district13. For all the districts, prevalence rates have been

fluctuating from year to year without a consistent pattern.

Table 1: HIV prevalence among antenatal women by district, Limpopo, 2010 to 201214

2010 2011 2012

Provincial 21.9% 22.1% 22.3%

Capricon 23.7% 25.3% 22.4%

Mopani 24.9% 25.2% 25.0%

Sekhukhune 20.2% 18.9% 23.0%

Vhembe 17.0% 14.6% 17.7%

Waterberg 26.1% 30.3% 27.3%

Figure 2: HIV prevalence among antenatal women by district, Limpopo, 2010 to 201215

Source: South African National HIV Survey, 2012

13 Department of Health. 2012. The 2011 National Antenatal Sentinel HIV and Syphilis Prevalence

Survey in South Africa. Pretoria.



15 Ibid


Page 6 of 19

The 2012 HIV prevalence among 15 - 24 year old pregnant women decreased over

from 14.2% in 2010 to 13.6% in 2011 and 12.3% in 2012. The 30-39 age group

recorded the highest HIV prevalence throughout the period under review (Table 2).

Data in the table below also shows that HIV prevalence for the 45-49 age group

dropped in 2011 from 25.0% to 15.8% before taking a spike in 2011 to 42.9%16.

Table 2: HIV prevalence among antenatal women by age group, Limpopo, 2010 to 2012.

Age Group (Years) 2010 2011 2012

<15 7.7 7.1 8.3

15-19 7.1 7.4 7.3

15-24 14.2 13.6 12.3

20-24 19.1 17.5 15.6

25-29 28.7 27.4 29.9

30-34 31.9 33.5 34.0

35-39 29.4 33.7 30.8

40-44 24.0 22.9 26.1

45-49 25.0 15.8 42.9

>49 100 ** **

Source: South African National HIV Survey, 2012

HIV Incidence

The 2012 HSRC survey estimates at national level that over the period mid-2011 to

mid-2012 there were approximately 469 000 new infections (95% CI: 381 000–557

000) in the population aged 2 years and older. This translates to 1.1% estimated

incidence for that period. A number of earlier models have produced estimates of

HIV incidence by province, and these estimates are summarised in Table 3 below.

Differences in HIV incidence trends by province are important in identifying variations

in changes in the epidemic, including potential influence of HIV prevention

programmes. The earlier Spectrum and ASSA 2008 estimates of adult HIV incidence

for Limpopo both suggested that incidence was among the lowest compared with

other provinces. The 2013 spectrum estimates is at 1.3% reflecting 35 000 new

infections.




Page 7 of 19

Table 3: Estimates of HIV Incidence by Province17

Province Spectrum

15-49

2010-11

ASSA2008

15-49 male

2007-08

ASSA2008

15-49 female

2007-08

SAPMTCTE

6-week peri-natally acquired 2011-12i

Eastern Cape 1.30% 1.20% 2.20% 1.3% (0.7-1.8)

Free State 1.65% 1.23% 1.89% 1.2% (0.7-1.7)

Gauteng 1.30% 0.97% 1.39% 0.8% (0.3-1.2)

KwaZulu-Natal 2.22% 1.60% 2.47% 0.9% (0.4-1.5)

Limpopo 1.00% 0.62% 1.59% 0.8% (0.3-1.2)

Mpumalanga 2.15% 1.23% 2.45% 1.2% (0.8-1.7)

Northern Cape 0.69% 0.59% 1.19% 1.0% (0.4-1.6)

North West 1.58% 1.21% 1.90% 0.8% (0.4-1.2)

Western Cape 0.34% 0.41% 0.77% 0.4% (0.1-0.6)

Total 1.43% 1.11% 1.81% 0.9% (0.7-1.1)

HIV incidence in children

Mother to child HIV transmission is characterised by transmission occurring at or

before the time of birth or after birth through breastfeeding. Reports have shown best

performance and significant strides for PMTCT programme for the two years under

review as more babies were born free from HIV infection. Dramatic decline was

shown in the prevention of Mother to child transmission between 2012 /13 and

2013/14 where the response towards HIV born free infants at 6-8weeks was found

to be 3 .0 and 2.3% respectively. This is attributable to the introduction of Dual

Therapy when AZT was commenced from 28 weeks of gestation and single-dose

Nevirapine was given in labour whilst HAART was being provided for women with

CD4 counts of less than 200.

