hiv/aids prevention in zimbabwe

Session 1: Welcome and Course Overview Slide 1

Chengdu Sichuan China

2-22 june 2011

SITUATIONAL ANALYSIS OF HIV/AIDS PREVENTION AND CONTROL IN ZIMBABWE


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

Total: 33 million (30 – 36 million)

Western and Central Europe730 000730 000

[580 000 – 1,0 million][580 000 – 1,0 million]

Middle East and N. Africa

380 000380 000[280 000 – 510 000][280 000 – 510 000]

Sub-Saharan Africa22,0 million22,0 million

[20,5 – 23,6 million][20,5 – 23,6 million]

Eastern Europe and Central Asia1,5 million 1,5 million [1,1 – 1,9 million][1,1 – 1,9 million]

South and Southeast Asia

4,2 million4,2 million[3,5 – 5,3 million][3,5 – 5,3 million]

Oceania74 00074 000

[66 000 – 93 000][66 000 – 93 000]

North America1,2 million

[760 000 – 2,0 million]

Latin America1,7 million1,7 million

[1,5 – 2,1 million][1,5 – 2,1 million]

East Asia740 000740 000

[480 000 – 1,1 million][480 000 – 1,1 million]Caribbean230 000

[210 000 – 270 000]

Source: UNAIDS report, 2008


Global HIV Epidemiology (2)

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

OMS, 2008


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 scientists• Further roll out and

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

• AZT 300mg 12 hourly in ANC (from 14 weeks or any time thereafter)

• SdNVP 200mg at onset of labour

• AZT 300mg+3TC 150mg 12 hourly during labour and delivery

• AZT 300mg+3TC 150mg 12 hourly for 7 days postpartum

Infant Breastfeeding:• NVP from birth until

one week after cessation of breastfeeding

Infant Non-breastfeeding• NVP for 6 weeks


HTC

• In an effort to increase HTC services, the MOHCW has adopted a four delivery model:

Integrated model within public health institutionsStand alone sites manned by NGOsPrivate sector workplace modelMobile outreach services

• Training of Primary Counselors• Task Shifting in Rapid HIV Testing to nurses

and primary counselors• 95 % of health facilities offering HTC services


89000135000

292941

477654535289

579767

0

100000

200000

300000

400000

500000

600000

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

20092009 20102010 20112011 20122012

AdultAdultss

210,00210,0000

260,000260,000 310,00310,0000

350,00350,0000

PaedsPaeds 20,00020,000 25,00025,000 30,00030,000 36,00036,000

04/11/23 25


Number of ART initiating sites, Zimbabwe, 2004-2008

0

20

40

60

80

100

120

2004 2005 2006 2007 2008

Year

Nu

mb

er

of

AR

T s

ite

s

Series2


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 imports


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 circumscions performed in 2012


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!!

Health & Medicine

hiv/aids prevention in zimbabwe