This document summarizes HIV/AIDS statistics and prevention strategies in South Africa. It provides the following key details: - Around 5-7 million people in South Africa are HIV positive, with 1-2 million in direct need of antiretroviral treatment but only 850,000-900,000 currently receiving it. - South Africa sees around 1,000 HIV-related deaths and 1,900 new HIV infections daily. Over 2 million children are orphaned by the epidemic. - The organization discusses primary, secondary, and tertiary prevention strategies like testing and counseling, monitoring and treatment, and decentralized community care. - Retention strategies include adherence management, social support programs, and motivation initiatives.

2. Rural Advancement Program

3. SA HIV AIDS Statistics
48-50 million South Africans
5,5-7,2 million SA’s HIV+
20-30% in direct need of medical intervention with ARV’s
(1,65-2,1 million)
Total ARV roll out 850.000-900.000 on ARV’s
Treatment gap 0,8-1,2 M people in direct need of ARV’s
In South Africa alone:
1000 HIV related deaths per day
1900 sero-conversions HIV- to HIV+ per day
Over 2 million children are orphaned by the epidemic

4. Associated Press

5. HIV- HIV+ CD4<350 VL<50 CD4>250

6. Prevention…
Primary prevention: prevention of diseases and
conditions before biological onset
Secondary prevention: the identification and
interdiction of diseases that are present in the
body, but that have not progressed to the point
of causing signs, symptoms, and dysfunction
Tertiary prevention: the prevention of disease
progression and suffering after it is clinically
obvious. It prevents morbidity and mortality
Retention through Motivation
Definition adapted from: Robert B Wallace, The Gale Group Inc

7. Retention
Intensive adherence management
Childcare program
Sports program
Drama and music
Theatre “The Miracle”
Entrepreneurship
Retention through motivation

9. Secondary Prevention…
VCT(+): HIV screening, CD4 staging, TB
questionnaire, referral
VCT+ is not an outcome
VCT+ entry point into a continuum of care
100% uptake of target group
Annual VCT+
Prevalence & incidence

12. Tertiary Prevention
The Autonomous Treatment Centre…
Decentralisation of all services to community
12 hour Clinic
Integrated PHC / TB / HIV & AIDS care
24 hour Clinic
Maternity, PMTCT, TB / AIDS in-patient care
Dedicated TB / HIV monitoring laboratory
Training, Research, M&E department

13. Outcome measures of success…
Primary prevention: reduced Prevalence &
Incidence
Secondary prevention: earlier care seeking
behaviour
Tertiary prevention: lowered morbidity &
mortality
Retention for life

14. Quality of Care

15. Background
Short-term (≤1 yr FU) virological results from ART
programs in sub Sahara Africa are promising
Similar results to those observed in western
countries have been reported
Consistant virological monitoring is often not feasible
though, due to limited financial and logistical means
Long-term (several yrs of ART) virological data from
sub Saharan, African treatment programs are
therefore scarce

16. Methods
• Retrospective Cohort Primary Endpoint:
• All adults who started - virological suppression
ART ≥2 yrs prior to data (HIV-RNA <50 copies/mL)
analysis included Secondary Endpoint:
• HIV-RNA prior to and - Patient retention +
every 6 months after mortality
initiating ART - Virological failure
• Modified intention to (HIV-RNA >1000 copies/mL after initial
suppression)
treat analysis

17. Results
Cohort baseline characteristics; N = 735
Months since start ART, mean (IQR)
Age in years at baseline, median (range)
37 (24-59)
34 (16-73) Cohort specifics:
Female sex, N (%) 526 (71,6)
TB treatment, N (%) No TB treatment 346 (47,1)
TB treatment prior to ARVs
TB treatment during ARVs
181 (24,6)
204 (27,8) • Median duration of follow
BMI, median (IQR) Total population 19.8 (17.4-23.0)
Men 18.7 (16.8-21.4) up >3 years
Women 20.4 (17.8-23.6)
WHO stadium, N (%) WHO 1 68 (9.3)
WHO 2 77 (10.5) • Low median CD4 count at
WHO 3 456 (62.0)
WHO 4 120 (16.3) baseline
Karnofsky score Karnofsky <= 50 47 (6,4)
Karnofsky > 50 666 (90.6)
Not recorded 22 (3,0) • Men were at a more
Starting CD4+ T-cel count, median (IQR) Total population 68 (20-140)
Men 52 (12-131) advanced stage of their
Women 77 (26-143)
10Log(Baseline Viral Load), median (IQR) 5.0 (4.5-5.4) disease when starting ART
ARV regimen, N (%) Lamivudine/Stavudine/Efavirenz 314 (42,7)
Lamivudine/Stavudine/Nevirapin 263 (35,8) than women
Lamivudine/Zidovudine/Efavirenz 88 (12,0)
Lamivudine/Zidovudine/Nevirapin 38 (5.2)
DDI/Stavudine/Efavirenz 2 (0.3)
Combivir/Efavirenz 23 (3.1)
Combivir/Nevirapin 2 (0.3)
Unknown 5 (0.6)
Employment rate, N (%) Employed 164 (22.3) Data: RE Barth, HA Tempelman et al.2009 IAS
Unemployed 512 (69.7) poster
Not recorded 59 (8,1)

18. Results
Long-term outcome
Time N Morta- Lost to Trans- Still in Total patient
since (%) lity follow fer Care retention
start N (%) up N (%) N (%) N (%)
ARVs* N (%)
Retention Rate
2–3 379 79 (21) 43 (11) 28 (7) 229 (60) 28+229= 257/379
years (52) (68)
100
Patient Retention (percentage)
3–4 232 56 (24) 31 (13) 14 (6) 131 (57) 14+131= 145/232
Lost to follow up
years (32) (63) 80
Mortality
>4 120 34 (28) 12 (10) 5 (4) 69 (58) 5+69= 74/120 (62)
years (16) 60 Total patient attrition
Total 735 171/735 88/735 47/735 429/735 47+429= 476/735 40
(100) (23) (12) (6) (58) (64)
20
Gender N1 Morta- Lost to Trans- Still in Total patient 0
0 6 12 18 24 30 36 42 48 54
(%) lity follow fer Care retention
Duration follow up (months)
N (%) up N (%) N (%) N (%) Retention (%): 76 71 70 68 66 64 62 61
N (%) No at risk: 546 503 480 463 321 206 128 67
Male 209 61 (29) 32 (15) 8 (4) 108 (52) 116 (56)
Female 526 110 (21) 56 (11) 39 (7) 321 (61) 360 (68)
P-value 0.02* 0.09 0.01*
Total 735 171/735 88/735 47/735 429/735 47+429= 476/735
(100) (23) (12) (6) (58) (64)

19. NCG Rural Advancement Program
Implementation of health care services in
areas without access to care
Remigrating skills to rural areas
Local capacity building through community
mobilisation
Strengthening of DHS
Implementation of NSP

20. Thank you
Questions & Discussion