1. Dr. Prosper Chonzi MBChB, MPH, MBA Director of Health Harare City 30 November 2015 Harare – A Fast Track City

2. Background Harare Province Population size approx. 1 706 691, 33.3% under 15 years HIV prevalence stabilized after sharp decline Declining incidence, estimate 2013: 0.68% Estimated number of PLHIV 2014: 170,754 – highest caseload among provinces Generalized heterosexual epidemic 56% of PLHIV are female

3. Evolution of HIV Care Services, Harare, 2004 - 2014 YearOI/ART SitesPMTCT Sites 200410 200560 2006727 20071527 20081527 20091527 20101927 20112527 20123127 20134237 201443

4. Trends in HIV Testing, Harare, 2010 – 2014 Variable20102011201220132014 Total offered HTC 42 181 83 683 99 642 109 528 183 880 Total tested for HIV 33 825 (80.2%) 76 510 (91.4%) 93 410 (93.7%) 106 136 (96.9%) 181 796 (98.9%) HIV positive 11 010 (32.5%) 17 066 (22.3%) 19 635 (21.0%) 18 083 (17.0%) 23 525 (12.3%)

5. ART Coverage of eligible PLHIV (85% of PLHIV) Harare, 2010 - 2014

6. ART Coverage for Key Population Groups Women Children People living with disability Sex workers LGBTI community

7. ART Coverage in ANC Women, Harare, 2010 - 2014

8. ART Coverage in Children, Harare, 2010- 2014

9. Viral Load Coverage in Harare Viral load services introduced in April 2015 Very small number of patients have been doing VLs in the private labs Doing targeted viral load monitoring: Suspected immunological failure Suspected clinical failure Estimated 3 981 people (5% of those on ART) are failing and therefore in urgent need of VL To date 333 (8.4% of the above) viral loads have been done Of the viral loads done 54% have been virally suppressed

10. Strategies Used In the ART Programmes, Harare

11. Task shifting and task sharing

13. Decentralisation of ART to all council clinics

14. Adolescent Friendly Clinics

16. Challenges so far Legal framework that is not so friendly to some key populations and therefore lack of data on these groups VL not readily accessible for Harare City Long viral load turnaround time

17. Moving forward…

18. Towards 90-90-90 HIV COUNSELLING AND TESTING

19. Initiatives to increase HTC High yield testing initiatives Key populations Men Long distance truckers Self testing Couple testing Enhanced and strengthened PITC at every contact Community testing – lay counsellor testing Outreach HIV Counselling and testing services Health facilities in new settlements

20. Towards 90-90-90 ART COVERAGE

21. Initiatives to increase ART Coverage Test and treat approach Integration of ART services into all other clinic activities Integration of SRH / HIV services for KPs Integration of SGBV / HIV services HIV services in peri-urban settlements

22. Towards 90-90-90 VIRAL SUPPRESSION

23. Initiatives to Increase Viral Suppression Strategies to enhance adherence and retention in care Community ART Groups ART Clubs More support groups 6 monthly ARV medicine refills for stable patients Adolescent friendly clinics Routine viral load monitoring Point of care VL platforms at clinics

24. Conclusion For Harare City 90-90-90 targets are achievable but: There is need to think outside the box There is need to provide services for the ordinarily neglected and marginalized population groups Resources need to be provided

25. THANK YOU