Access to treatment for HIV/AIDS in Zimbabwe has improved in recent years, but remains limited for certain vulnerable groups.
Children with HIV have particular difficulty in obtaining appropriate care. Staff shortages, restricted clinic hours, high fees and long distances to facilities are some of the barriers that patients face. Médecins Sans Frontières (MSF) has worked with the health authorities to develop integrated care in government health facilities, decentralising diagnosis and treatment to help meet people’s needs close to home.
In Epworth, Harare, MSF focuses on paediatric and adolescent HIV and tuberculosis (TB), and on providing treatment to patients whose standard HIV or TB treatment has failed. More than 2,660 patients under 20 were tested for HIV and more than 200 were started on treatment. Routine HIV and TB management was handed over to the health ministry in 2014 after more than a year of building up the necessary staff capacity.
MSF’s HIV–TB programmes in Buhera, Gutu and Chikomba concentrated on staff training and mentoring, and provided technical and material support to local health centres to implement new World Health Organization guidelines and increase access to routine viral load monitoring. Testing and antiretroviral (ARV) treatment is now available to everyone and has been decentralised to all clinics in the three supported districts. MSF continued to implement patient-friendly models of care to relieve the pressure on health centres. By the end of the year there were 72 community ARV groups in Gutu, with a total of 477 members, who take turns in picking up drug refills for each other. New strategies were also tried in Gutu to increase the number of people taking HIV tests, including weekly night clinics and testing and counselling campaigns directed at young people or linked with sporting events.
MSF also continued to support viral load testing at the central hospital in Harare, which enables the monitoring of patients on ARVs. UNITAID financed the viral load testing machine and covered its running costs, whilst MSF piloted the implementation. A total of 35,439 tests were conducted in 2014.
In Nyanga district, HIV and TB care was decentralised to 18 out of a total of 21 clinics in 2014.
Psychiatric care in prisons
MSF provides diagnosis and treatment of male and female inmates with mental illness at Chikurubi maximum security prison, Harare. Staff in 10 prisons are also receiving training on the appropriate diagnosis and management of mental illness. MSF ensures that diagnosis and treatment for HIV and TB is available in the prisons via the Ministry of Health.
Sexual violence programme
Sexual violence is a critical issue in Zimbabwe, which MSF continues to address. In Mbare, Harare, MSF’s clinic for victims of sexual violence offers free medical care, and counselling and referrals for further psychological, social and legal support.
MSF’s project in the rural district of Gokwe North decentralised and improved medical care for people with HIV and TB and victims of sexual violence through two hospitals and 18 healthcare facilities. After three years, during which time 12 facilities obtained accreditation as ARV initiation sites and another six as ARV follow-up sites, the project was handed over to the Ministry of Health and Child Care, as the initial objectives had been achieved. In Harare, MSF has also supported the ministry to decentralise these services, which are now available at six health centres. The team’s recent focus had been on improving care for children with HIV and more complicated cases of HIV and TB. The project was handed over to the ministry in October, as they had the capacity to offer the necessary medical care.
After more than nine years working on HIV in Tsholotsho, the HIV project was handed over to local health authorities in November. The programme had achieved its overall goal of treating HIV/AIDS and reducing transmission and related morbidity and mortality. By the end of August, more than 10,400 people were on ARVs, 85 per cent of all people in need of HIV treatment in the district.
No. staff in 2014: 362 | Expenditure: €13.6 million | Year MSF first worked in the country: 2000 | msf.org/zimbabwe