Let’s make AIDS councils work

by Vuyokazi Gonyela, SECTION27

Provincial AIDS Councils (PACs) should be chaired by Premiers, and District AIDS Councils (DACs) by mayors. All councils should meet at least once a quarter – but many do not. If your DAC or PAC is not meeting, write to your Premier or mayor to urge them to organise and chair these meetings. Once we are at the meetings, it is up to us to use them to ensure we get an effective, non-corrupt response to HIV, TB and STIs in our provinces or districts.

Send an e-mail to tell us about your PAC or DAC experiences.

Seven questions to ask at your PAC

Not sure what to say at Provincial AIDS Council meetings? Here are some ideas for questions you could ask

1.    South Africa’s new NSP envisages an ambitious new HIV Counselling and Testing Campaign. When are we starting to implement this HCT campaign in our province.

Here is the relevant part of the NSP, if you want to quote it in the meeting:

“A new national HIV testing effort to find the remaining people who don’t know their status and those who become newly infected will be strategically focused on optimising testing yield. Testing will be decentralised, and expanded testing services will be delivered in and outside health facilities, e.g. in workplaces and community settings. Specific efforts will be made to close testing gaps for men, children, adolescents, young people, key and vulnerable populations, and other groups who are not currently accessing HIV testing at sufficient levels.

“The importance of at least annual HIV testing will be emphasised, especially for young people. Self-screening will be rolled out as part of the strategy to expand HIV testing, and to close testing gaps. A major push will be made to ensure 100% birth-testing of newborns exposed to HIV, and of provider-initiated counselling of mothers and testing for all children up to 18 months to identify those who have acquired HIV through breastfeeding. All children of HIV-positive parents will be tested for HIV. Every person tested for HIV will also be screened for other STIs, as well as for TB.”

2.  The new NSP says that the tracing of TB contacts must be prioritised; and that it envisages intensified TB case-finding in key populations, “including household contacts of people with TB disease, healthcare workers, inmates, and people living in informal settlements.” What are we doing to step up contact tracing and active case-finding in our province?

Here is the relevant part of the NSP, if you want to quote it in the meeting:

“Every person who is tested for HIV must also be screened for TB, as must all TB contacts. Tracing of TB contacts is especially urgent for DR-TB, and will be prioritised. This Plan envisages intensified TB case-finding in key populations, including household contacts of people with TB disease, healthcare workers, inmates, and people living in informal settlements. People with diabetes and every child contact of an adult TB patient will be screened. All patients suspected to have TB will receive appropriate diagnostics, including GeneXpert MTB/RIF as an initial diagnostic, and rapid confirmation of results.”

3.    The NSP sets important national targets. What are our provincial targets relating to reducing new HIV infections and reducing new cases of TB?

Setting provincial targets is essential if we wish to create greater accountability in our province. It also helps focus and direct the work that needs to happen in the province. Yet most provinces do not have targets. Getting your province to set ambitious and concrete targets will be an important achievement.

Some key national targets in the NSP for which we require provincial equivalents are as follows:

  • Reduce new HIV infections to under 100 000 per year by 2022.
  • Reduce TB incidence by at least 30%, from 834/100 000 population in 2015 to fewer than 584/100 000 by 2022.
  • 10 million people should receive an HIV test every year.

4.   Can the Department of Health please provide us with detailed, up-to-date statistics for our province on our progress towards the 90-90-90 targets for HIV and the 90-90-90 targets for TB?

The 90-90-90 targets for HIV and TB are at the centre of the NSP. To create local accountability, and to identify areas that need work, we should track progress against these targets within our provinces, not only at national level. As members of AIDS councils, you have a right to this information.

For HIV, the 90-90-90 targets for provinces are:

  • By 2020, 90% of all people in the province living with HIV will know their HIV status.
  • By 2020, 90% of all people in the province with diagnosed HIV infection will receive sustained antiretroviral therapy.
  • By 2020, 90% of all people in the province receiving antiretroviral therapy will have viral suppression.

For TB, the 90-90-90 targets for provinces are:

  • By 2020, 90% of vulnerable groups in the province will have been screened for TB.
  • By 2020, 90% of people in the province with TB will have been diagnosed and started on treatment.
  • By 2020, 90% of people in the province on treatment will have been successfully treated.

5. What is the status of our provincial implementation plan (PIP)?

The PIPs may sound boring, but they are the plans that must make the goals and broad strategies of the NSP a reality in the communities across our provinces. By engaging in these plans, we can help improve the HIV and TB response in our provinces. Developing these plans is some of the most important work that AIDS councils will do. Once they have been developed, adapting these plans over time and monitoring their implementation will be just as important. In short, if you are on a PAC, part of your responsibility is to know exactly what is going on with your PIP.

In addition to the above question, here are some follow-up questions you could ask:

  • Is the implementation of the PIP in our province fully costed?
  • Where is the money going to come from to implement our PIP?
  • Do we have the human resources to implement our PIP?

6.  Can the Department of Health please provide us with detailed statistics on the best- and worst-performing districts in our province?

‘Best’ and ‘worst’ can be measured in different ways. For that reason, it might be worth asking for more specific indicators of how districts are performing. Here are some examples:

  • What are the viral load coverage rates for each of the districts in our province? (Viral load coverage tells you whether all people on HIV treatment are getting viral load tests, as they are supposed to. If a district has a low viral load coverage rate, then you know there is a problem in that district, because people are not getting the tests that they are supposed to get.)
  • What are the districts in our province with the most medicine stock-outs?
  • What are the TB treatment success rates for each of the districts in our province?

