PROGRESS ON KEY INDICATORS 2012-2014 - SANACsanac.org.za/wp-content/uploads/2015/11/MP-Progress-Report-Key-NS… · PROGRESS ON KEY INDICATORS 2012-2014 PROGRESS ON KEY INDICATORS

PROGRESS ON KEY INDICATORS 2012-2014


MPUMALANGA PROVINCIAL STRATEGIC PLAN FOR HIV, TB AND STIS

(2012-2016)


Page 1 of 19

Introduction

The 2012-2016 Mpumalanga Provincial Strategic Plan (PSP) is aligned to the National

Strategic Plan (NSP) 2012-2016 whose vision is “zero new infections, zero AIDS deaths and

zero discrimination”. The purpose of the PSP is firstly, to provide clear guidance for the

province, the districts, NGOs, and the private sector, to enable them to work in a

collaborative manner in achieving the ultimate goal of eliminating HIV infection and reducing

the impact of AIDS in Mpumalanga Province. Secondly, it is to articulate, disseminate, and

provide education to the public at large on agreed provincial priorities and strategies within

the scope of Vision 2016.

To achieve the identified goals and objectives the PSP put emphasis on the need for a

coordinated approach to implementation and management of the provincial response. To

that end, clearly delineated roles of the AIDS Councils at provincial, district and local levels

were identified. The process through which the 2012-2016 PSP was developed reflects the

importance placed upon the need for a multi-sectoral response to the burden of AIDS. Figure

1 shows that a combined review of the 2007-2011 NSP and the 2009-2011 PSP was

conducted to ensure a synergetic approach to fighting HIV, STIs and TB. Results from the

combined NSP and PSP review inevitably influenced the form and shape that the PSP under

review would ultimately take without losing focus of the provincial needs, priorities and

uniqueness.


Page 2 of 19

NSP 2012-16

PSP 2012-16

POP2012-16

PSP Review 2009-11

NSP Review2007-11

M&E Plan

Civil Society

District AIDS Councils

M&E Plan

Figure 1: Strategic Framework informing the 2012-2016 PSP

In line with the need for a coordinated multi-sectoral approach to fighting HIV, STIs and TB,

the Mpumalanga province identified the civil society sector, in addition to the AIDS councils,

as an important stakeholder. These are important stakeholders as they provide a

comprehensive infrastructure required to rollout and implement programmes targeted at

impacting the overall PSP goal. The provincial operational plan (POP) developed sought to

operationalize the broader strategy of the province by breaking it into implementable priority

activities. An M&E plan supported by a management information system (MIS) was identified

as a critical piece of the process of monitoring progress towards the achievement of the PSP

goal. Other external instruments and guidelines that influenced the development of the PSP

were the United Nations General Assembly Special Session (UNGASS), the Millennium

Development Goals (MDGs) and the National Service Delivery Agreement (NSDA), inter

alia.

Strategic Objectives

In alignment to the NSP, the Province has decided on the following strategic goals:

1. Acceleration of prevention interventions in order to reduce the rate of new HIV and TB

infections and deaths by 50%


Page 3 of 19

2. Improvement of access to comprehensive treatment, care and support services to 80% of

all eligible people living with HIV, STIs and TB; 70% of them being alive 5 years following

initiation of treatment

3. Mitigation of the socio-economic impacts of HIV, STIs and TB, especially among the most

vulnerable groups such as orphans and children, PLHIV and their caregivers and/or

families, and guarding against any form of discrimination and stigmatisation

4. Strengthening the capacity of all sectors and the Mpumalanga AIDS Council (MPAC) to

respond effectively to the priority goals that have been established.

These strategic goals were to be achieved through the prioritised implementation of the

following broad activities:

1. Increase HIV awareness throughout all sectors particularly in the high risk populations

such as the youth and farm workers

2. Intensify case finding and follow up through screening for HIV, STIs and TB

3. Intensify HCT campaigns and testing in clinical settings through provider initiated

counselling and testing

4. Maintain the health and wellness of all citizens

5. Utilise combination prevention strategies to maximize HIV prevention

6. Promote the core values of the South African constitution to mitigate stigma,

discrimination and related behaviours

7. Strengthen the MPAC, DACs, and the LACs to promote a multi-sectoral approach to HIV,

STIs and TB prevention, treatment and support.


