hiv/aids prevention in zimbabwe

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dr b t tachiona
hiv conference for african countries
sichuan china

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  • N.B. This data is not disaggregated by reason for test either first PCR in a PMTCT infant, first PCR test where there was no PCR or symptomatic infant
  • World aids day held annually fron national to district level His exellency gives a statev of the nation adress every year
  • hiv/aids prevention in zimbabwe

    1. 1. SITUATIONAL ANALYSIS OF HIV/AIDS PREVENTION AND CONTROL IN ZIMBABWE Chengdu Sichuan China 2-22 june 2011Session 1: Welcome and Course Overview Slide 1
    2. 2. 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 pandemicallySession 1: Welcome and Course Overview Slide 2
    3. 3. Global HIV Epidemiology Western and Central Eastern Europe and Europe Central Asia 730 000 1,5 million North America [580 000 – 1,0 million] [1,1 – 1,9 million] 1,2 million East Asia [760 000 – 2,0 million] Middle East and N. Africa 740 000 Caribbean [480 000 – 1,1 million] 380 000 230 000 [280 000 – 510 000] South and Southeast [210 000 – 270 000] Sub-Saharan Africa Asia 22,0 million 4,2 million Latin America [3,5 – 5,3 million] [20,5 – 23,6 million] 1,7 million Oceania [1,5 – 2,1 million] 74 000 [66 000 – 93 000] Total: 33 million (30 – 36 million) Source: UNAIDS report, 2008Session 1: Welcome and Course Overview Slide 3
    4. 4. Global HIV Epidemiology (2) 33 Million People Living with HIV Worldwide, 2007 [Range: 30-36 million]Session 1: Welcome and Course Overview OMS, 2008 Slide 4
    5. 5. 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 :3.3Session 1: Welcome and Course Overview Slide 5
    6. 6. Background of the HIV epidemicin 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%Session 1: Welcome and Course Overview Slide 6
    7. 7. TRENDS IN ADULT PREVALENCE:1970-2009Session 1: Welcome and Course Overview Slide 7
    8. 8. TRENDS IN HIV INCIDENCE(15-49)Session 1: Welcome and Course Overview Slide 8
    9. 9. Factors which contributed to therapid spread and sustained highprevalence• 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 patternsSession 1: Welcome and Course Overview Slide 9
    10. 10. Factors attributed to the rapiddecline 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 approachSession 1: Welcome and Course Overview Slide 10
    11. 11. 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 servicesSession 1: Welcome and Course Overview Slide 11
    12. 12. National HIV and AIDSProgrammes• Testing and Counselling Programme• STI Programme• National Condom Programme• Male Circumcision Programme• PMTCT Programme• OI/ART Programme• TB ProgrammeSession 1: Welcome and Course Overview Slide 12
    13. 13. 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)Session 1: Welcome and Course Overview Slide 13
    14. 14. 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 2015Session 1: Welcome and Course Overview Slide 14
    15. 15. PMTCT TRENDSSession 1: Welcome and Course Overview Slide 15
    16. 16. % OF HIV POSITIVE WOMEN WHORECEIVED ART PROPHYLAXIS FORPMTCTSession 1: Welcome and Course Overview Slide 16
    17. 17. Current geographic coverage ofPMTCT/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)Session 1: Welcome and Course Overview Slide 17
    18. 18. DNA PCR for Early infant diagnosis of HIV 2007 - 2010YEAR Positive Negative TOTAL2007 77 (31%) 245 3222008 581 ( 38%) 1585 2 1692009 901 (25%) 3597 4 4982010 2373 ( 17%) 14159 16 532Session 1: Welcome and Course Overview Slide 18
    19. 19. 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 • Further roll out and scientists evaluation of the machines under field conditions is planned • MOHCW has given go-ahead to procure the machines Session 1: Welcome and Course Overview Slide 19
    20. 20. MER 14 plus extended infant prophylaxisMother Infant Breastfeeding:• AZT 300mg 12 hourly in • NVP from birth until ANC (from 14 weeks or any one week after time thereafter) cessation of• SdNVP 200mg at onset of breastfeeding labour• AZT 300mg+3TC 150mg 12 Infant Non-breastfeeding hourly during labour and • NVP for 6 weeks delivery• AZT 300mg+3TC 150mg 12 hourly for 7 days postpartum Session 1: Welcome and Course Overview Slide 20
    21. 21. HTC• In an effort to increase HTC services, the MOHCW has adopted a four delivery model: Integrated model within public health institutions Stand alone sites manned by NGOs Private sector workplace model Mobile outreach services• Training of Primary Counselors• Task Shifting in Rapid HIV Testing to nurses and primary counselors• 95 % of health facilities offering HTC servicesSession 1: Welcome and Course Overview Slide 21
    22. 22. 600000 579767 535289500000 477654400000300000 292941200000 135000100000 89000 0 2002 2003 2004 2005 2006 2007Session 1: Welcome and Course Overview Slide 22
    23. 23. 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/NVPSession 1: Welcome and Course Overview Slide 23
    24. 24. NEED FOR ART IN ADULTS 15+(CD4 350)Session 1: Welcome and Course Overview Slide 24
    25. 25. Targets OI/ART – 2009-2012 2009 2010 2011 2012Adults 210,000 260,000 310,000 350,000Paeds 20,000 25,000 30,000 36,000 01/22/13 Session 1: Welcome and Course Overview 25 Slide 25
    26. 26. Number of ART initiating sites, Zimbabwe, 2004-2008 120 100 Number of ART sites 80 60 Series2 40 20 0 2004 2005 2006 2007 2008 YearSession 1: Welcome and Course Overview Slide 26
    27. 27. Coverage and uptake for the ARTprogramme – 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 supplimentingSession 1: Welcome and Course Overview Slide 27
    28. 28. 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 1.1millionSession 1: Welcome and Course Overview Slide 28
    29. 29. 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 exposureSession 1: Welcome and Course Overview Slide 29
    30. 30. 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 breaksSession 1: Welcome and Course Overview Slide 30
    31. 31. MC at clinic levelSession 1: Welcome and Course Overview Slide 31
    32. 32. Group counselling before MCoutreach siteSession 1: Welcome and Course Overview Slide 32
    33. 33. 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 positiveSession 1: Welcome and Course Overview Slide 33
    34. 34. 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 facilitiesSession 1: Welcome and Course Overview Slide 34
    35. 35. 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 2015Session 1: Welcome and Course Overview Slide 35
    36. 36. 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 interventionsSession 1: Welcome and Course Overview Slide 36
    37. 37. Felisiya GwarazimbaSession 1: Welcome and Course Overview Slide 37
    38. 38. Farayi .aka. Daddy MarufuSession 1: Welcome and Course Overview Slide 38
    39. 39. Blessing . TachionaSession 1: Welcome and Course Overview Slide 39
    40. 40. Xie xie – Thank you • Muchas gracias • Merci beacoup!! • Grazie • Obrigado • asante • Tatenda!!Session 1: Welcome and Course Overview Slide 40

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