James McIntyre & Glenda Gray

Transcription

1 James McIntyre & Glenda Gray

2 Thirty years of AIDS July 3, 1981

3 A generation in the shadow of AIDS...

4 AIDS in South Africa First South African publication: 1983: two cases in homosexual men, both died in 1982

5 AIDS in South Africa September 1986: The present status of AIDS cases in the RSA is: (i) South African residents 30 cases comprised of: homosexual/bisexual men (26), heterosexual (I), blood transfusion AIDS (I), and haemophiliacs (2); all these are white males; R Sher, SAMJ, 1986

6 Thirty years of AIDS.. has a new microbe arisen like a phoenix from the cauldron of evolution and flourished here and now because of the special social and sexual circumstances of the times? Ruben Sher, SAMJ 1986

7 HIV in Soweto

8 HIV at Baragwanath Maternity Hospital

9 HIV prevalence among ANC attendees PHRU Soweto PMTCT service, South Africa National Survey, 1990 to Prevalence (%) Prevalence (%) 100 fold increase: from 1 in 300 to 1 in 3 over 20 years Source: 1] PHRU, 2] SA Dept. of Health, 2008

10 Setting the scene: ten years ago in in 5 South Africans estimated to be HIV infected 1 million women give birth in SA There is no uniform access to VCT There is no uniform access to HIV related information during antenatal care There is no access to ARV to prevent MTCT There is no access to ARV in the public sector to treat HIV infection

11 Sarafina II and Virodene "It has little more to say about the HIV virus than it's great fun to sleep with lots of partners and then you get Aids and then you die and go to heaven". Anonymous health worker, 1995 "The rationale of the MCC should be questioned. I surmise that the council is driven by other interests than concern for proper control of medicines". Kgalema Motlanthe, ANC Secretary General, Press conference, 6 March, 1998 accusing the MCC of ulterior motives in banning trials of Virodene

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13 Prevention of mother-to-child transmission

14 Transmission (%) Trends in reduction of MTCT: results over time 1994 ACTG Bangkok AP/IP ZDV 2000 PHPT 2004: PHPT-2 HAART HAART 1998 Abidjan AP/IP ZDV 1999 PETRA AZT/3TC ZDV ZDV + NVP 2002 DITRAME +1 ZDV + NVP : HIVNET 012 sdnvp DITRAME +1.1 ZDV/3TC+ NVP USA & Europe Thailand Africa

15 PHRU research contributions

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18 In search of a future

19 The Soweto PMTCT Programme First sub district wide PMTCT programme in the country as a partnership between PHRU and Gauteng Health, established in 2000, ahead of the first government pilot sites, grew out of the PHRU PMTCT research site, extending across Soweto in Initial support from Elizabeth Glaser Pediatric AIDS Foundation, French government Fonds de solidarité thérapeutique internional (FSTI) From 2003, funding moved to direct funding from USAID to PHRU, and then moved to Anova from 2009 Acknowledged as a leading flagship PMTCT programme in Africa

20 MTCT at Chris Hani Baragwanath and Soweto Antenatal VCT service since 1987 at CHBH MTCT Research from 1993 Phase 1 Phase III trials * breastfeeding & HIV * PETRA * Emivirine phase I * SAINT * AI : ddi/d4t/ddi+d4t * PEP (NVP vs ZDV) Postpartum VCT for women who have not had access to antenatal testing now in place

21 MTCT at Chris Hani Baragwanath and Soweto NVP implementation programme at CHBH from July 2000 Zola and Lillian Ngoyi Clinics added October 2000 and January 2001 Additional 11 Soweto Community Health Centres added February 2002 Funded: EGPAF, FSTI, USAID, Gauteng Department of Health

22 A unique focus on community and psycho-social support From the start of the services at Baragwanath, close links were established with emerging AIDS NGO s Agreement from hospital management to have NGO s work together with clinical staff in the antenatal clinic unheard of at that time! Focus on community education and empowerment Linkages with NGO groups SELAF, NACOSA and AIDS Consortium Emergence of HIVSA as major community support partner since 2002

23 Early success in the Soweto PMTCT programme In the original three sites from January to December 2001, women were offered pre-test counselling of which (91.6%) accepted VCT. Of these, (98.4%) were tested, of which (31.2%) were HIV positive. The number of women receiving their results was (86.9%) with 71.3% (8 560) receiving their results on the same day as testing. Nevirapine was dispensed to (78.2%) of the HIV positive women constituting 90.8% of those who received their results. Violari et al, XV International AIDS Conference,2004

24 Soweto PMTCT Service Jan December ANC attendances, 3741 HIV positive (28%) pre test vct test - hivpos NVP

25 Soweto PMTCT Service Jan December ANC attendances, 8516 HIV positive (29.2%) Estimated proportion of positive women given Nevirapine: 72% ANC clinic visits Accepting VCT Post-test counselling HIV-positive Given Nevirapine

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29 Soweto PMTCT Service Jan December ,648 ANC attendances, 8,527 HIV positive (30.2%) Estimated proportion of positive women given Nevirapine: 93% ANC clinic visits Accepting VCT Post-test counselling HIV-positive Given Nevirapine NVP baby

30 Soweto PMTCT Programme: Major achievements (Jan - Dec 2003) 99% of the women took part in counselling Majority of women (90%) in ANC have an HIV result 92% of positive women received results 86% of all positives received NVP 50% of all infants receive NVP

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33 PMTCT Soweto ANC clinic visits Accepting VCT Post-test counselling HIV-positive Post-test counselled NVP Mom NVP baby Referred for CD4 test CD4 test done Received results CD4 < 200 Received results % women test HIV-positive 14.9% CD4 < 200

34 AIDS and politics: a new era in South Africa "Shall I repeat garlic, shall I talk about beetroot, shall I talk about lemon... these delay the development of HIV to Aids-defining conditions, and that's the truth." Health Minister Manto Tshabalala Msimang, 7 June 2006 I would thoroughly endorse the roleout of antiretrovirals and any way we can accelerate that, the better Health Minister Barbara Hogan, 26 September 2008

35 Back on track... South Africa has rapidly scaled up its prevention of mother to child HIV transmission (PMTCT) programmes. By 2010, PMTCT was offered at 98% of health facilities with virtual universal coverage of mothers booking and delivering in health facilities. In 2010, early transmission from mother to child was found to be 3.5 percent in South Africa, and only 1.1 percent of 4- to 8-week-old infants in the country were infected with HIV.

36 Soweto: Cumulative PMTCT stats ( ) ANC visits Women tested Positive

37 Soweto PMTCT: Infections averted ( ) Estimated number of children infected with no intervention Infections averted Estimated number of children infected

38 With acknowledgements and thanks to all the staff of the Soweto PMTCT programme: clinic staff, PHRU staff, HIVSA staff and Anova staff, and to the Department of Health & donors who have made this possible over the last ten years, and changed the lives of mothers and children in Soweto

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