Zimbabwe

The Union collaboration with the Health Services Departments of the City of Bulawayo and the City of Harare funded by a European Commission grant was completed in December 2012.

The main objective of the programme for 'Integrated HIV Care for Tuberculosis Patients with HIV/AIDS' (IHC) for over five years was to develop innovative strategies for feasible and sustainable TB-HIV services that could be replicated in other urban centres and district health services in the country and outside Zimbabwe.

Three municipal clinics, namely Mabvuku Polyclinic in Harare and Magwegwe and Emakhandeni Clinics in Bulawayo, were chosen to implement joint TB-HIV services and operational research. The implementation was totally embedded into the municipal health services provided by health professionals employed by the Health Services Departments.  The only full-time staff members who were supported by the IHC programme were two nurse coordinators.

High TB-HIV care enrolment
The decentralised and integrated TB-HIV services piloted at the clinics included:

  • TB diagnosis and TB treatment, including daily nurse-supported directly observed therapy during intensive phase of TB treatment;
  • Provider-initiated testing and counselling for HIV of all TB patients;
  • Initiation and follow up of antiretroviral treatment (ART) and cotrimoxazole preventive therapy (CPT) for patients found to be HIV-positive;
  • TB and HIV screening of family contacts and sexual partners and offering them with appropriate treatment, when necessary;
  • Provision of other HIV care and support, such as treatment of other opportunistic infections, psychosocial support and referral to support groups;
  • Regular TB screening of patients attending HIV care-ART clinics;

These services were provided largely by nurses and supported by medical doctors.  Minor renovations were carried out at the pilot sites to improve natural ventilation and patient flows.  Infection control measures, particularly against spread of TB bacilli, in these health facilities were intensified.

Since the accreditation of the pilot sites as ART initiating sites in 2008, the preliminary data suggest that a total of 4,158 TB patients were registered.  HIV testing and counselling offer was taken up by at least 3,701 (89%) of patients some of whom knew their current HIV status at the time of TB diagnosis.  Of these, 2,988 (81%) were found to be HIV-infected and 2,275 (76%) were commenced on ART.  The ART uptake continued to be one of the highest in Zimbabwe.  Cotrimoxazole prophylactic treatment (CPT) coverage was almost universal.

In 2010-2011, all three pilot sites were ready to extend ART initiation services to all persons living with HIV (PLH) – not only those with TB.  A total of 2,933 PLHs benefited from the services provided at a facility closest to their home.  These easily accessible services that did not necessitate travelling to a hospital were appreciated by members of communities who, in a survey, strongly recommended expansion of decentralised TB and HIV services in Harare and Bulawayo.  This has become possible, in spite of the end of European Commission support, through finances from the President's Emergency Program for AIDS Relief (PEPFAR) in the two major and other cities in the country.