We spoke with Chiedza Mupanguri, National Antiretroviral Therapy Coordinator in Zimbabwe’s Ministry of Health and Child Care (MOHCC).
Chiedza, please could you describe the policy frameworks that guide HIV service delivery in Zimbabwe?
In 2022, the MOHCC updated its HIV prevention, testing and treatment guidelines in line with WHO guidance and launched a revised Operational and Service Delivery Manual for the Prevention, Care and Treatment of HIV in Zimbabwe (OSDM) with the aim of increasing retention at all steps of the cascade. Re-engagement in care is one of the updates in the guidelines and OSDM.
Can you share details on how the new OSDM supports sustained engagement and re-engagement in care?
The OSDM defines what re-engagement in care is, describes the re-engagement cycle across the whole cascade, provides algorithms for the management of recipients of care re-engaging in care, and assists healthcare workers on how to approach and counsel this group of recipients of care.
How have these updates been received and implemented thus far? Can you share any preliminary results?
These guidelines have been disseminated to all facilities, and data shows that between July 2022 and September 2023, most recipients of care (65%) who re-engaged in care had interrupted treatment for more than six months. Tracing programmes were more likely to find older adults in the community than younger individuals who may be involved in economic activities that require high mobility. Hence, differentiated approaches are essential in ensuring that recipients of care are supported to return to treatment.
Based on these results and learnings, what are the next steps?
There is a need to address socioeconomic determinants of health by recognizing and addressing those that hinder engagement in care. This includes implementing strategies to reduce poverty, improve access to education and provide financial support for healthcare expenses, for example, as done by the DREAMS project.
What are some of the priorities around HIV service delivery more specifically?
We need to leverage technology, such as mobile health applications, telemedicine and text messaging, which can help overcome geographical barriers and improve access to care. Such innovations can facilitate appointment reminders, medication adherence support and access to health information.
Lastly, addressing the issue of community engagement and support is critical. Involving people living with HIV and their communities in the design, implementation and monitoring of HIV programmes has proven effective and can help reduce stigma, improve access to care and ensure the relevance and acceptance of interventions.