17 South African National AIDS Council. Progress Report on the National Strategic Plan for HIV, TB

AND STIs (2012 – 2016). Pretoria: South African National AIDS Council; November 2014.


Page 8 of 19

Goal 2: Initiating at least 80% of eligible patients on antiretroviral

treatment (ART), with 70% alive and on treatment five years after

initiation

This indicator is concerned about coverage, effectiveness and impact of the ART

programme. Flowing from the country’s national strategic plan for HIV, STIs and TB

2012-2016, the Department’s strategic objectives were to scale up combination

prevention interventions to reduce the rate of new infections, and to improve the

quality of life of people living with HIV, by providing a comprehensive package of

care, treatment and support services to at least 80% of people living with HIV and

AIDS.

According to the LPAC/DOH province annual report for 2012/13, the total number of

patients initiated on ART was 49,276 against a target of 46,000. This represents

107% achievement for that year. In terms of the number of people on ART, the

province reached 197,719 against a target of 188,410 adults and children for the

same year. This represents 105% achievement on that indicator for the same year.


Page 9 of 19

Goal 3: Reducing the number of new TB infections and deaths from

TB by 50%

The table below indicates that Limpopo’s TB cure rate is estimated to be 75.3%, an

achievement slightly above the national average of 74.2%. Those who died as a

result of TB were at 8.5% which puts Limpopo at second highest position across the

country. Expanded programmes of monitoring TB patients and initiating them early

on treatment to improve patient outcomes are required in Limpopo. The lost to

follow-up rate is the lowest across the country which buttresses the point on ensuring

early diagnosis, timely initiation on treatment, adherence to treatment and course

completion.

Table 4: TB cases per province indicating proportion of cases in children <15 years in 201218

18 Department of Health. The 2012 Annual Tuberculosis Report for South Africa (Unpublished). Research, Information,

Monitoring, Evaluation & Surveillance, National TB Control and Management Cluster, Pretoria, South Africa.

Table # :Treatment Outcomes: 2011 - New Smear Positive TB cases (Source: ETR.Net 2013)

Prov. SS +

Cases

Cured Success Failed Died Lost to follow

up

Transferred Not

Evaluated

No. % No. % No. % No. % No. % No. % No. %

EC 21,541 14,575 67.7% 16,818 78.1% 344 1.6% 1,459 6.8% 1,651 7.7% 1,195 5.5% 74 0.3%

FS 8,966 6,491 72.4% 6,964 77.7% 215 2.4% 884 9.9% 424 4.7% 441 4.9% 38 0.4%

GP 22,495 18,233 81.1% 18,421 81.9% 343 1.5% 1,241 5.5% 1,149 5.1% 975 4.3% 366 1.6%

KZN 34,078 25,249 74.1% 27,274 80.0% 649 1.9% 1,810 5.3% 1,970 5.8% 1,645 4.8% 730 2.1%

LP 8,648 6,513 75.3% 6,697 77.4% 175 2.0% 739 8.5% 406 4.7% 592 6.8% 39 0.5%

MP 9,453 6,608 69.9% 7,511 79.5% 185 2.0% 637 6.7% 555 5.9% 554 5.9% 11 0.1%

NW 9,668 6,662 68.9% 7,329 75.8% 159 1.6% 780 8.1% 742 7.7% 560 5.8% 98 1.0%

NC 3,610 2,469 68.4% 2,803 77.6% 96 2.7% 247 6.8% 262 7.3% 125 3.5% 77 2.1%

WC 14,790 12,038 81.4% 12,518 84.6% 265 1.8% 449 3.0% 1,015 6.9% 424 2.9% 119 0.8%

SA 133,249 98,838 74.2% 106,335 79.8% 2,431 1.8% 8,246 6.2% 8,174 6.1% 6,511 4.9% 1,552 1.2%


Page 10 of 19

Goal 4: Ensuring an enabling and accessible legal framework that

protects and promotes human rights in order to support

implementation of the NSP.

Chapter 2 of the South African Constitution makes provision for the protection and

promotion of human rights and obliges the state to ensure the realisation of such

rights particularly for specific vulnerable groups. These rights include amongst

others, the rights to equality, dignity, life, freedom, privacy and security of the person,

irrespective of sexual orientation. In line with this provision, the Limpopo province

emphasised the need for programming that is sensitive and targeted at such groups

of people as truck drivers, farm workers, and commercial sex workers, among

others.

