HAST CHIEF DIRECTORATE
The Chief Directorate comprises HIV, STIs and TB and HAST Stakeholder
1. The TB directorate
The TB program provides TB screening services, TB management, community TB care, TB recording and reporting, Inpatient care and MDR TB and TB/HIV integration. The TB caseload is declining from 18000 in 2014 to 13000 in 2018 due to intensified TB case finding and the implementation of the strategy to find the missing TB patients.
1.2. TB screening
- The TB screening services are provided in all primary health care (PHC) facilities including Hospitals.
- People attending all health facilities should be provided with TB screening where they will be asked about the four signs and symptoms of TB e.g. coughing for more than two weeks, drenching nigh sweat even when it is cold, loss of weight without any effort and fever.
- The TB directorate therefore request those who are having at least one of the above-mentioned signs and symptoms to visit the public health facilities free TB screening services.
- This will enable the department to diagnose TB early and reduce the spread in the community.
1.3. TB treatment and DOT
- Once TB is diagnosed, the patient is expected to take TB treatment for 6 months under Direct Observed treatment (DOT).Therefore the directorate expect all TB patients to have a treatment supporter, who will be able to encourage the patients to take treatment everyday(7 days per week) for six months.
- All contacts (Everybody that is close to a TB patient) should be screened for TB and contacts without the symptoms of TB should be initiated on TB prevention treatment/therapy
1.4. MDR TB
- If the patients do not take TB treatment regularly as expected will develop Multi Drugs Resistance (MDR) TB that will be 9-12 months injection free short regimen.
- The short regimen is provided in all the sites that are proving MDR TB services including the MDR Specialized Hospital in Modimolle.
- Currently the directorate is decentralizing the management of MDR-TB and we have 28 active sites where patients are treated near their place of stay, work and play.
- Patients with complicated MDR-TB are managed at the Modimolle MDR Specialized Hospital which is the centers of excellence.
- All Drug Resistance TB (DR-TB) should be on Direct Observed Treatment to ensure treatment adherence.
1.5. TB/HIV services
- The directorate provides integrated TB/HIV services to all HIV positive clients by ensuring that all HIV positive are provided with TB screening and testing services.
- Those clients that are not having the sign and symptoms of TB are provided with TB preventive therapy.
- All the HIV patients with CD4 count of less than 100 will be diagnosed through Urine TB diagnostic test called Urine-LAM
- The above mentioned test will enable the patients to his/her TB status within 25 minutes and initiate TB treatment within 25 minutes.
- All TB positive patients are offered HIV counselling and testing so that they are provided with comprehensive treatment, care and support.
2. HAS DIRECTORATE
The directorate comprises of the following sub programs: HTS, PMTCT,HTA,STI, CONDOM LOGISTICS,
ART, VMMC, PEP & PrEP
2.2.High Transmission Area Programme
Provides services to Populations at higher risk of HIV exposure – more likely to be exposed to HIV or to transmit it. Includes both vulnerable populations and most at risk populations. Engagement of key populations is critical to a successful HIV response
Vulnerable: People who are particularly vulnerable to HIV infection in certain contexts, such as: – adolescents; orphans; street children; people in closed settings (e.g. correctional centres); people with disabilities and migrant and mobile workers.
Most-at-risk: men who have sex with men; transgender people; people who inject drugs; sex workers; offenders in prison settings
Interventions through peer education include the following services:
- Increased HIV prevention through health promotion
- Treatment; care and support services
- HTS, STI, and TB screening and treatment
- Sexual and reproductive health screening and family planning
- Providing condoms and lubricant
- Risk reduction Counselling
2.3. Male and female condom use
Correct and consistent use of male and female condoms during vaginal or anal penetration can protect against the spread of sexually transmitted infections, including HIV. Evidence shows that male latest condoms have an 85% or greater protective effect against HIV and other sexually transmitted infections (STIs).
2.4.Voluntary medical male circumcision (VMMC)
Medical male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. This is a key prevention intervention supported in 15 countries in Eastern and Southern Africa (ESA) with high HIV prevalence and low male circumcision rates. VMMC is also regarded as a good approach to reach men and adolescent boys who do not often seek health care services.
2.5. Pre-exposure prophylaxis (PrEP) for HIV-negative partner
Oral PrEP of HIV is the daily use of ARV drugs by HIV-negative people to block the acquisition of HIV. More than 10 randomized controlled studies have demonstrated the effectiveness of PrEP in reducing HIV transmission among a range of populations including serodiscordant heterosexual couples (where one partner is infected and the other is not), men who have sex with men, transgender women, high-risk heterosexual couples, and people who inject drugs.
PrEP is recommended as a prevention choice for people at substantial risk of HIV infection as part of a combination of prevention approaches. The World Health Organization has also expanded these recommendations to HIV-negative women who are pregnant or breastfeeding.
2.6. Post-exposure prophylaxis for HIV (PEP)
Post-exposure prophylaxis (PEP) is the use of ARV drugs within 72 hours of exposure to HIV in order to prevent infection. PEP includes counseling, first aid care, HIV testing, and administration of a 28-day course of ARV drugs with follow-up care. PEP use is recommended for both occupational and non-occupational exposures and for adults and children.
2.7. Prevention of Mother to Child transmission of HIV ( PMTCT)
This is an HIV prevention strategy aiming to reduce and finally eliminate transmission of HIV from pregnant and breastfeeding mothers to their infants/ babies. 100% of Limpopo Public facilities offer this service to all women booking Antenatal care (ANC) and those diagnosed during their postnatal care (PNC). The number of HIV positive pregnant women receiving ART treatment has increase in the past 5 year and this has positively affected the reduction of mother to child transmission of HIV (MTCT ).
The province has reduced MTCT from 2.7% in 2011/12 to 0,78% in 2018/2019. HIV positive pregnant women are encouraged at all visits to adhere to their ART treatment and to breastfeed exclusively for six months
- HIV Testing Services (HTS)
The Department of Health in the HAST Section is providing the quality HIV Testing Services at all Health and Non Health facilities. Eighteen TVET Colleges and Universities are amongst the non-medical sites offering the service. The special focus is currently on hard to reach population, which includes men and key populations.
- ART( Antiretroviral Treatment)
The Department provides HIV treatment in all Public Health Facilities and non-public health facilities like Farms, Mines, NGOs, Universities and Correctional Centres. The Department will be switching to new ARV regimen of Fixed Dose Combination, which contains Dolutegravir, Lamivudine and Tenofovir from the 01 October 2019.
NB: For more information contact your nearest health facility