Page 4 of 19

Impact Indicators in Mpumalanga Province

NSP Goals Indicator

Reducing new infections by at least

50% using combination prevention

approaches

MTCT rate (six weeks and 18 months) 2.1%1

HIV prevalence among women and men

aged 15-24

21.8%2

HIV Antenatal Prevalence among

women aged 15-49

36.7%3

HIV Incidence 1.4%4

Total number of New HIV Infections (2 years +) 28,0005

Initiating at least 80% of eligible

patients on ART with 70% alive and

on treatment 5 years after initiation

Total number of patients initiated on

treatment

270 9956

Patients alive and on treatment 243 3747

HIV mortality 5.1%8

Reducing the number of new

infections and deaths from TB by

50%

TB Incidence 9453 new cases9

TB mortality 10.6%10

1 Mpumalanga Departmenet of Health Annual Report 2013/2014. 2 Shisana O, Rehle T, Simbayi LC, et al. South African National HIV Prevalence, Incidence and Behaviour

Survey, 2012. Cape Town: HSRC Press; 2014.

3 The 2012 National Antenatal Sentinel HIV and Herpes Simplex type-2 prevalence Survey, South

Africa, National Department of Health: Pretoria.

4 Spectrum 2013

5 Ibid

6 Mpumalanga Departmenet of Health Annual Report 2013/2014. 7 Ibid

8 Statistics South Africa. Mid-year population estimates 2013. Pretoria: Statistics South Africa; 2013a

9 ETR.NET 2013

10 Statistics South Africa. Mid-year population estimates 2013. Pretoria: Statistics South Africa; 2013a


Page 5 of 19

Goal 1: Reducing new infections by at least 50% using combination

prevention approaches

National HIV prevalence was estimated at 12.2% in 2012 (95% CI: 11.4-13.1). In 2008

prevalence was estimated at 10.6% indicating an increase of 1.6%. Mpumalanga recorded

the HIV prevalence 35.6%, above the national estimate of 29.5%. The province remains the

second province with the highest HIV prevalence after Kwa-Zulu Natal. The graph below

presents the trends of HIV prevalence in Mpumalanga from 2002 to 2012.

Figure 2: HIV prevalence in Mpumalanga (2 years and older) 2002, 2005, 2008 and 2012.

Source: South African National HIV Survey, 2012

Figure 2 above shows that the HIV prevalence for people 2 years and older in Mpumalanga

took a curvilinear shape from 2002 to 2012. It shows a steady increase from 2002 to 2008

when it reached its high and dropped from 15.4% in 2008 to 14.5% in 2012. The drop could

be attributed to intensified and coordinated efforts to fight HIV, STIs and TB in the province

and nationally. While there is a drop in prevalence among this population, the drop is yet to

reach the level it was estimated to be in 2002. This trend was similar to that observed among

the 2-14 age-group although this group registered a drop as early as 2008. The prevalence

for this group was 3.7% (2002), 5.4% (2005), 3.8% (2008) and 1.7% (2012). This shows

some significant gains and strides made in the prevention-of-mother-to-child transmission as

a result of mother-baby pair tracking from birth to 18 months.


Page 6 of 19

Percentage distribution of HIV prevalence by district in the Mpumalanga Province

The district level variations in the HIV prevalence over the past three years are depicted in

Table 1 and Figure 3 below. Two districts in the Mpumalanga province: Gert Sibande and

Ehlanzeni recorded the 12th highest HIV prevalence among the 52 health districts in the

country in 2012. Gert Sibande antenatal HIV prevalence has significantly declined from

46.1% in 2011 to 40.5% in 2012, a decrease by 5.6%. On the other hand, Nkangala

antenatal HIV prevalence has increased from 29.6% in 2011 to 32.1% in 2012, though still

the lowest in the province11.

Table 1: HIV prevalence among antenatal women by district, Mpumalanga, 2010 to 2012.

Mpumalanga 2009 (%) 2010 (%) 2011 (%)

Provincial 35.1 36.7 35.6

Ehlanzeni 37.7 35.8 35.1

Gert Sibande 38.2 46.1 40.5

Nkangala 27.2 29.6 32.1

Figure 3: HIV prevalence among antenatal women by district, Mpumalanga, 2010 to 2012.12

11 The 2012 National Antenatal Sentinel HIV and Herpes Simplex type-2 prevalence Survey, South

Africa, National Department of Health: Pretoria

12 Ibid


Page 7 of 19

A decrease is realised in HIV prevalence among young women in the age group 15 to 19-

year-old group, from 17.4% in 2010 to 14.0% in 2011 to a very slight increase 0.4% in 2012

(Table 2). Data in the table below also shows that HIV prevalence was high among the 30 to

34-years-old age group. The 45 to 49-years-old age group registered a significant decrease

that is consistent from 2010 to 2012, dropping from 37.5% to 20.0%.