Goal 5: Reducing self-reported stigma related to HIV and TB by at

least 50%.

The stigma index is the indicator for measuring this goal; the index is currently not

measured in the DHIS. SANAC is driving efforts to implement the stigma index to

monitor efforts to reduce stigma and discrimination and meet this fifth goal of the

NSP. Local government departments continue to deliver stigma and discriminating

reduction programmes in line with the NSP goals and objectives.


Page 11 of 19

Strategic objective 1: Addressing social and structural drivers of HIV, STI and

TB prevention, care and impact

Social and structural approaches address the social, economic, political, cultural and

environmental factors that lead to increased vulnerability. As pointed out in the NSP,

every government department — at national, provincial and municipal levels — has a

critical role to play in addressing the structural factors driving HIV and TB. With a

cumulative total of 22 independent development plans (IDPs) developed by different

sectors mainstreaming HIV, TB and STIs, Limpopo province is on track to meet its

target by 2016. In line with the human rights provision of the Constitution of South

Africa as well as strategic objective 4 of the PSP, the Limpopo province also reached

out to under-privileged communities of people staying in informal settlements

providing HIV and TB services. By the end of 2013/14 year, the province had

reached its target of 100%.

In terms of orphans and vulnerable children (OVC) school attendance, the province

was at 55% by 2012/13 year. While it is acknowledged in the UNGASS report that

data for this indicator has been consistently missing over the years, the province as

a source of the data needs to be aggressive in collecting data on this indicator.

Spending on HIV/TB was also on track for the province. As shown by the data in the

table below, the province achieved 90% and 94% spending for the two year period

under review. Against a target of 2,700, the province has already overachieved by

reaching 247% by the end of 2013/14 year on the number of women and children

reporting gender-based violence (GBV) to the police in the last year. This

achievement for Limpopo could be a sign of the comprehensive programmes rolled

out to reach the target population as well as the multi-sectoral approach used

effectively to address social issues related to HIV.


Page 12 of 19

Indicator Baseline

Values

Provincial

Target Values

Data

Source

Achieved

2012.13

Achieved 2013/14

% government departments

and sectors with operational

plans with HIV, TB and related

gender- and rights-based

dimensions integrated

To be

determined in

2012

(100%)

30 IDPs and

20 APPs

LPAC

annual

report

2012/13 &

2013/14

16 IDPs

9 APPs

22 IDPs

5 APPs

% municipalities with at least

one informal settlement where

targeted comprehensive HIV,

STI and TB services are

implemented

To be

determined in

2012

100% LPAC

annual

report

2012/13 &

2013/14

96.6% 100%

Current school attendance

among orphans and among

non-orphans aged 10-14

(UNGASS and MDG indicator)

98% (2008

SABSSM

survey)

100% Social

Dev

annual

report

LPAC

annual

report

2012/13 &

2013/14

55%

6 469

Delivery rates under 18 – NIDS To be

determined in

2012

6.5% LPAC &

LDoH

annual

report

2012/13 &

2013/14

7.8% 7.9%

HIV and TB spend NASA 2010 Not set Financial

annual

report

2012/13 &

2013/4

90% (DoH only) 94% (DoH only)

Number of women and

children reporting gender-

based violence (GBV) to the

police in the last year

To be

determined

2700 LPAC

annual

report

2012/13 &

2013/14

6 467 6 423

Proportion of women who

have experienced physical or

sexual violence in the last

year

To be

determined

Not set LPAC

annual

report

2012/13 &

2013/4

6 467

(Limpopo SAPS

Crime statistics)

6 423

(Limpopo SAPS Crime

statistics)


Page 13 of 19

Strategic Objective 2: Preventing new HIV, STI and TB infections

"Targeted, evidence-based combination prevention is needed to achieve the long-

term goal of zero new HIV, STI and TB infections. Focusing prevention efforts in high

transmission areas and on key populations is likely to have the greatest impact,

whilst simultaneously sustaining efforts in the general population19." A Combination

Prevention approach acknowledges that no prevention intervention on its own can

adequately address the HIV and TB epidemics at the population and individual

levels. Combination prevention uses a mix of structural, social, behavioural and

biomedical interventions that, when implemented simultaneously, will have the

greatest power to reduce transmission, as well as mitigate individuals’ susceptibility

and vulnerability to infection20.

Reach of HCT Programme and TB Screening in the province

As indicated in the introductory section of this report above, a combination of factors

including the HCT campaign launched in 2010 and outreach programmes targeted at

specific vulnerable populations contributed to the achievements under this indicator.

