The new National Strategic Plan (NSP) for HIV, TB, and STIs for 2023-2028 will focus on forming close partnerships with local communities to help reduce barriers and increase fair access to HIV, TB, and STI prevention and treatment services. The new plan will be released by Deputy President Paul Mashatile in Rustenburg on Friday. 

The release comes days after the TB Accountability Consortium released its State of TB report, which revealed ongoing gaps between South Africa’s policy around treating and preventing TB and implementing it at healthcare facilities.

“The success in the implementation of this NSP will rely on a coordinated multi-sectoral approach to strengthen health and social systems. High impact and proven tools remain the mainstay of ending the HIV, TB, STI and viral hepatitis epidemics once barriers to access are removed,” reads the NSP 2023-2028.

New NSP focuses on training healthcare workers and communities

It further states investment in training of health workers, communities and other stakeholders will be of much importance towards the proper implementation of these new guidelines as set out in the new NSP.

South Africa treats STIs using the syndromic management approach. This system allows all trained first-line healthcare providers to diagnose and treat patients on the first visit, thus preventing the further spread of STIs. As diagnostic testing is not routinely performed, there is limited STI surveillance resulting in a lack of population-level prevalence and incidence data. 

The National Institute for Communicable Diseases (NICD) states that diagnostic testing is not routinely performed at clinics. But if you present signs and symptoms of an STI, you will be treated for common infections. You will be offered an HIV test if you do not know your status. You will receive HIV treatment if you test positive.

Playing catch-up

Gauteng Programme Manager for AIDS Healthcare Foundation, Mmatsie Tsotetsi, says the delay in STIs diagnosis results in the spread of disease to partners, mother-to-child transmission and complications such as pelvic inflammatory disease, cervical cancer and infertility.

“STIs are mostly diagnosed in the age group 14-49 years, and mostly in females as they are the ones who usually seek medical attention. If an STI goes untreated there is a risk of spread and complications,” explains Tsotetsi.

The main aim of NSP-2023-2028 is to work more closely with the local communities and form partnerships, to help reduce some of the barriers and increase fair access to HIV, TB, and STI prevention and treatment services.

Nompumelelo Zikalala, Chairperson of the South African National Aids Council(SANAC) Private Sector Forum says South Africa currently faces the monumental task of combating HIV, TB and STIs, whilst simultaneously confronting an array of complex socio-economic challenges.

“Whilst we are slowly moving towards the recovery phase, we need to urgently catch up in our fight against HIV, TB, and STIs in South Africa. As 2030 looms ever closer, this date is of great relevance, not just the vision set for the promotion of health in our country in the National Development Plan. But also to the Sustainable Development Goals,” says Zikalala.

She says they welcome the new National Strategic Plan(NSP), on HIV, TB, and STIs. She believes this plan has the potential to galvanize a ‘whole-of-society’ effort as the country strives towards accessible and quality healthcare for all.

“The new NSP is grounded on robust situational analysis and sets four clear goals, with a cascade of targets, to address key priorities. Importantly, this NSP emphasises an inclusive community-based approach while broadening its scope to encompass other important communicable diseases, mental health, and cancer of the cervix. Emphasis is also placed on joining social services and healthcare to ensure integrated and effective delivery at scale,” explains Zikalala.

Fifth NSP for HIV, TB and STIs

The NSP 2023-2028 officially launched on Friday and highlights strategies aimed at reducing barriers to accessing health and social services. Such as stigma, discrimination, violence, uneven power relations, harmful gender beliefs and norms, poverty, migration, disability and poor service delivery.

NSP for HIV, TB, and STIs serves as a blueprint and roadmap to guide and inform the country’s response to these epidemics. This is the fifth one and it carries strategic objectives and priority plans aimed at eliminating these diseases as public health threats by 2030. It has been organised into four interlinked goals and 28 objectives.

The four strategic goals are:

• Break down barriers to achieving solutions for HIV, TB, and STIs.
• Maximise equitable and equal access to services and solutions for HIV, TB, and STIs
• Fully resource and sustain efficient NSP-led revitalised, inclusive and accountable institutions.
• Build resilient systems for HIV, TB, and STIs that are integrated into systems for health, socio protection and pandemic response

Has SA done enough?

Speaking ahead of the launch of the new NSP Executive Director from the Rural Healthcare Advocacy Project (RHAP), Russel Rensburg, questioned whether South Africa is doing enough to address the burden of TB. “What’s quite jarring to me is that we don’t have a universal framework for the measurement of facilitating the implementation of the TB recovery plan, sometimes it can vary from province to province – so how are decisions being made?” questions Rensburg.

He says that even within the National Health Act, there is no mechanism to prioritise TB recovery. 

“We would like to see what the National TB programme can do to better coordinate between the provinces which are responsible for the delivery of TB services to ensure that they have more focus on achieving the goals in the national plan,” he says. 

Compiled by the TB Accountability Consortium (TBAC), an initiative of the Rural Health Advocacy Project (RHAP), the report focuses on strengthening TB programmes governance and grassroots-level community-led governance approach. 

In SA, the most recent figures show that in 2021, a total of 56 000 people died of TB in the country. About 172 000 people were diagnosed with the disease. In total, an estimated 304 000 people fell ill with this disease. 

Figures show that only 106 000 of the people who were diagnosed were initiated into care, and 70% completed the treatment. Rensburg said this is very far off from the targets that the nation set for in the TB national program, contributing to the sad reality of the thousands of people who have lost their lives to this curable disease.

Community-led governance

The Governance of TB Programmes report launched earlier this week describes the concept of community governance under the indicator of inclusiveness. This measures the extent to which community groups such as TB-affected communities, key populations and civil society, are encouraged to participate in national TB responses.

RHAP Community Liaison Officer, Zimbini Madikiza, explained that health governance at a community level looks like conducting policy briefs in the community about their clinic committees, their roles and what they do, as well as, how they can be strengthened. Using them effectively as a mechanism of improving healthcare and the implementation of the TB recovery plan. 

“The role of governance at a community, facility, and district level is to make sure that the TB recovery plan is being implemented. Governance at the local level is very important because it has a great potential of empowering communities in realising their rights”, she says.

The report also recommends the inclusion of community health workers who can play a vital role in community-led governance by contributing to screening, treatment success, contract tracing, community education, and the creation of a demand for TB services. 

Missing targets

Commenting on NSP 2023-2028, Chairperson of the Civil Society Forum, Steve Letsike says it addresses the main factors that contribute to the high rates of infections. “We saw in the last NSP and the current one that we are closing out, that we still have not reached the targets that we set for ourselves, that we wanted to see less than 88000 new infections in the country annually. We are still not close to that target, “says Letsike.

According to SANAC, there are approximately 8 million people living with HIV in South Africa, with 5.7 million people currently on antiretroviral therapy.

The new plan calls for the urgent strengthening of the national response to reduce the morbidity and mortality associated with HIV, TB and STIs.

South Africa remains the epicentre of the HIV epidemic as inequalities such as low socio-economic status, high levels of gender-based violence, poor sex education and lack of access to quality healthcare and social services, continue to place adolescent girls and young women at disproportionately high HIV risk.

Key populations, which include sex workers, gay men, men who have sex with men, transgender people, people who inject drugs and people in prisons and other enclosed settings, have the highest prevalence and incidences of HIV in South Africa. This is for multiple reasons such as inadequate efforts to reach these populations, stigma, discrimination and punitive laws. – Health-e News