Zimbabwe HIV Self-testing presentation

1. HIV Self-Testing to address the
testing gap in Zimbabwe
Dr Owen Mugurungi
Director AIDS and TB program
Ministry of Health and Child Care Zimbabwe
Status and Future for HIVST Meeting
BMGF
Seattle , 27th of February 2015

2. Background
• Population: 12, 9m
• 1, 39 m PLHIV including
170,717 children
• HIV Prevalence: 15%, 15-49
yrs.
– Female 18%
– Male 12%
• General decline in HIV
incidence from 1.42 in 2011,
1,07 in 2013 and 0.9 in 2016
• # PLHIV requiring ART in
2014
– 1,207,175 (CD4 <500)
– 101,106 children
HIV Prevalence by sex, age
group 15-49

3. 3
Staveteig et al, DHS Comparative Reports, 2013
13% - 76%8% - 69%
In Zimbabwe, only 57% of adult women and 34% of
adult men have ever had an HIV test and received
results, according to the ZDHS 2010/11
Too few take a test and receive their
result

4. HIV testing uptake
40% 36%
57%
66%
0%
20%
40%
60%
80%
100%
120%
Early Infant
Diagnosis
Males 15‐49
yrs
Females 15‐
49 yrs
PLHIV
Don’t Know Status
Know HIV status
ZDHS 2010/11

5. Zimbabwe cascade of the UNAIDS 90-90-90
Targets
PLHIV
73%81%90%100%
1,400,000
1,260,000
1,134,000
1,020,600
Identified
as Positive

6. HIV Testing Models
• 1.7 Million HIV tested
annually
• PITC provided in 1445 (out of
1625) health institutions
• CITC provided through PSI’s
16 New Start centres & 25
mobile outreach contributing
about 23% to the annual
national HIV testing outputs

7. 7
Home-Based
• Community
through the
Campaigns
• Index cases
• Door to door
• Self Testing
Campaigns plus
(+) integration
• HTC + malaria,
safe water,
non-
communicable
diseases
Outreach (e.g.
mobile)
• General
populations
• Key populations
Institutions i.e.
workplaces &
Schools
• Reach out to
places with
concentrated and
easy to reach
populations
Moving testing:
Out of the facility & into the
community
Community-Based HTC

8. National Data
Jan‐Sept 2014
Provincial Data
Jan –Sep 2014

9. HIV Self-Testing Rationale
• HIV Self‐testing to complement current HTC strategies (PITC and
CITC) to reach treatment goal
• Specific questions/concerns around HIV testing and self‐testing:
• How to promote testing among key populations currently
underrepresented in HIV testing and repeat testing
• How to encourage regular repeat testing
• How to ensure that people who self –test access treatment and care
services or are linked to HIV prevention, such as Male Circumcision
• Evidence to support use of self testing and explore how it could most
usefully be implemented
• Potential Social Harms
• Cost‐effectiveness
• Regulated access to self test kits
• Policy support for HIV self‐testing

10. HIV Self‐Testing Introduction
• OraQuick Advance has been validated for use
with oral fluids in Zimbabwe
• HIV Self‐Testing included in the new recently
launched HIV Testing and Counselling Guidelines
• HIV Self‐Testing Steering Committee
• HIV Self‐Testing pilot study collaboration with
PSI/CeSSHAR/RTI
– Acceptability
– Feasibility
– Accuracy
– Linkage into care, treatment and prevention

11. HIV Self‐Testing Study
Aims and Methods

12. Study Timelines
• Anticipate completion of supervised testing in
February
• Observational study to start early March
• Linkage to care data will be available in June
• Results to feed into UNITAID HIV STAR PROJECT
planned to start in June

13. Thank You