With a target of reaching 1 093 133 with HCT services by the end of 2016, the

province had reached 1 165 082 people who are counselled and tested. This

represents above the target achievement by the end of 2013/14 year. While the table

below shows that there were no set targets for the number of people screened for

TB, an achievement of 5 627 509 people reached which is five more times of those

counselled and tested for HIV for the same period could be an indication of

consistency in the integration of health services in the province.

According to HIV treatment guidelines of, all HIV positive but TB negative people

should be initiated on IPT to prevent them from developing active TB disease.

Against a cumulative target of 60,000 on this indicator for the period under review,

the province has already overachieved reaching 68,490 people. Condom use among

15-24 age group remained low in the province. An achievement of 39.3% is below

19 SANAC. National strategic plan on HIV, STIs and TB 2012-2016. Pretoria: SANAC; 2011.

20 SANAC. National strategic plan on HIV, STIs and TB 2012-2016. Pretoria: SANAC; 2011.


Page 14 of 19

the baseline value of 40%. This is an area the province needs to improve on. This

trend in performance is observed again for indicators on young women and men

having sexual intercourse before the age of 15 and having multiple sexual partners.

Performance on these indicators has remained below the baseline values21.

Reach of male condom distribution

In terms of male condom distribution, the province appears to be on target to reach

105,000,000 condoms distributed having already reached a cumulative number of

over 90,000,000 by 2013/14 year. However, the situation was better for female

condom distribution as the province has already more than doubled the target of

425 953 female condoms distributed. This is a positive sign and an indication that

maybe the province should extend its focus to cover correct and consistent use of

condoms by target populations.

Reach of Male medical circumcision

In accordance with Voluntary Male Medical Circumcision (VMMC) Policy of South

Africa there is a need to upscale this programme and reach more men as this is

regarded as one of the effective strategies to reduce HIV transmission amongst

men. With a target of 50,000 men medically circumcised, the Limpopo province has

a cumulative achievement of 105,949 which is already more than double the set

target by the end of 2013/14 year.

With an achievement of over 70,000 people reached with prevention communication

at least twice a year against a target of 20,000, the province has been effective in

increasing its reach to the target population which may explain its over achievement

in most of its indicators.

21 LPAC & LDoH Annual report 2012/13 & 2013/14.


Page 15 of 19

Indicator Baseline Values Provincial

Target

Value

Data Source Achieved

2012/13

Achieved 2013/14

Number (and percentage) of men

and women 15–49 counselled and

tested for HIV

13 million (HCT

Review Report);

62% ever tested,

37% tested in the

past 12 months

(2008 NCS)

1 093 133 DHIS & LPAC

annual report

2012/13 &

2013/14

979 813 3667

(not separated)

Counselled= 1 161 960

Tested= 1 165 082

Number and percentage of people

screened for TB

Eight million(2011

HCT Review)

DHIS & LPAC

annual report

2012/13 &

2013/14

1 546 928 5 627 509

Number of newly diagnosed HIV

positive people started on IPT for

latent TB infection

53%(2011 HCT

Review)

60 000 DHIS & LPAC

annual report

2012/13 &

2013/14

35 026 33 464

% men and women aged 15–24

reporting the use of a condom

with their sexual partner at last

sex

40% (NCS 2008) Not set Human Sciences

Research Council

(HSRC) National

HIV Prevalence,

Incidence and

Behaviour Survey

2012

39.3% Not available

% young women and men aged

15–24 who had sexual intercourse

before age 15 (age at sexual

debut)

10% (UNGASS

Report 2010)

Not set Human Sciences

Research Council

(HSRC) National

HIV Prevalence,

Incidence and

Behaviour Survey

2012

11.8% Not available

% women and men aged15–49

years who have had sexual

intercourse with more than one

partner in the last 12 months

7% (UNGASS

Report 2010)

Not set Human Sciences

Research Council

(HSRC) National

HIV Prevalence,

Incidence and

Behaviour Survey

2012

13.1% Not available

Male condom distribution 492 million(2010/11) 105 000 000 LPAC annual

report & DHIS

2012/13 &

2013/14

43 803 145 52 166 855

Female condom distribution 5,1 million(2010/11) 425 953

(630 000)

