hiv/aids prevention in zimbabwe

SITUATIONAL ANALYSIS OF
HIV/AIDS PREVENTION AND
CONTROL IN ZIMBABWE
Chengdu Sichuan China
2-22 june 2011

Session 1: Welcome and Course Overview Slide 1

Introduction
• Southern africa is the epicentre of the HIV
epidemic
• 30% of PLWHA are in southern africa of
which we contribute only 2% to the world’s
population
• Zimbabwe is central to this epidemic
geographically and pandemically


Global HIV Epidemiology
Western and Central Eastern Europe and
Europe Central Asia
730 000 1,5 million
North America [580 000 – 1,0 million] [1,1 – 1,9 million]
1,2 million East Asia
[760 000 – 2,0 million] Middle East and N.
Africa 740 000
Caribbean [480 000 – 1,1 million]
380 000
230 000 [280 000 – 510 000]
South and Southeast
[210 000 – 270 000]
Sub-Saharan Africa Asia
22,0 million 4,2 million
Latin America [3,5 – 5,3 million]
[20,5 – 23,6 million]
1,7 million Oceania
[1,5 – 2,1 million]
74 000
[66 000 – 93 000]

Total: 33 million (30 – 36 million)
Source: UNAIDS report,
2008

Global HIV Epidemiology (2)

33 Million People Living with HIV Worldwide,
2007 [Range: 30-36 million]

Session 1: Welcome and Course Overview OMS, 2008
Slide 4

Country profile
• Zimbabwe is a landlocked country
bordered by Zambia to the north,
Botswana to the west, South africa to the
south and mozambique.
• Population : 12 121 565
• M : F ratio 1:1,08
• ANC coverage :93%
• Institutional deliveries : 68% (2010)
• Fertility rate :3.3

Background of the HIV epidemic
in Zimbabwe
• index case detected in 1985
• By end of the 80s 10% of the population
was infected reaching a peak of more than
33% between 1995-97
• Since the year 2000 zimbabwe has
experienced a phenomenal decline in HIV
prevalence to 13,7% in 2010
• Transmission modes – heterosexual-92%,
vertical -7% ,other- 1%

TRENDS IN ADULT PREVALENCE:1970-2009


TRENDS IN HIV INCIDENCE(15-49)


Factors which contributed to the
rapid spread and sustained high
prevalence
• high prevalence of STIs
• Low levels of male circumscion
• High rates of multiple concurrent sexual
relationships
• Incorrect or inconsistent condom use
• Low socio-economic status of women
• Distressed economic conditions
,population mobility and settlement
patterns

Factors attributed to the rapid
decline in HIV prevalence
• Implementation of the Zimbabwe National
HIV/AIDS strategic plan which declared
HIV a national emergency in 1999
• Enactment of the National AIDS Council
by an act of parliament
• Introduction of 3% AIDS levy on all taxable
income in all sectors.
• A multisectoral approach
• Gender sensetive approach

Cont...
• Meaningful involvement of PLWHA
• Well pakaged and targeted interventions
for high risk groups
• Robust BCC programme leading to a
massive cultural shift in sexual behaviour
• Rapid scaling up of PMTCT services


National HIV and AIDS
Programmes
• Testing and Counselling Programme
• STI Programme
• National Condom Programme
• Male Circumcision Programme
• PMTCT Programme
• OI/ART Programme
• TB Programme


PMTCT PROGRAM
• ANC sero-prevalence 16,1%
• 398,889 expected deliveries in 2010
– 94% received ANC (DHS)
– 68% deliver in Health Institutions
• 47,494 HIV infected pregnant women expected in
2010
• 14,976 new pediatric HIV infections in 2010
(90% from MTCT)


PMTCT Program Goal 2011-2015

• Elimination of Pediatric HIV by 2015
• Elimination campaign officially launched in
February by the MOHCW through EGPAF
• Overall elimination targets
– 90% reduction in new pediatric infections
– and; MTCT rate <5% by 2015


PMTCT TRENDS


% OF HIV POSITIVE WOMEN WHO
RECEIVED ART PROPHYLAXIS FOR
PMTCT


Current geographic coverage of
PMTCT/HTC SERVICES
Total ANC facilities: 1643

Total # of ANC providing PMTCT: 1560
(95%)

Comprehensive PMTCT 1200
(Both on site HIV testing & ARV prophylaxis)
Minimum PMTCT sites 360
(No on-site HIV testing but have ARV prophylaxis)

883 sites of all ANC sites in the 62 districts offer
MER while 366 sites collect DBS for HIV DNA PCR
(EID)

DNA PCR for Early infant diagnosis of HIV

2007 - 2010
YEAR Positive Negative TOTAL

2007 77 (31%) 245 322

2008 581 ( 38%) 1585 2 169

2009 901 (25%) 3597 4 498

2010 2373 ( 17%) 14159 16 532


Point of Care (POC) CD4 machines
• Recent evaluation of Point of Care CD4
machines
– No significant difference between POC and
laboratory based CD4 machines
– Nurses able to operate as well as lab
• Further roll out and
scientists
evaluation of the machines
under field conditions is
planned
• MOHCW has given go-ahead
to procure the machines