Table 2: HIV prevalence among antenatal women by age group, Mpumalanga, 2010 to 2012.

Age Group (Years) 2010 2011 2012

<15 22.2 12.5 0.0

15-19 17.4 14.0 14.4

15-24 25.6 25.0 23.7

20-24 32.0 32.8 30.8

25-29 46.1 48.9 48.4

30-34 53.6 53.8 49.7

35-39 38.7 52.6 48.0

40-44 30.9 34.0 40.0

45-49 37.5 24.0 20.0

>49 ** ** **

HIV Incidence

The 2012 HSRC survey estimates that nationally over the period mid-2011 to mid-2012

there were approximately 469 000 new infections (95% CI: 381 000–557 000) in the

population aged 2 years and older. This translates to 1.1% estimated incidence for that

period. There are no recently published estimates of HIV incidence in adults by province.

However, a number of earlier models have produced estimates of HIV incidence by

province, and these estimates are summarised in Table 3 below. Differences in HIV

incidence trends by province are important in identifying variations in changes in the

epidemic, including potential influence of HIV prevention programmes. The earlier Spectrum

and ASSA 2008 estimates of adult HIV incidence both suggested that incidence was

second-highest in Mpumalanga after KwaZulu Natal. In 2013, spectrum estimated incidence

in Mpumalanga at 1.4% translating to 28 000 actual new infection.


Page 8 of 19

Table 3: Estimates of HIV Incidence by Province.13

HIV incidence in children

Mother to child HIV transmission is characterised by transmission occurring at or before the

time of birth or after birth through breastfeeding. Reports have shown best performance and

significant strides for PMTCT programme for the two years under review as more babies

were born free from HIV infection. A dramatic decline was shown in the prevention of Mother

to Child transmission between 2012/13 and 2013/14 where the response towards HIV born-

free infants at 6-8weeks was found to be between 2.3% and 3%. This is attributable to the

introduction of Dual Therapy when AZT was commenced from 28 weeks of gestation and

single-dose Nevirapine was given in labour whilst HAART was being provided for women

with CD4 counts of less than 200.

13 South African National AIDS Council. Progress Report on the National Strategic Plan for HIV, TB

AND STIs (2012 – 2016). Pretoria: South African National AIDS Council; November 2014.


Page 9 of 19

Goal 2: Initiating at least 80% of eligible patients on antiretroviral

treatment (ART), with 70% alive and on treatment five years after

initiation

This indicator is concerned with coverage, effectiveness and impact of the ART programme.

Flowing from the country’s national strategic plan for HIV, STIs and TB 2012-2016, the

Department’s strategic objectives were to scale up combination prevention interventions to

reduce the rate of new infections, and to improve the quality of life of people living with HIV,

by providing a comprehensive package of care, treatment and support services to at least

80% of people living with HIV and AIDS.

Data from the DHIS has shown that in 2012/13 year, antenatal clients initiated on ART were

6,139 tripling to 18,419 in 2013/14 year for the Mpumalanga province. The total number of

clients started on ART for the same periods were 57,186 and 61,228 respectively. The

cumulative total of those currently on treatment for the same periods increased from 209,714

in 2012/13 to 243,374 in 2013/14.


Page 10 of 19

Goal 3: Reducing the number of new TB infections and deaths from

TB by 50%

The table below indicates that Mpumalanga’s TB cure rate is estimated to be 69.9%. Those

who died as a result of TB were at 6.7% which puts Mpumalanga at fifth position across the

country. While a commendable achievement, the province TB cure rate is below the national

average of 74.2%. About 5.9% were estimated to have been lost to follow-up. This indicates

the need for strengthened efforts for referral and retention of clients in care.