LPAC annual

report &DHIS

2012/13 &

2013/14

2 683 824 1 499 593

Number of men medically

circumcised

143 000(2010/11) 50 000 LPAC annual

report &DHIS

2012/13 &

2013/14

57 165 48 784

Number of people reached by

prevention communication at

least twice a year

To be determined in

2012

20 000 LPAC annual

report 2012/13 &

2013/14

51 416 70 447


Page 16 of 19

Strategic objective 3: Sustaining health and well being

Morbidity and Mortality

As part of their contribution to the work of Health Data Advisory and Co-ordination

Committee (HDACC), the Medical Research Council (MRC) of South Africa and the

School of Actuarial Sciences at the University of Cape Town (UCT), released data

from the Rapid Mortality Surveillance (RMS) System on four key outcome indicators

for South Africa in August 2012. The data reflected that the life expectancy of South

Africans has increased from 56.5 years in 2009 to 60 years in 2011. The Infant

Mortality Rate (IMR) decreased from 40 deaths per 1000 live births in 2009 to 30

deaths per 1000 live births in 2011; and the Under-5 Mortality Rate decreased from

56 deaths per 1000 live births in 2009 to 42 deaths per 1000 live births in 2011.

These achievements far exceeded the targets set for 2014 in the NSDA of the Health

Sector for 2010 to 2014. Undoubtedly, more work still needs to be done to fight

maternal and infant mortality, however, the NDoH report points to the fact that South

Africa should recognise and leverage these profound achievements as a celebration

of the unity of purpose and the high value our nation places on the wellbeing and

productivity of its children, mothers, workers and society at large.

Control and management of Tuberculosis in the province

Based on data obtained from the ETR.Net system, the Mpumalanga TB programme

has been largely successful. Inter-sectoral collaboration is very crucial towards

winning the battle against the scourge of HIV and AIDS, TB and STI. At sub-

national level this need to be elevated for the purpose of monitoring and

evaluation of HIV and TB programmatic activities as well as reducing infection

rates and the related burden of diseases affecting our communities. For the

percentage of people per year becoming eligible who receive ART, the province

attained 51% towards the 2016 target of 188,410. The rates of TB case registration

is reduced from the baseline values and also lower than provincial target as reflected

by a 137/100,000 in 2012/13 and 140/100,000 in 2013/14 year. The province is on

track to reach a target of 22,000 TB case detection by 2016 as they have already

reached over 90% of the target.


Page 17 of 19

The table also shows that the smear positive successfully treated cases have been

consistent at around 78%, an achievement above the baseline values. However, the

case fatality has been increasing from a baseline of 7.1% to the highest of 8.6%. The

causes of deaths related to TB need to be investigated so that appropriate and

targeted interventions can be developed and implemented for improved patient

outcomes.

Data in this table also supports an earlier observation made that the province has

successfully integrated HIV with TB in its programming. From the TB entry point, the

percentage of TB patients testing for HIV is 92.3% which is above the target of 90%.

Indicator Baseline

Values

Provincial

Target Values

Data Source Achieved

2012/13

Achieved

2013/14

% people per year becoming eligible

who receive ART

58%

(96 409)

188 410 LPAC report & DHIS

2012/13 & 2013/14

49 276 47 612

TB case registration rate 708/100 000

155/100 00 LPAC report & DHIS

2012/13 & 2013/14

137/100 00 140/100 00

TB case detection rate 72%

(2010,WHO)

22 040 LPAC Annual report & DHIS

2012/13 & 2013/14

19 620 (is

not in rate)

17 713 (is not in

rate)

% smear positive TB cases that are

successfully treated

73% smear

positive

8.2 % DHIS & LPAC annual report

2012/13 & 2013/14

78.6% 78.4%

TB case fatality rate (CFR) 7,1% 8.5% DHIS & LPAC annual report

2012/13 & 2013/14

8.6% 8.4%

CFR HIV-positive = CFR HIV-negative 54% (2010

WHO)

Number and percentage of registered

TB patients who tested for HIV

54% (2010

WHO)

(83%)

90% DHIS & LPAC annual report

2012/13 & 2013/14

90.1% 92.3%


Page 18 of 19

Data Elements Missing and to be collected by Limpopo AIDS Council

Strategic Objective 3

Number of all newly TB patients who are expressed as a propotion of all newly

registered TB patients.

CFR HIV-positive = CFR HIV-negative

PROGRESS ON KEY INDICATORS MARCH 2015 - sanac.org.za filePrevention, Care and Impact Strategic...

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