Progress towards 90-90-90 and 95-95-95 strategy implementations and HIV positivity trends in the City of Johannesburg.

BACKGROUND: The 95-95-95 strategy implementation is a positive initiative for moving the HIV tide towards elimination, with a focus on addressing the huge inequalities in existence in access to HIV services. OBJECTIVES: To establish performance towards the 90-90-90 and 95-95-95 targets and trends in HIV positivity rates since strategy implementation rollout in the City of Johannesburg (CoJ), South Africa. METHODS: This was a descriptive study, part of the bigger quasi-experimental study using the monthly District Health Information System during the implementation and rollout of the 90-90-90 strategy. HIV access trends were tracked and compared with the set strategy implementation targets. In addition, the HIV positivity rate was analysed to observe trends. A time trend analysis for aggregated data was performed on all the measured indicators to determine whether the decrease or increase was statistically significant. P<0.05 was used to indicate statistical significance. RESULTS: The study has shown that by March 2022, 15 months after December 2020, CoJ had reached 91-65-88. There were significant steady increases in the number of people who knew their HIV status (slope = 0.044, p<0.001) and initiating on antiretroviral therapy (ART) (slope = 0.001, p<0.001), and significant decreases for overall HIV positivity rate (slope = -0.016, p<0.001), adolescent positivity rate (slope = -0.0087, p<0.001) and antenatal care HIV positivity rate (slope = -0.013, p<0.001). CONCLUSION: This study has established positive progress made by the CoJ towards HIV testing, ART initiation, viral load suppression and HIV positivity rate. On the other hand, gaps in linkage to care after testing positive have been highlighted. It is therefore critical in the 95-95-95 strategy implementation era to focus on finding those missed during the 90-90-90 phase through revised and renewed innovative approaches.

Politics and implications on the health systems preparedness to COVID-19 pandemic response: The Malawian experience.

The spread of the COVID-19 disease to Africa has raised concerns around the resultant effects on the fragile and non-resilient health systems. Malawi reported its first COVID-19 cases in early April 2020 at the time of the country's political turmoil, as the courts ruled for a re-run of presidential elections in July 2020 due to irregularities observed in the May 2019 elections. Therefore, assessing the implications of politics on the COVID-19 health systems preparedness is critical to design health systems strengthening efforts during the pandemic. We applied the WHO health systems framework to assess the implications of politics on the COVID-19 on the Malawi health systems preparedness. There was the population's lack of trust in government hampering government efforts, which posed as a huge concern for Malawi to navigate through the pandemic including the health systems preparedness for the pandemic. This, coupled with mass demonstrations by the public disagreeing with the Lockdown and health service providers put across their COVID-19 related demands. The political environment and the trust people have in the government determines a country's response to a pandemic. In a pandemic situation like COVID-19, the government's ability to coordinate the various key stakeholders while instilling trust in people remain critical in strengthening health systems to contain and mitigate the pandemic. However, the Malawi political turmoil highlighted in this paper derailed the process and efforts to contain the and timely prepare the health systems to manage the pandemic whilst maintaining its core functions of delivering essential health services. Therefore, governments should consider the effects of political challenges in supporting a country's health system to prepare for pandemics.

NIMART rollout to primary healthcare facilities increases access to antiretrovirals in Johannesburg: an interrupted time series analysis.

INTRODUCTION: South Africa has made remarkable progress in rolling out antiretroviral therapy (ART), with the largest number of people (more than 1.4 million) enrolled on antiretroviral in the world. Decentralisation of services to primary health centres (PHCs) has strengthened retention of patients on ART and reduced the burden of managing uncomplicated cases at referral hospitals. METHODS: This was a ten-step Nurse Initiation Management of Antiretroviral Treatment (NIMART) rollout intervention in which nurses from 17 primary healthcare facilities of Region F, City of Johannesburg, South Africa, were trained and mentored in NIMART by the Wits Reproductive Health and HIV Research Institute (WRHI) to commence patients on ART in their PHCs. A total of 20 535 patients initiated ART during the 30-month study period. Monthly initiations at both PHCs and referral clinics were monitored. To test the statistical significance of the impact of NIMART rollout on the referral hospital initiations and Region F monthly initiations, interrupted time series analysis was applied. FINDINGS: Ten-step NIMART was applied, with the first step being establishment of NIMART as a priority in order to obtain primary buy-in by the Department of Health (DoH) and City of Johannesburg (CoJ). Forty-five professional nurses were trained in NIMART by WRHI quality improvement mentors. By the end of September 2011, all 17 PHCs in Region F were initiating patients on ART. Total initiations significantly increased by 99 patients immediately after NIMART rollout (p=0.013) and continued to increase by an average of 9 every month (p=0.013), while referral facility initiations decreased by 12 (p=0.791) immediately after NIMART and then decreased by an average of 18 every month (p=0.01). CONCLUSION: In this study, decentralisation of ART initiation by professional nurses was shown to increase ART uptake and reduce workload at referral facilities, enabling them to concentrate on complicated cases. However, it is important to ensure capacity building, training and mentoring of nurses to integrate HIV services in order to reduce workload and provide a comprehensive package of care to patients. Engaging and having buy-in from DoH/CoJ partners in rolling out NIMART was crucial in increasing outputs as well as for sustainability of the NIMART programme.