South Africa’s 2030 plan to ‘turn the tide on Aids’

23 July 2014

South Africa is set to make major increases in the scale of an already massive HIV/Aids treatment and prevention programme as the country pushes to meet ambitious new targets for turning the tide on HIV/Aids by 2030, says Health Minister Aaron Motsoaledi.

Speaking during his department’s budget vote in Parliament in Cape Town on Wednesday, Motsoaledi said the new targets were in line with those set both by the country’s National Development Plan (NDP) and by delegates currently attending the 20th International Aids Conference in Melbourne, Australia.

Motsoaledi said the conference had gone beyond existing international goals by declaring that the world needed to “bring an end to HIV/Aids” by 2030, adding that this had been defined as follows: “It means 90% of people know their status; 90% of those that are HIV positive are on treatment; 90% of those on treatment are virally suppressed.”

South Africa’s next step would therefore be “to increase coverage in the manner proposed by the 90% approach. This means testing most, if not all, of the population annually, initiating everyone who is positive on treatment regardless of CD-4 count and supporting all those that are on treatment.

“In summary, it will mean mass testing in every possible setting: schools, universities, workplaces, churches and communities,” Motsoaledi said.

The minister also announced that, as of January 2015, HIV-positive patients would start receiving free antiretroviral treatment once their CD4 count fell below 500, instead of current threshold of less than 350.

At the same time, the Department of Health will shift all HIV-positive pregnant women from the World Health Organisation’s “option B” treatment model – the current norm in the country – to the “option B+” treatment model.

Under the “B” model, HIV-positive pregnant women receive free antiretroviral treatment while they are breastfeeding, and stop receiving treatment once they have finished breastfeeding if their CD4 count is lower than 350.

“Option B+ simply means every pregnant HIV positive woman goes on lifelong treatment, regardless of their CD4 status,” Motsoaledi said, adding that these interventions represented a milestone in the country’s fight against HIV/Aids.

While research has shown that the treatment of as many people as possible is itself a highly effective form of prevention, the minister said, the country’s massive treatment programme would be accompanied by a wide range of prevention techniques.

These will include programmes for mass education and communication, social mobilisation, HIV counselling and testing, prevention of mother-to-child transmission, and the management of sexually transmitted infections in general.

They will also include massive condom distribution, the provision of safe blood transfusion, and a widescale medical male circumcision campaign targeting 4-million men by 2016.

The minister also announced that government would be undertaking a massive campaign to decentralise the management of multi-drug-resistant TB (MDR-TB) in the country.

“Presently, we have 100 such decentralised sites, and we intend to increase them to 2 500. This will happen through a rapid establishment and scale-up of nurse-led MDR-TB treatment management teams at municipal ward level.”

He said his department also aimed to screen all 150 000 inmates in the country’s correctional services facilities for MDR-TB, as well as all 500 000 miners and the 600 000-strong peri-mining communities in six districts identified as having a high level of mining activity.