Table 4: TB treatment outcomes

Treatment Outcomes: 2011 - New Smear Positive TB cases (Source: ETR.Net 2013)

Prov. SS +

Cases

Cured Success Failed Died Lost to follow

up

Transferred Not

Evaluated

No. % No. % No. % No. % No. % No. % No. %

EC 21,541 14,575 67.7% 16,818 78.1% 344 1.6% 1,459 6.8% 1,651 7.7% 1,195 5.5% 74 0.3%

FS 8,966 6,491 72.4% 6,964 77.7% 215 2.4% 884 9.9% 424 4.7% 441 4.9% 38 0.4%

GP 22,495 18,233 81.1% 18,421 81.9% 343 1.5% 1,241 5.5% 1,149 5.1% 975 4.3% 366 1.6%

KZN 34,078 25,249 74.1% 27,274 80.0% 649 1.9% 1,810 5.3% 1,970 5.8% 1,645 4.8% 730 2.1%

LP 8,648 6,513 75.3% 6,697 77.4% 175 2.0% 739 8.5% 406 4.7% 592 6.8% 39 0.5%

MP 9,453 6,608 69.9% 7,511 79.5% 185 2.0% 637 6.7% 555 5.9% 554 5.9% 11 0.1%

NW 9,668 6,662 68.9% 7,329 75.8% 159 1.6% 780 8.1% 742 7.7% 560 5.8% 98 1.0%

NC 3,610 2,469 68.4% 2,803 77.6% 96 2.7% 247 6.8% 262 7.3% 125 3.5% 77 2.1%

WC 14,790 12,038 81.4% 12,518 84.6% 265 1.8% 449 3.0% 1,015 6.9% 424 2.9% 119 0.8%

SA 133,249 98,838 74.2% 106,335 79.8% 2,431 1.8% 8,246 6.2% 8,174 6.1% 6,511 4.9% 1,552 1.2%


Page 11 of 19

Goal 4: Ensuring an enabling and accessible legal framework that

protects and promotes human rights in order to support

implementation of the NSP.

Chapter 2 of the South African Constitution makes provision for the protection and promotion

of human rights and obliges the state to ensure the realisation of such rights particularly for

specific vulnerable groups. These rights include amongst others, the rights to equality,

dignity, life, freedom, privacy and security of the person, irrespective of sexual orientation. In

line with this provision, the Mpumalanga province emphasised the need for programming

that is sensitive and targeted at such groups of people as women (pregnant, with child-

bearing potential or post-menopausal), men, adolescents, children, sex workers, LGBT,

MSM and persons with disabilities.

Goal 5: Reducing self-reported stigma related to HIV and TB by at

least 50%.

The stigma index is the indicator for measuring this goal; the index is currently not measured

in the DHIS. SANAC is driving efforts to implement the stigma index to monitor efforts to

reduce stigma and discrimination and meet this fifth goal of the NSP. Local government

departments continue to deliver stigma and discriminating reduction programmes in line with

the NSP goals and objectives.


Page 12 of 19

Strategic objective 1: Addressing social and structural drivers of

HIV, STI and TB prevention, care and impact

Social and structural approaches address the social, economic, political, cultural and

environmental factors that lead to increased vulnerability. As pointed out in the NSP, every

government department — at national, provincial and municipal levels — has a critical role to

play in addressing the structural factors driving HIV and TB. There was a high proportion of

women who have experienced physical or sexual violence in both financial years 2012/13

(60.3%) and 2013/14 (62.4%) as shown in the table below based on data from the district

health information system (DHIS). While the proportion is high, it may be an indication of the

progress and successes of community mobilisation efforts in the province resulting in more

people aware of their rights and not afraid to report cases of violence to the police.

Indicator Baseline Values Provincial

Target

Values

Data Source Achieved

2012/13

Achieved

2013/14

Delivery rates under 18 – NIDS To be determined

in 2012

10.5

(2012/13) <

10.51%

(2013/14)

Mpumalanga

Department of

Health Annual

Report(2013/14)

8.9 % 9.1%

Number of women and children reporting gender-

based violence (GBV) to the police in the last year

To be determined

in 2012

…………

(2012/13)

……….

(2013/14)

Crime Research

and Statistics -

South African

Police Service

4267 3953


Page 13 of 19

Strategic Objective 2: Preventing new HIV, STI and TB infections

"Targeted, evidence-based combination prevention is needed to achieve the long-term goal

of zero new HIV, STI and TB infections. Focusing prevention efforts in high transmission

areas and on key populations is likely to have the greatest impact, whilst simultaneously

sustaining efforts in the general population." (SANAC, 2011a: 39). A Combination Prevention

approach (ibid.) acknowledges that no prevention intervention on its own can adequately

address the HIV and TB epidemics at the population and individual levels. Combination

prevention uses a mix of structural, social, behavioural and biomedical interventions that,

when implemented simultaneously, will have the greatest power to reduce transmission, as

well as mitigate individuals’ susceptibility and vulnerability to infection.

