Zimbabwe

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Primrose and her child Panashe as doctors confirm the seven-year-old boy is suffering from TB

Why are we there?

Endemic/epidemic disease
Social violence
Healthcare exclusion

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Historical

Plans to further improve HIV care in Zimbabwe were frustrated in 2011, when the Global Fund to Fight AIDS, Tuberculosis and Malaria – one of the major donors supporting the country’s fight against HIV and tuberculosis (TB) – announced the cancellation of its next funding round.

Antiretroviral treatment

According to the Zimbabwean government, 63 per cent of people in need of antiretroviral (ARV) medication are currently receiving treatment.

Médecins Sans Frontières/Doctors Without Borders (MSF) works within public facilities, mainly delivering HIV and TB – including drug-resistant TB – care.

The programme covers the testing, diagnosis, treatment and counselling of patients with HIV and/or TB, and for pregnant women, antenatal care and prevention of mother-to-child transmission (PMTCT) of HIV.

In 2011, MSF was supporting about 48,430 people on ARV treatment. Laboratory services, health promotion activities and assistance for victims of sexual violence were also available.

A nurse takes a blood sample from a patient in Murambinda, Buhera. © Kenneth M Tong

Increasing treatment

Teams have been providing care for people with HIV and TB in Buhera district, in the eastern province of Manicaland, since 2004. Today, 86 per cent of the people who need ARV treatment are receiving it.

Scale-up has been possible thanks to new models of care. MSF has implemented task-shifting, so that trained nurses, instead of doctors, initiate ARV treatment and follow-up.

Staff have also been working in rural health centres so that people living far from urban areas have better access to HIV care: 75 per cent of the 18,590 patients who have started ARV treatment since the programme began live in rural areas.

In an effort to rapidly extend services elsewhere in the country, MSF trained 26 Ministry of Health staff to provide support in HIV care to clinics in Gutu district, Masvingo province, and Chikomba district, Mashonaland East province.

In Tsholotsho, in the west of the country, teams focused on treating adolescents and children and pregnant women with HIV, and providing PMTCT.

By the end of the year, more than 9,000 patients were on ARV treatment.

Successful and sustainable treatment

Being integrated into public health facilities has enabled MSF to offer training and transfer expertise, including PMTCT services, and therapeutic feeding for children.

In 2011, nearly 4,000 patients were transferred from Domboramwari clinic in Epworth to a new clinic built by MSF in Overspill, on the outskirts of Epworth. The Overspill clinic was handed over to the Ministry of Health, whose staff now run most services there.

MSF continues to work at the Domboramwari clinic. In total, more than 26,600 people were tested for HIV in Epworth, of whom 7,116 tested positive.

At the end of the year, MSF was treating 14,220 patients for HIV, with just over 10,500 receiving ARV medication. MSF also treated 1,353 patients for TB, including 11 for DR-TB.

Another 11,000 HIV patients from MSF programmes in Gweru and Bulawayo were also fully integrated into the national health system.

A nurse manages patients’ referrals to MSF’s mobile team in the Murambinda area, Buhera. © Kenneth M Tong

Caledonia Farm

MSF opened a new clinic in Caledonia Farm, a settlement on the outskirts of Harare that sprang up following the clearance of urban ‘squatters’ several years ago.

The clinic provides basic healthcare, counselling and HIV testing, ARV treatment and treatment for TB.

In Mbare, a densely populated suburb of the city, MSF set up a new programme in October, offering support to victims of sexual violence.

Working with local non-governmental organisations, clinics and national health staff, MSF provides medical and psychological care. By the end of the year, the programme had already assisted 125 people.

Beitbridge

In January, the MSF project in Beitbridge, close to the South African border, which had been offering basic healthcare, changed its focus to provide local people with HIV and TB treatment, targeting those at particular risk of infection.

By the end of the year, staff had seen around 2,500 patients in Beitbridge district hospital, a clinic within the town and four rural clinics in the area.

Emergencies

MSF continued to assist in responding to emergencies and outbreaks of disease. When cholera broke out in Buhera, and typhoid in Harare, teams supported the national health services, treating more than 950 people for typhoid and nearly 70 for cholera.

Staff also carried out rapid assessments and response following the declaration of an anthrax outbreak and a measles alert in Tsholotsho.

At the end of 2011, MSF had 886 staff in Zimbabwe. MSF has been working in the country since 2000.

Patient story

Joyce

“At the age of six months, our baby fell ill. We would go to the hospital and get some form of treatment for Nokutenda. She would improve and then get sick again.

"My husband got fed up and left us. I was desperate. I went to an MSF clinic and my child was admitted to the therapeutic feeding programme. We both were diagnosed HIV positive. They also diagnosed TB in Nokutenda and started her on TB medication.

“Now she is three years old and MSF continues to supply her with ARVs. Being a single mother and not having a job, there was no way I could have done this on my own. My baby starts pre-school this year.”