Six questions to ask at your DAC

Not sure what to say at District AIDS Council meetings? Here are some ideas for questions you could ask.

1. South Africa’s new NSP envisages an ambitious new HIV Counselling and Testing Campaign. When are we starting to implement this HCT campaign in our district?

Here is the relevant part of the NSP, if you want to quote it in the meeting:

“A new national HIV testing effort to find the remaining people who don’t know their status and those who become newly infected will be strategically focused on optimising testing yield. Testing will be decentralised, and expanded testing services will be delivered in and outside health facilities, e.g. in workplaces and community settings. Specific efforts will be made to close testing gaps for men, children, adolescents, young people, key and vulnerable populations, and other groups who are not currently accessing HIV testing at sufficient levels.

“The importance of at least annual HIV testing will be emphasised, especially for young people. Self-screening will be rolled out as part of the strategy to expand HIV testing, and to close testing gaps. A major push will be made to ensure 100% birth-testing of newborns exposed to HIV, and of provider-initiated counselling of mothers and testing for all children up to 18 months, to identify those who have acquired HIV through breastfeeding. All children of HIV-positive parents will be tested for HIV. Every person tested for HIV will also be screened for other STIs, as well as for TB.”

2.  The new NSP says that the tracing of TB contacts must be prioritised; it envisages intensified TB case-finding in key populations, “including household contacts of people with TB disease, healthcare workers, inmates, and people living in informal settlements.” What are we doing to step up contact tracing and active case-finding in our province?

Here is the relevant part of the NSP, if you want to quote it in the meeting:

“Every person who is tested for HIV must also be screened for TB, as must all TB contacts. Tracing of TB contacts is especially urgent for DR-TB, and will be prioritised. This Plan envisages intensified TB case-finding in key populations, including household contacts of people with TB disease, healthcare workers, inmates, and people living in informal settlements. People with diabetes and every child contact of an adult TB patient will be screened. All patients suspected to have TB will receive appropriate diagnostics, including GeneXpert MTB/RIF as an initial diagnostic, and rapid confirmation of results.”

3.  The NSP sets important national targets. What are our district targets relating to reducing new HIV infections and reducing new cases of TB?

Setting district and provincial targets is essential if we wish to create greater accountability in our districts and provinces. It also helps focus and direct the work that needs to happen at district level. Yet most districts do not have targets. Getting your district to set ambitious and concrete targets will be an important achievement.

Some key national targets in the NSP for which we require district and provincial equivalents are as follows:

  • Reduce new HIV infections to under 100 000 per year by 2022.
  • Reduce TB incidence by at least 30%, from 834/100 000 population in 2015 to fewer than 584/100 000 by 2022.
  • 10 million people should receive an HIV test every year.

4.  Can the Department of Health please provide us with detailed, up-to-date statistics on our progress towards the 90-90-90 targets for HIV and the 90-90-90 targets for TB in our district?

The 90-90-90 targets for HIV and TB are at the centre of the NSP. To create local accountability, and to identify areas that need work, we must track progress against these targets within our districts and provinces, and not only at national level. As members of AIDS councils, you have a right to this information.

For HIV, the 90-90-90 targets for districts are:

  • By 2020, 90% of all people in the district living with HIV will know their HIV status.
  • By 2020, 90% of all people in the district with diagnosed HIV infection will receive sustained antiretroviral therapy.
  • By 2020, 90% of all people in the district receiving antiretroviral therapy will have viral suppression.

For TB, the 90-90-90 targets for districts are:

  • By 2020, 90% of vulnerable groups in the district will have been screened for TB.
  • By 2020, 90% of people in the district with TB will have been diagnosed and started on treatment.
  • By 2020, 90% of people in the district on treatment will have been successfully treated.

5.  What is the status of our provincial implementation plan (PIP)? And if we have a District Implementation Plan (DIP), what is the status of that?

The PIPs and DIPs may sound boring, but they are the plans that must make the goals and broad strategies of the NSP a reality in our communities. By engaging in these plans, we can help improve the HIV and TB response. Developing these plans is some of the most important work that AIDS councils will do. Once they have been developed, adapting these plans over time and monitoring their implementation will be just as important. In short, if you are on a DAC or PAC, part of your responsibility is to know exactly what is going on with your DIP and/or PIP.

In addition to the above question, here are some follow-up questions you could ask:

  • Is the implementation of the PIP and DIP in our district fully costed?
  • Where is the money going to come from to implement our PIP (or DIP)?
  • Do we have the human resources to implement the PIP (Or DIP)?

6.  Can the Department of Health please provide us with detailed statistics on the best- and worst-performing clinics in our district?

‘Best’ and ‘worst’ can be measured in different ways. For that reason, it might be worth asking for more specific indicators of how clinics are performing. Here are some examples :

  • What are the five clinics in our district with the lowest viral load coverage rate? (Viral load coverage tells you whether all people on HIV treatment are getting viral load tests, as they are supposed to. If a clinic has a low viral load coverage rate, then you know there is a problem at that clinic, because people are not getting the tests that they are supposed to get.)
  • What are the five clinics in our district with the most medicine stock-outs?
  • What are the five clinics in our district with the worst TB treatment success rates?

 

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