Reach of HCT Programme and TB Screening in the province

Following the launch of the HCT campaign in 2010 and the subsequent annual efforts at

national level to ensure a wider reach and coverage with HCT services, the Mpumalanga

province has made good progress for the period 2012/13 and 2013/14. During 2012/13,

566 696 people were reached with HIV counselling and testing services. Although a slight

decrease was recorded in the 2013/14 financial year with 556 782 people reached, the

provinces is already over achieved its cumulative target (900,000) for the PSP period 2012-

2016. The multi-sectoral approach in reaching people with HCT services should be

maintained for the rest of the PSP period. In terms of population coverage of TB screening,

data obtained from the DHIS indicate that the province screened an estimated 112 842

people representing 84% of the financial year 2012/13 target. Continued efforts should be

put on screening for TB all health facility clients.

Reach of male condom distribution

In terms of male condom distribution, the province achieved about 86% of its 2012/13

financial year target. This is a commendable achievement. Based on the 2012/13

performance, the target for 2013/14 financial year was increased to 60,000,000 condoms

distributed. This was a 25% increase from 48,000,000. In 2013/14, the province fell short of

the target by 33%.

Reach of Male medical circumcision

In accordance with Voluntary Male Medical Circumcision (VMMC) policy of South Africa

there is a need to upscale this programme and reach more men as this is regarded as one of

the effective strategies to reduce HIV transmission amongst men. In line with the national

proposal of reaching more men in 2015, the Mpumalanga Province achieved over 99% of its


Page 14 of 19

target for male medical circumcision in both financial year 2012/13 and 2013/14. The

province reported 49 609 males medically circumcised in financial year 2012/13 and 42,604

in financial year 2013/14.


Page 15 of 19

Indicator Baseline Values Provincial Target

Value


2012/13

Achieved

2013/14

Number (and percentage) of men

and women 15–49 counselled and

tested for HIV

13 million (HCT Review

Report); 62% ever tested,

37% tested in the past 12

months (2008 NCS)

900 000 (2012-

2016)

90% (2012-

2016)

Mpumalanga PSP (2012-

2016)

Mpumalanga Department of

Health Annual Report

(2013/14)

566 696 556 782

Number and percentage of people

screened for TB

Eight million(2011 HCT

Review)

DHIS 112 842

84%

Number of newly diagnosed HIV

positive people started on IPT for

latent TB infection

53%(2011 HCT Review) 50%(2012/13)

60% (2013/14)

DHIS



(2013/14)

38 214

28,4%

43 947

95,8%

% men and women aged 15–24

reporting the use of a condom

with their sexual partner at last

sex

40% (NCS 2008) HSRC,2012 39.4%

% young women and men aged

15–24 who had sexual intercourse

before age 15 (age at sexual

debut)

10% (UNGASS Report

2010)

HSRC,2012 7.7%

% women and men aged15–49

years who have had sexual

intercourse with more than one

partner in the last 12 months

7% (UNGASS Report 2010) HSRC,2012 13.7

Male condom distribution 492 million(2010/11) 48, 000, 000

APP(2012/13)

60 000 000 APP

(2013/14)

APP (2012/13 to 2014/15)



(2012/13 & 2013/14)

41 149

000

40 317

964

(29.3%)

Female condom distribution 5,1 million(2010/11) 100,000

APP(2012/13)

50,000

APP(2013/14)

APP (2012/13 to 2014/15)



(2012/13 & 2013/14)

600 918 1 194 475

(0.8%)

Number of men medically

circumcised

143 000 (2010/11) 50 000 (2012/13)

10 000 (2013/14)

APP(2013/2014)



(2012/13 & 2013/14)

DHIS

49 609 42 604

Number of people reached by

prevention communication at

least twice a year

To be determined in 2012 NCS 84%


Page 16 of 19

Strategic objective 3: Sustaining health and well being

Morbidity and Mortality

As part of their contribution to the work of Health Data Advisory and Co-ordination

Committee (HDACC), the Medical Research Council (MRC) of South Africa and the School

of Actuarial Sciences at the University of Cape Town (UCT), released data from the Rapid

