SA launches new blueprint for ending its biggest public health threats

The country’s fifth National Strategic Plan (NSP) for HIV, TB and STIs (2023-2028) was launched on World TB Day in March, following extensive consultations with organisations and people with disabilities, sex workers and the LGBTQI+ community, among others. 

Known as The People’s NSP, the plan has one overarching goal – to remove the barriers to accessing services and treatments for HIV, tuberculosis (TB) and sexually transmitted diseases (STIs). It aims to ensure SA is on track to end these devastating epidemics, that affect millions of lives, as public health threats by 2030.

The SA National Aids Council (Sanac) believes that, with collaboration, this can be achieved. Our mandate has been to unite government entities, development partners, health workers, scientists and all South Africans to respond to the challenge.

Aligned with the government’s National Development Plan 2030, the People's NSP draws on in-depth reviews of the three epidemics in SA, as well as evidence-based interventions, international guidelines and global strategies.

SA is committed to the UN's 2030 Agenda for Sustainable Development – including ending HIV as a public health threat by 2030. The contribution of the NSP 2023-2028 is significant since it is the last one ahead of the 2030 deadline.

The NSP sets four critical goals:

1. Breaking down barriers to achieving HIV, TB and STIs outcomes;
2. Maximising equitable and equal access to HIV, TB and STIs services and solutions;
3. Building resilient systems for HIV, TB and STIs that are integrated into existing systems for health; and
4. Social protection and pandemic response, and fully resourcing and sustaining an efficient NSP led by revitalised, inclusive and accountable institutions.

The plan targets the optimal implementation of high-impact HIV-prevention interventions to ensure SA meets its “95-95-95” targets: that 95% of people living with HIV should know their status; 95% of those diagnosed should be on treatment; and that 95% of those on treatment should be virally suppressed (with a viral load of less than 200 copies per millilitre of blood).

It also promotes HIV-prevention measures such as condom use, voluntary medical male circumcision and pre-exposure prophylaxis.

Importantly, this new blueprint for eradicating SA’s most prominent public health threats has a broadened scope.

It has responded to a call to include mental health services and social support, based on the strong link between HIV, TB, STIs, sexual and gender-based violence, human rights violations, inequalities and mental health.

Another new focus is viral hepatitis as a highly prevalent infection linked to HIV and STIs – 6.8% of adults in SA are infected with hepatitis B, and hepatitis C prevalence is high - particularly among those who inject drugs.

The plan also targets increased cervical cancer screening and prevention, and the STIs section includes an expanded focus on access to diagnostic tests and vaccines.

We have seen good progress since the first of a series of NSPs was launched in 2000 to guide the national response to HIV, TB and STIs.

SA has the most extensive HIV treatment programme in the world, with nearly 6-million people on antiretroviral therapy. The new HIV infections and the mother-to-child transmission rate continues to decline, while life expectancy has increased significantly.

We’ve built robust partnerships and collaboration between the government, civil society, organised labour, business sectors, development partners and other stakeholders to ensure that we continue to drive a truly multi-sector response that leaves no-one behind. 

We cannot lose sight of the persistent inequalities in our country. The Covid-19 pandemic derailed the national response to HIV, TB and STIs, reduced access to services and diverted healthcare funds elsewhere. Economic conditions remain harsh, and disparities have deepened. As we drive the implementation of the People’s NSP, our approach should be nuanced and our interventions tailored and targeted. 

Roughly 8-million South Africans still live with HIV, with adolescent girls and young women facing disproportionately high risks. TB remains a significant cause of morbidity and mortality, with a high HIV-TB infection rate.

Health minister Joe Phaahla, a member of the Sanac inter-ministerial committee, says in his preface to the NSP that in 2021, SA had a TB incidence of 304,000, but only 187,375 notifications were recorded. He says “we must work harder” to scale up awareness, screening and testing, and treatment adherence, and we must increase our efforts to combat TB-related stigma and discrimination.

He notes an increasing trend of people infected with TB who are asymptomatic and not picked up with routine screening.

“This calls for an urgent move to utilise advanced testing tools such as digital chest X-rays, which are game changers in the detection of asymptomatic TB,” Phaahla writes.

Statistics included in the NSP indicate a significant decline in the prevalence of syphilis in SA. The same cannot be said for gonorrhoea and chlamydia, where the infection rate has not declined for three decades. In 2017, an estimated 4.5-million South Africans were diagnosed with gonorrhoea and 5.8-million with chlamydia (compared with 70,675 with syphilis).

There is work to be done, and the new NSP provides a clear road map to roll up our collective sleeves and get to work.

The People’s NSP belongs to all South Africans. Its successful implementation and the elimination of HIV, TB and STIs as public health threats by 2030 will require a solid multi-sector response, strong political will and civil society involvement, robust private sector commitment and sustained partnerships. Transparency, inclusivity and collaboration remain vital to achieving the ambitious target of ending Aids.

Click here to access the NSP for HIV, TB and STIs (2023-2028). 

This article was sponsored by The SA National Aids Council.