South Africa’s National Strategic Plan on HIV, STIs and TB: 2012 – 2016. Sections of Government Document.
South Africa’s National Strategic Plan on HIV, STIs and TB: 2012 – 2016.
Sections of Government Document.
South Africa is part of an international initiative working towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive.
For the full 84-page document, click below:
Key introductory excerpts from the document:
Vision and Goals
The NSP 2012–2016 is driven by a long-term vision for the country with respect to the HIV and TB epidemics. It has adapted, as a 20-year vision, the Three Zeros advocated by UNAIDS. The vision for South Africa is:
* Zero new HIV and TB infections;
* Zero new infections due to vertical transmission;
* Zero preventable deaths associated with HIV and TB;
* Zero discrimination associated with HIV and TB.
In line with this 20-year vision, the NSP 2012-2016 has the following broad goals:
* Reduce new HIV infections by at least 50% using combination prevention approaches;
* Initiate at least 80% of eligible patients on antiretroviral treatment (ART), with 70% alive and on treatment five years after initiation;
* Reduce the number of new TB infections as well as deaths from TB by 50%;
* Ensure an enabling and accessible legal framework that protects and promotes human rights in order to support implementation of the NSP; and,
* Reduce self-reported stigma related to HIV and TB by at least 50%.
The plan has four strategic objectives, which will form the basis of the HIV, STI and TB response. These are:
- Address social and structural barriers to HIV, STI and TB prevention, care and impact;
- Prevent new HIV, STI and TB infections;
- Sustain health and wellness; and
- Increase protection of human rights and improve access to justice.
1.2 Strategic Objectives of the NSP 2012–2016
Strategic Objective 1:
Address Social and Structural Drivers of HIV, STI and TB Prevention, Care and Impact
Strategic Objective 1 (SO 1) is focused specifically on addressing the structural, social, economic and behavioural factors that drive the HIV and TB epidemics. The sub-objectives are:
- Mainstream HIV and TB and its gender- and rights-based dimensions into the core mandates of all government departments3 and all other sectors of SANAC;
- Address social, cultural, economic and behavioural drivers of HIV, STIs and TB. This includes addressing challenges posed by: socialisation practices; living in informal settlements, as well as rural and hard-to-reach areas; migration and mobility; and alcohol and substance abuse;
- Implement interventions to address gender norms and gender-based violence;
- Mitigate the impact of HIV, STIs and TB on orphans, vulnerable children and youth;
- Reduce the vulnerability of young people to HIV infection by retaining them in schools as well as increasing access to post-school education and work opportunities;
- Reduce HIV- and TB-related stigma and discrimination;
- Strengthen community systems to expand access to services; and
- Support efforts aimed at poverty alleviation and enhancing food security programmes.
Strategic Objective 2: Prevent New HIV, STI and TB Infections
Strategic Objective 2 (SO 2) is focused on primary strategies to prevent sexual and vertical transmission of HIV and STIs, and to prevent TB infection and disease, using a combination of prevention approaches.
Combination prevention is a mix of biomedical, behavioural, social and structural interventions that will have the greatest impact on reducing transmission and mitigating susceptibility and vulnerability to HIV, STIs and TB. Different combinations of interventions will be designed for the different key populations.
The following sub-objectives are included for HIV, STI and TB prevention:
- Maximise opportunities for testing and screening to ensure that everyone in South Africa is tested for HIV and screened for TB, at least annually, and appropriately enrolled in wellness and treatment, care and support programmes;
- Increase access to a package of sexual and reproductive health (SRH) services, including for people living with HIV and young people, and conduct prevention activities in non-traditional outlets4 . The package includes medical male circumcision (for adults and neonates), emphasis on dual protection, provision of both male and female condoms, termination of pregnancy and provision of contraception;
- Reduce transmission of HIV from mother to child to less than 2% at six weeks after birth and less than 5% at 18 months of age by 2016. This includes strengthening the management, leadership and co-ordination of the prevention of mother to child HIV transmission (PMTCT) programme and ensuring its integration with maternal and child health programmes. TB screening will be integrated into the PMTCT programme. In addition, screening and treatment of syphilis will be strengthened to eliminate neonatal syphilis;
- Implement a comprehensive national social and behavioural change communication strategy with a focus on key populations. This aims to increase demand and uptake of services, to promote healthy behaviours, and to address norms and behaviours that put people at risk for HIV, STIs and TB;
- Prepare for the potential implementation of future innovative, scientifically proven HIV, STI and TB prevention strategies, such as pre-exposure prophylaxis, new TB vaccines and microbicides;
- Prevent TB infection and disease through intensified TB case finding, TB infection control, workplace/occupational health policies on TB and HIV, isoniazid preventive therapy (IPT), immunisation, prevention of multidrug-resistant TB (MDR-TB), and reducing TB-related stigma, alcohol consumption and smoking; and
- Address sexual abuse and improve services for survivors of sexual assault.
Strategic Objective 3: Sustain Health and Wellness
The primary focus of Strategic Objective 3 (SO 3) is to achieve significant reduction in deaths and disability as a result of HIV and TB. This will be accomplished by universal access to affordable and good quality diagnosis, treatment and care.
The sub-objectives of SO 3 are:
- Reduce disability and death resulting from HIV and TB. This includes: annual testing/screening for HIV and TB, particularly for key populations; improved contact tracing; early diagnosis and rapid enrolment into treatment; increased access to high-quality drugs; improved access to treatment for children, adolescents and youth; early initiation of all HIV-positive TB patients on ART; strengthened implementation of a patient-centred pre-ART package; early referral of all patients with complications; appropriate screening and treatment for cryptococcal infection; and strengthened screening and treatment of pregnant women for syphilis;
- Ensure that people living with HIV and TB remain within the health care system, are adherent to treatment and maintain optimal health. The means to achieve this includes the establishment of ward-based PHC teams and regular communication using all appropriate media; and
- Ensure that systems and services remain responsive to the needs of people living with HIV and TB. This includes integrating HIV and TB care with an efficient chronic care delivery system; expanding operating hours of service delivery points; ensuring continuum of care across service delivery points; strengthening quality standards; and adequate monitoring of drug resistance.
Strategic Objective 4: Ensure Protection of Human Rights and Improve Access to Justice
South Africa’s response to HIV, STIs and TB is based on the understanding that the public interest is best served when the rights of those living with HIV, STIs and/or TB are respected, protected and promoted. The NSP 2012-2016 recognises the need to continuously assess barriers to access to services and instances of stigma and discrimination and provides the framework for addressing such issues.
It aims to ensure that rights are not violated when interventions are implemented, and that discrimination on the basis of HIV and TB is reduced, and ultimately eliminated.
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