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Background and Justification
South Africa has made significant progress towards preventing Mother to Child Transmission (MTCT) over the last decade that has contributed to improved health outcomes for mothers and babies. The MTCT of HIV rate has declined from 6.24 per cent in 2014 to 4.1 per cent in 2018, preventing 53,000 new HIV infections among newborns. However, there are still remaining challenges that hinder the reach targets to full elimination of MTCT and access to pediatric and adolescent HIV & TB services:
- With the decline in the absolute number of new infections that occurred at or before birth, the post-natal period now accounts for 70 – 75 per cent of all the new HIV infections among exposed children. Children have not reached the desired and planned 90-90-90 targets; just 56 per cent of children under 15 needing ART were on treatment and 67 per cent were virally suppressed. For adolescents, 64 per cent of those aged 10-14 years and 44 per cent of the 15-19 years old were initiated on ART, which is far less than the targeted 95 per cent.
- Adolescent girls and young women (AGYW) in South Africa in particular face many challenges. Teen pregnancy, high-risk sexual practices, gender-based violence, drug and alcohol abuse and poverty placing them at higher risk of sexually transmissible infections and HIV/AIDS. Adolescent girls and young women aged 15-24 years (AGYW) remain at higher risk of new HIV infections. Although new infection among this group have declined from 80,000 in 2016 to 66,000 in 2019, the country still has the highest infection rates. AGYW are disproportionately impacted, for instance they have eight times higher HIV prevalence rates than their male counterparts. An explanation for this gender differential is that this vulnerability is fuelled by women’s socio-economic dependency position, the role of power in sexual relations and socio-cultural norms that encourage gender inequality, and prevalence of gender-based violence.
UNICEF worked with National Department of Health (NDOH) and relevant partners to review of routine programme and national laboratory data which showed that about 60% of HIV infections in children were coming from 14 districts (out of 52) in the country, across seven out of the nine provinces. These are districts with very large populations (e.g. Metros) or districts where there are high levels of MTCT. Some of the issues contributing to the high burden of HIV infections include poor adherence, poor retention in care and loss to follow up leading to inadequate viral load suppression and unsafe breast-feeding practices, especially among adolescent girls and young women (AGYW) including those pregnant and breastfeeding. The findings of the 2019 joint review of the HIV, STI, TB and PMTCT program especially identified data issues, reporting systems, weak linkages between community and facilities as bottlenecks hindering the performance of the health care systems and emphasizes the need to pay more attention (monitoring implementation and performance) to the high transmission districts (focus for impact) and at the same time monitoring the rest of the districts.
UNICEF’s Health and Nutrition programme contributes to national efforts to prevent new HIV infections, specifically among pregnant adolescent girls and young women, provide treatment and care to adolescents living with HIV, as well as to eliminate mother-to-child transmission of HIV (eMTCT). This includes supporting Government with the design, implementation, monitoring and evaluation of innovative and sustainable high impact combination prevention and treatment interventions for adolescents and young people. In addition, UNICEF has worked with UNFPA and government counterparts to develop a Joint program that focuses on improving SRH and reducing Gender Based Violence (GBV) among vulnerable AGYW (ages 15-24) in Alfred Nzo, uThukela and Nelson Mandela districts.
Scope of Work
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