Going the Last Mile for HIV in Zimbabwe During COVID-19

By Noah Taruberekera, Monitoring, Evaluation and Learning Advisor, PSI Zimbabwe

In March 2020, Zimbabwe recorded its first case of COVID19, announcing the arrival of the COVID19 pandemic in the country. This Government oZimbabwe (GoZ) soon declared COVID as a national emergency, resulting in a nationwide lockdown and the cessation of elective procedures like voluntary medical male circumcision (VMMC), a key activity under PSI’s Going the Last Mile for HIV Prevention- a $95 million, USAIDfunded four-year award.   

At the beginning of the COVID pandemic, PSI immediately began working with the GoZ’s AIDS and TB units to ensure that all services delivered by the Last Mile team were declared as essential services and could continue without interruption during lockdown. This forward planning from the PSI team ensured that upwards of 80% of clients received a three to six-month supply of ART, PrEP and modern contraception to keep them supplied throughout the lockdown period.   

“Thank you [PSI] for calling me in March to tell me that New Start will be scaling down due to COVID19 and asking me to come collect my ARVs. I was due April.Female New Start client 

PSI also quickly re-organized its work to respond to the COVID19 pandemic by developing a business continuity plan, scenario plans, standard operation procedures for safety and other relevant guidance for field implementation. PSI leadership sits on all eight COVID19 response pillars—which include infection prevention and control, surveillance, laboratory, case management, risk communication and community engagementports of entry, logistics and supply chain, coordination and security—to assist and support national teams to craft and lead the response. PSI, through COVID19-specific funding provided by USAID, is contributing technical and financial support for the Ministry of Health and Child Care (MoHCC)-led Risk Communications and Community Engagement and Laboratory Testing responses.  

When lockdown measures were introduced, I was in Gweru and had to spend six weeks alone in my rented apartment. I thought of my family in Chinhoyi. Though we continuously engaged each other through video calling, we were missing each other and imagined if one of us gets infected. We then stocked groceries to last for a period of three months.” –PSI Clinician  

In full recognition of the new reality set by COVID-19, PSI and the Last Mile team are adjusting to the new normal for delivering much needed integrated HIV and sexual and reproductive health services in new and innovative ways. The COVID19 pandemic and related response efforts have altered how the Last Mile team works and how it interacts with clients. Here are some of the ways the team has altered its response:  

1.The Last Mile management teams have shifted from physical to virtual working arrangements, successfully transitioning all engagement with field teams to Microsoft O365 and allowing for work to continue while giving program leadership pathways for staying even more connected with field management structures than before the pandemic.   

2. Clinical sites have re-oriented client flow at the sites to allow for proper social distancing, hand and respiratory hygiene and other related infection prevention and control requirements. New Start Centers (facilities that provide HIV and sexual and reproductive health services) and support staff located at central and regional offices are now working in shifts to enable a reasonable staffing level at a capacity that is safe for both clients and staff.  

3.PSI has shifted to virtual platforms for engaging communities and for booking appointments to prevent congestion at the sites.  

4. All site staff and community health workers have been oriented on the safety precautions required to deliver services in the community safely and to resupply health products for their clients.  

I was dismissive that [COVID-19] is a condition for China and European countries. I then started to research online more on pathogenesis/pathophysiology, preventive measures and complications [of COVID-19]. I then watched BBC news where videos on the number of deaths recorded in China were rapidly escalating. Tension started to build up in me. Our organization then started to give updates through leadership team, managers, and PSI email.” –PSI Clinician  

The new working arrangements have enabled the team to resume community implementation for most HIV and sexual and reproductive health services. Voluntary Medical Male Circumcision (VMMCservices for walk-in clients have resumed at two supported standalone sites. PSI is supporting the MoHCC to conduct a two-week assessment of the state of HIV service delivery in light of COVID, with a special emphasis on working with the MoHCC to develop a phased plan for the safe reopening of VMMC services.  

Despite the many evolving challenges of working in the Zimbabwe economic climate and of remaining safely nimble at scale during the time of COVID, the Last Mile team moves forward, upbeat and ready to deliver innovative work and substantial health impact for the people of Zimbabwe. PSI would like to extend its gratitude for the support rendered by the USAID team to the Last Mile team.   

   

 

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