Zimbabwe government to scale up anti-retroviral therapy services

Zimbabwe’s Ministry of Health and Child Care has announced plans to scale up anti-retroviral therapy services by the end of 2014, amid concerns over the current huge deficit.

The announcement comes as health professionals call on the government to improve its provision of anti-retroviral therapy.

According to Calvin Fambirai, from the Zimbabwe Association of Doctors for Human Rights (ZADHR): “There is a huge deficit with only 600,000 people currently receiving anti-retroviral therapy services against the backdrop of up to 1.3 million people who are in need of the life-saving drugs.”

Focus on UN goals

Fambirai said that while there has been a steady decline in the prevalence of HIV, there is need to maintain the downward trend and focus on achieving the UN goal of zero infections, zero deaths and zero discrimination. He added that the current situation negatively impacts on the country’s ambition to achieve the Millennium Development Goal to combat HIV, malaria and other diseases.

In June 2013, the World Health Organization (WHO) changed its guidelines, recommending that patients start anti-retroviral therapy when their CD4 count (their level of infection-fighting white blood cells) falls below 500. The civil society health sector has raised concerns about the government’s continued use of the previous guidelines, which recommend a CD4 count of 350 as the cut off point.

“An implementation strategy [for the new guidelines] for the nation has not yet been shared,” Fambirai said. ZADHR also raised the issue of children, claiming few are on anti-retrovirals and emphasising the need to scale up services.

Improving health facilities

According to Dr Tsitsi Apollo, deputy director of sexually transmitted infections, HIV and AIDS at the Ministry of Health, 1,200 health facilities in the country currently offer full anti-retroviral services, out of a total of 1,560.

“These health facilities include a mix of urban and rural and we hope that by year end all of them should be offering full anti-retroviral services. We started the process of bringing HIV and AIDS treatment services close to people long back and hope to finalise this very soon,” Dr Apollo said.

She added that from March 2014, 671 000 people in the country were accessing anti-retroviral services, including 50,000 children. As a way of expanding services, Apollo said the Ministry was providing resources, increasing the capacity of health facilities and offering mentorship and training programmes for senior health personnel.

New guidelines

Addressing the new World Health Organization guidelines on anti-retroviral therapy, Dr Apollo said the Ministry of Health sent out a circular to all health facilities on the on-going transition process to implement the new 500 CD4 cut off point.

“In November 2013, we launched the new WHO anti-retroviral treatment guidelines focusing on the HIV-infected and breastfeeding women Option B+ initiative,” Apollo said. This will provide lifelong anti-retroviral therapy for these woman, regardless of their CD4 count.

She added that the new guidelines were also disseminated through workshops held in February and March 2014. The guidelines have been unveiled at district, provincial and private sector health facilities.

Apollo also said the total figure of 1.3 million people in need of anti-retroviral therapy (more than 1.2 million adults and 101,000 children) is not the same as a waiting list. It is the estimated number of people who might need treatment, some of whom do not even know their status. She also raised concerns about the low uptake of HIV testing in Zimbabwe.