1. Zimbabwe’s shift towards treat all: national country context
Dr G Mhlanga,
Ministry of Health and Child Care, Zimbabwe
23 July 2017

2. Country HIV Perspective
Total Popn ~ 13 million (2012 Census)
Zimbabwe remains one of countries in the world heavily burdened by HIV/AIDS & TB
~1.3M PLHIV
PLHIV on ART: 975,
HIV Prevalence: 13.8%
HIV Incidence: 0.48
Need for PMTCT: 65,158
MTCT rate 5,2%
TB/HIV co-infectivity rate 69%
Zimbabwe has a projected population of 13m people and is among the countries in Sub-Saharan
Africa worst affected by the HIV
[Sources: 2016 Global TB Report, 2016 ZIMPHIA & National HIV Estimates 2016]

3. Zimbabwe has experienced a significant decline in HIV incidence & prevalence, but prevalence remains high
Sources: National HIV Estimates 2011,2013,2016, ZDHS 2015/16
Decline attributed to successful implementation of prevention strategies especially behavior change, high condom use and reduction in multiple sexual partners
HIV Prevalence beginning to plateau due to improved survival linked to improved ART coverage

4. 2013 National ART Guidelines

5. National ART Coverage by Age Group, 2016

6. Treatment Cascade and Progress Towards 90-90-90 Targets, by Sex (2016)
Though prevention gaps persist, the treatment cascade suggests the country is on
track to achieve the targets. As of 2016,
74.2% of all PLHIV know their status,
86.8% of those are on treatment
86.5% of people on treatment are virally suppressed

7. Lessons lEARNT FOR ADAPTATION OF 2013 HIV GUIDELINeS IN ZIMBABWE
Processes for adapting clinical (what to do) and operational (how to do) guidance should be conducted concurrently
There is need to adequately prepare and strengthen logistics, supply chain management systems, lab services and M&E systems prior to launch and implementation of new guidelines
There is need to involve all stakeholders from the health delivery system (provinces, districts and the private sector) in adaptation processes
In 2015, the country in collaboration with key partners commissioned an assessment entitled: ‘Zimbabwe’s Experience in the Adaptation of the ‘2013 World Health Organization Consolidated Guidelines on the Use of Antiretrovirals’ and Status of its Implementation in the Country with objectives
To document Zimbabwe’s experiences in the adaptation of the 2013 WHO HIV guidelines
To inform future adaptive processes

8. Community dialogues during ICASA, 2015
2015 WHO Guidelines Launch
New guidance on HIV testing services (HTS), pre-exposure prophylaxis and “Test and Treat” published in 2015
Objective to achieve the targets by 2020 and ending AIDS by 2030
High Level Country Involvement from inception
Participation of Zimbabwe’s technical team in review and formulation processes of 2015 WHO HIV Consolidated Guidance
High level country delegation participated at WHO HTS guidelines launch at IAS Vancouver, Canada in July 2015
WHO “Test and Treat” Guidelines launched at International Conference on AIDS and STIs in Africa (ICASA) in Zimbabwe, on 1 December 2015
Early
Initiation of adaptive processes
Community dialogues during ICASA, 2015
Stakeholder consultative meetings with College of Public Health Physicians & panel discussion conducted during a National Partnership Forum meeting in early 2016
Overwhelming recommendations from stakeholders to adopt “Test and Treat” with adequate preparations and phased implementation

9. Demonstration Projects
To complement adaptation processes of new 2015 WHO HIV consolidated guidelines, MOHCC also commissioned the following demonstration projects with support from partners
‘TREAT ALL’ pilot approaches (community & health facility based) in nine (9) selected districts with support from PEPFAR
Differentiated Service Delivery (DSD) models implemented in selected districts with support from PEPFAR and Global Fund
PreP demonstration projects implemented in selected districts with support from USAID
HIVST demonstration projects (multi-country) implemented in selected districts under the STAR Project
To inform

10. Adaptation Processes for the 2015 WHO HIV Consolidated Guidelines
Reconstitution of the Adaptation Committee
Adaptation subcommittee meetings
Stakeholders consultative meetings
Review and finalization of national guidelines by *NMTPAC and presentation to MOHCC management
Endorsement of finalized national HIV guidelines by MOHCC management and subsequent printing
Launch & Dissemination of adapted guidelines
Mar 2016
Oct 2016
Dec 2016
*NMTPAC – National Medicines Therapeutic Policy And Advisory Committee
Demonstration Projects Concurrently Running
Key activities undertaken consistently to support implementation of new guidelines
Resource mobilization
Revision of monitoring and evaluation tools
Capacity building of Health Care Workers & relevant stakeholders

11. Thank You