MER 14 plus extended infant prophylaxis

Mother
Infant Breastfeeding:
• AZT 300mg 12 hourly in • NVP from birth until
ANC (from 14 weeks or any one week after
time thereafter) cessation of
• SdNVP 200mg at onset of breastfeeding
labour
• AZT 300mg+3TC 150mg 12
Infant Non-breastfeeding
hourly during labour and
• NVP for 6 weeks
delivery
• AZT 300mg+3TC 150mg 12
hourly for 7 days postpartum


HTC
• In an effort to increase HTC services, the
MOHCW has adopted a four delivery model:
Integrated model within public health institutions
Stand alone sites manned by NGOs
Private sector workplace model
Mobile outreach services
• Training of Primary Counselors
• Task Shifting in Rapid HIV Testing to nurses
and primary counselors
• 95 % of health facilities offering HTC services

600000 579767
535289
500000 477654
400000

300000 292941

200000
135000
100000 89000

0
2002 2003 2004 2005 2006 2007

ART Programme Goal
• To reduce mortality & morbidity, and
improve quality of life for PLWHA including
CLHWA
• Ultimate goal of ART Programme is to
provide Universal access to treatment

• First line – TDF/3TC/NVP (2010)
• Alternative- AZT/3TC/NVP


NEED FOR ART IN ADULTS 15+(CD4 350)


Targets OI/ART – 2009-2012
2009 2010 2011 2012

Adults 210,000 260,000 310,000 350,000

Paeds 20,000 25,000 30,000 36,000

01/22/13
Session 1: Welcome and Course Overview 25 Slide 25

Number of ART initiating sites, Zimbabwe, 2004-2008

120

100
Number of ART sites

80

60 Series2

40

20

0
2004 2005 2006 2007 2008
Year


Coverage and uptake for the ART
programme – June 2009
• 111 facilities initiating adult ART and 80
initiating pediatric ART
• 179 follow up clinics
• 56.1% coverage on ART (est. private
-10,000)
• 15,500 children on ART
• 1st line -95%, Alternate 1st line- 4 %, 2nd line
– 1%
Local manufacture of ARVs supplimenting

Male circumscion
• Male circumscion has shown to reduce a
man’s risk of HIV acquisition by up to
60%
• 750 000 new HIV infections could be
averted in Zimbabwe if 80% of men are
circumscised over the next 7years
• This would result in cumulative net
savings of more than 3.8billion during the
period up to 2025 and this require a rapid
scale up with a peak of 1.1million

Cont...
• If all other preventions are scaled up to
reach 80% coverage by 2015 with
maximum impact, adding a scaled up
programme of medical MC projects a
prevalence of < 4% by 2025
• 5 pilot sites : 4 stand alone
• : 1 intergrated
• Priority pop- 13-49yrs, male , newborn
males and males at higher risk of
exposure

Cont...
• Service delivery models- hospitals, clinic,
outreach, mobile van, public, private,
NGOs and others
• Task shifting and task sharing- surgeon -
GP -clinical officer
• Forceps guided method
• MOVE method
• Demand creation eg. school campaigns
on school breaks

MC at clinic level


Group counselling before MC
outreach site


TB programme
• Reducing the burden of TB in PLWA
• Reducing the burden of HIV in TB pts
• Stop TB strategy
• 60% of PLWA develop TB and 80% of TB
pts are HIV positive


Best practices
• Leadership and political committiment
• GOZ continues to provide a strong political committiment
to respond to the HIV epidemic

• testing and counselling : HTC campaigns

• Family approach to HIV/AIDS services

• Decentralisation of HIV/AIDS services to all primary health
care facilities


Continued success
• Impementation of the ZNASP II 2011-2015
will ensures zimbabwe achieves continued
success in the fight against HIV
• Some of the targeted interventions within the
ZNASP II include the following
• i) working torwards reducing annual HIV
death toll to 59000 by 2015 (66000 current)
• ii) reducing new HIV infections by at least 20
000 by 2015


Cont…
• iii) reducing HIV infected infants born to HIV
positive mothers from 30% in 2009 to <5% in
2015
• iv)reducing pregnant women aged 15-19 who are
HIV infected from 6.8% in 2009 to 6% in 2011 to
5% in 2013 to 4.5% in 2015
• v) circumcising 240 000 HIV negative men aged
15-29yrs annually between 2011 and 2015
• vi) expanded HTC and condom promotion
programmes anchored within targeted social and
BCC interventions

Felisiya Gwarazimba


Farayi .aka. Daddy Marufu


Blessing . Tachiona


Xie xie – Thank you
• Muchas gracias
• Merci beacoup!!
• Grazie
• Obrigado
• asante
• Tatenda!!


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