Why are we there?
- Endemic/epidemic disease
- Social violence
- Healthcare exclusion
- Zimbabwe: Beating the virus - stories about HIV
- Zimbabwe: On the wings of a moth - a night in an HIV mobile clinic
- Zimbabwe: "I had to pass through hell to get to heaven"
This is an extract from our latest Activity Report, looking back on our work in the previous year.
Although Zimbabwe has made significant progress, gaps in treatment for HIV/AIDS and tuberculosis (TB), including drug-resistant TB (DR-TB), remain. The needs of children and teenagers are particularly overlooked.
Treatment for HIV is reportedly widely available but there are still areas where coverage is extremely low. The main barriers include a lack of human resources, treatment fees, clinic hours and the long distances people must travel to reach facilities.
Patients with multidrug-resistant TB (MDR-TB), where standard first-line drugs have failed, lack access to the best available treatment. Integration of TB and HIV care, ensuring treatment is available at a more local level, and moving tasks over from doctors to nurses are all key strategies being undertaken by Médecins Sans Frontières/Doctors Without Borders (MSF) in collaboration with the Ministry of Health. This streamlining enables more people to obtain the medical care they require.
MSF supported HIV and TB projects throughout the country in 2013: in Harare (Epworth and Caledonia Farm), Gokwe North, Tsholotsho, Beitbridge, Buhera, Gutu and Chikomba. A new project also opened in Nyanga district, after an assessment revealed that only five per cent of people were getting the antiretroviral (ARV) treatment they needed for HIV.
The emphasis in Nyanga is on paediatric ARV care. The strategy used aims to increase patient access to treatment by providing quality HIV and TB care using existing healthcare facilities and human resources. Services in Nyanga are being integrated into the district hospital and nine health clinics, with nurses undergoing training to initiate treatment.
MSF supports the health team with the organisation of services, patient records and patient flow, so facilities can manage the additional workload. Community ARV treatment refill groups and the provision of a three-month drug supply for healthy patients reduce the number of visits to busy clinics.
The Gokwe North project made progress with its approach in 2013, increasing decentralisation of services through training and mentorship. Treatment for HIV and TB and for victims of sexual violence is being integrated into two rural hospitals and 16 rural health centres.
Eleven facilities currently provide care for people with HIV, and four are treatment initiation sites. The Gutu/Chikomba programme has decentralised care to 28 facilities in Gutu and 31 in Chikomba. Support groups have also been established.
MSF pushed for seven health facilities within high-density suburbs in Harare, including the Caledonia Farm clinic, to be accredited as ARV treatment and follow-up sites. HIV and TB training was provided for 16 nurses from Harare, thereby preparing for nurse-led treatment to be implemented in these facilities.
The HIV and TB programme in Epworth was integrated into the Epworth polyclinic at the end of the year, with clinical responsibilities handed over to ministry of health staff.
The Tsholotsho project is also in the process of being handed over, having achieved 98.7 per cent coverage of all people in need of HIV treatment in the district. Provision of ARVs, treatment of opportunistic infections and prevention of mother-to-child transmission (PMTCT) of HIV continued at Nyamandhlovu hospital as part of the decentralisation of the project. The standard implementation of PMTCT is a key strategy in achieving an HIV-free generation in Zimbabwe.
At the end of December, MSF was forced to abruptly close the project in Beitbridge, on the border with South Africa, after the authorities decided not to allow the team to continue activities. Before leaving, MSF arranged a three-month drug buffer for patients to postpone interruption of their treatment, but remains concerned for the future healthcare of HIV patients in the area.
Over the course of the project, 7,590 patients started ARV treatment. In 2013, 853 patients started TB treatment, five of these for DR-TB. Mental health specialists saw 16,300 people for counselling sessions over the course of the year.
Implementing newer technology
MSF is striving to implement modern technology that will improve HIV patient care in Zimbabwe. Routine yearly viral load (VL) monitoring – the gold standard for monitoring HIV patients – was already being used in Buhera and Gutu, and it was introduced in January in Chikomba. Laboratory technicians and scientists were trained at three hospitals in Harare (Harare hospital, Parirenyatwa and Chitungwiza), and these were included as potential sites to send VL results. New diagnostic technology (GeneXpert) was introduced to improve the speed of diagnosis for TB and MDR-TB in most MSF-supported health facilities.
In May, MSF installed the NUCLISENSE platform at the National Microbiology Reference Laboratory (NMRL) in Harare hospital. This project, funded by UNITAID and run in close collaboration with NMRL and the health ministry, aims to provide VL analysis throughout the country. Between September and December 11,500 samples were processed, paving the way for more to be dealt with in the country instead of being sent to a laboratory in South Africa.
Prison psychiatric care
A team of MSF mental health professionals continued to provide psychiatric support to inmates in 10 prisons, including Harare maximum security prison, where 250 male and 30 female inmates receive care in a psychiatric wing. Occupational therapy was also available. The team treated 1,880 patients in individual and group counselling sessions.
Care for victims of sexual violence
Free medical care, counselling and referrals for psychological, psychosocial and legal support were provided for victims of sexual violence in the high-density suburb of Mbare in Harare.
Health promotion activities were conducted to raise awareness of sexual violence in the community, and the importance of seeking immediate medical care. A total of 1,220 new patients came to the centre in 2013 and the team saw more than 920 people for follow-up. A new building is under construction to accommodate the growing programme.
At the end of 2013, MSF had 604 staff in Zimbabwe. MSF began working in the country in 2000.