Mortality Surveillance (RMS) system on four key outcome indicators for South Africa in

August 2012. The data reflected that the life expectancy of South Africans has increased

from 56.5 years in 2009 to 60 years in 2011. The Infant Mortality Rate (IMR) decreased from

40 deaths per 1000 live births in 2009 to 30 deaths per 1000 live births in 2011; and the

Under-5 Mortality Rate decreased from 56 deaths per 1000 live births in 2009 to 42 deaths

per 1000 live births in 2011. These achievements far exceeded the targets set for 2014 in

the NSDA of the Health Sector for 2010 to 2014. Undoubtedly, more work still needs to be

done to fight maternal and infant mortality, however, the NDoH report points to the fact that

South Africa should recognise and leverage these profound achievements as a celebration

of the unity of purpose and the high value our nation places on the wellbeing and

productivity of its children, mothers, workers and society at large.

Control and management of Tuberculosis in the province

Based on data obtained from the ETR.Net system, the Mpumalanga TB programme has

been largely successful. Inter-sectoral collaboration is very crucial towards winning the battle

against the scourge of HIV and AIDS, TB and STI. At sub-national level this needs to be

elevated for the purpose of monitoring and evaluation of HIV and TB programmatic activities

as well as reducing infection rates and the related burden of diseases affecting our

communities. Against a target of 80%, the province achieved 90% TB case detection rate in

financial year 2012/13. While the province increased its smear positive TB case treatment

rate in financial year 2013/14 to 80%, it fell short of the >85% target for that year.

Consistently, the TB case fatality rate has been declining from a baseline of 7.1% to 6.7% in

financial year 2012/13 and 6% in financial year 2013/1414.

14 Mpumalanga Departmenet of Health Annual Report 2013/2014.


Page 17 of 19

Indicator Baseline

Values

Provincial

Target

Values


2012/13

Achieved

2013/14

% people per year becoming eligible who

receive ART

58% DHIS 100,5%

TB case registration rate 708/100 000 Mpumalanga

Department of

Health Annual

Report,

(2012/13)

ETR.net

676/100 000 570/100 000

TB case detection rate 72%

(2010,WHO)

80% ETR.net 90 %

% smear positive TB cases that are

successfully treated

73% smear

positive

78.5%

(2012/13)

>85%

(2013/14)

Mpumalanga

Department of

Health Annual

Report

(2012/13 &

2013/14)

ETR.net

79.2% 80%

TB case fatality rate (CFR) 7,1% Mpumalanga

Department of

Health Annual

Report,

(2012/13 &

2013/14)

ETR.net

6.7% 6.0 %

Number and percentage of registered TB

patients who tested for HIV

54% (2010

WHO)

DHB

(2013/14)

Mpumalanga

Department of

Health Annual

Report,

(2013/14)

ETR.net

10 991 (85%)

Number of all newly registered TB patients

who are , expressed as a proportion of all

newly registered TB patients

60% (WHO) ETR.net 60.5% Not available


Page 18 of 19

Indicators to be reported on by Mpumalanga AIDS Council

Strategic Objective 1

Number of women and children reporting gender-based violence (GBV) to the police

in the last year

Proportion of women who have experienced physical or sexual violence in the last

year

Current school attendance among orphans and among non-orphans aged 10-14

(UNGASS and MDG indicator)

% municipalities with at least one informal settlement where targeted comprehensive

HIV, STI and TB services are implemented

% government departments and sectors with operational plans with HIV, TB and

related gender- and rights-based dimensions integrated


% men and women aged 15–24 reporting the use of a condom with their sexual

partner at last sex

% young women and men aged 15–24 who had sexual intercourse before age 15

(age at sexual debut)

% women and men aged15–49 years who have had sexual intercourse with more

than one partner in the last 12 months

Number of people reached by prevention communication at least twice a year


% people per year becoming eligible who receive ART

Substance abuse.

Implementing interventions to address gender norms and gender-based violence.

Mitigating the impact of HIV, STIs and TB on orphans, vulnerable children and

youths.

Reducing the vulnerability of young people to HIV infection by retaining them in

schools, and increasing access to post-school education and work opportunities.

Reducing HIV- and TB-related stigma and discrimination.

Strengthening community systems to expand access to services.

Supporting efforts aimed at poverty alleviation and enhancing food-security

programmes.

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