Zimbabwe

PSI/Zimbabwe estimates that in 2015, its products and services helped avert 2,132,832 DALYs, including, by health area:

• 35,913 Malaria DALYs
• 1,990,406 HIV DALYs
• 104,942 FP DALYs
• 352 TB DALYs
• 706 WASH DALYs
• 512 NCD DALYs

PSI/Zimbabwe’s family planning programs also provided 441,028 couple-years of protection. 

HIV/AIDS

PSI/Zimbabwe seeks to improve health in Zimbabwe through the provision of the following services and products:

Voluntary Medical Male Circumcision (VMMC)

VMMC has increased protection against HIV by 60%. PSI/Zimbabwe started the VMMC program in 2009 and has grown from a pilot in five districts to 43 districts. Quality assured VMMC services are offered at three PSI-operated sites, public sector hospitals and clinics. Since inception, PSI/Zimbabwe has contributed over 70% male circumcisions to the national goal of circumcising 1.3 million men by 2018.

Condom Social Marketing

Male condoms are an important part of Zimbabwe’s national HIV prevention strategy and have contributed to a 25% decrease in new infections between 2010 and 2015. Since 1996, PSI/Zimbabwe has been responsible for generating demand for condoms and ensuring accessibility to its branded condom, Protector Plus. PSI/Zimbabwe socially markets an average of 20 million Protector Plus male condoms annually, through a network of over 5,000 retail outlets. Most outlets are situated in areas with high-risk activity and are open outside normal retail hours, giving people access to condoms when they are most likely to need them. PSI/Zimbabwe is moving towards cost recovery to achieve sustainability of the male condom program.

New Start Testing Services

PSI/Zimbabwe introduced New Start centers in 1999. New Start has evolved from offering testing services only, to offering integrated sexual and reproductive health (SRH)/HIV services. This includes a wide range of family planning services, STI screening and treatment, TB symptom screening, diagnosis and treatment, ART, PrEP, cervical cancer screening and treatment of pre-cancerous lesions and services for survivors of sexual violence

HIV Testing Services

HIV testing services provide an entry point to treatment and care, and are crucial to achieving the 90-90-90 target. By 2020, this target is aiming for 90% of people living with HIV to know their status, 90% of all people with a diagnosed HIV infection to receive sustained antiretroviral therapy, and 90% of those on treatment will achieve viral suppression. When New Start centers were introduced in 1999, testing was still taboo and highly stigmatized. At that time, only 160 clients were tested per month through one site. This has now grown to outreach testing of over 30,000 people per month, through a network of 13 sites.

The package of HIV services incorporates testing and counseling, STI and TB symptom screening, screening for hypertension, CD4 cell count testing, counseling and referrals into HIV care and treatment, and other integrated services, including out- of- network referrals. HIV testing services are offered as both client-initiated testing and counseling (CITC) and provider-initiated testing and counseling (PITC), from the other integrated services offered through New Start. Clients now also have the option of accessing HIV testing through provider-delivered HIV testing services (PDHTS) or through HIV self-testing (HIVST). In addition, through the UNITAID/PSI HIV-Self-Testing AfRica (STAR) Project, PSI/Zimbabwe is also distributing HIV self-testing kits through community-based distributors, VMMC clinics, and interpersonal communication agents as well as clinics via peers of key populations. 

HIV Care and Treatment Services

PSI’s Antiretroviral Therapy (ART) program is supporting the government’s efforts to reach the 90-90-90 goal in Zimbabwe. In 2013, PSI/Zimbabwe started offering ART services in Bulawayo, Harare and Mutare, as part of the treatment-as-prevention strategy. In 2017, the ART program is providing services in seven districts:

Harare (including Chitungwiza), Bulawayo, Gweru, Mutare, Masvingo, Makoni, and Chipinge. PSI has a robust care and treatment program that provides specialized services to key populations. At the start of 2017, there were over 3,500 key population clients on treatment. PSI’s commitment to fighting HIV saw the

development, approval and roll-out of the Treat All: Identify, Initiate, and Transition strategy. Through this strategy, PSI identifies newly diagnosed HIV-positive clients, and initiates them on ART. Stable clients are then transitioned to the public sector for further management. This strategy is expected to improve the linkage of HIV-positive clients from testing to care and treatment services. There are four ART laboratories (New Africa House, Bambanani, Masvingo and Mutare) that have been set up to support client monitoring in the ART program. Laboratory testing services are available for haematology, chemistry, serology, CD4 and viral load (VL) testing. A dedicated VL testing laboratory has been set up in Chitungwiza to run VL on the Abbott system. Tests that are not available on testing menu are outsourced. All PSI laboratories are enrolled for an external quality assurance program for the various tests that are done.

PrEP

PSI is offering pre-exposure prophylaxis (PrEP) to people at substantial risk of HIV. The DREAMS program focuses on adolescent girls and young women aged 15 to 24 years. Following significant demand for PrEP services from clients outside the DREAMS target population, PSI/Zimbabwe is expanding the PrEP. Now, people at substantial risk that fall outside the DREAMS age group can access PrEP through the New Start network. By the end of December 2016, just over 400 clients had been enrolled on PrEP through PSI.

Tuberculosis

Since 2004 PSI/Zimbabwe has been engaged in TB activities including symptom screening using the recommended WHO questionnaire. In 2011, TB diagnosis services were introduced at four New Start centers. There are currently four GeneXpert machines in Harare, Bulawayo, Masvingo, and Mutare for TB screening, as well as detection of drug-resistance TB, in sputum culture. By December 2016, 3,507 active TB cases had been diagnosed. All identified cases were either treated at PSI/Zimbabwe’s New Start sites or were referred to public health institutions for treatment. Client follow-ups are also done on those referred to the public health sector, with 95% successfully starting TB treatment. In 2015, isoniazid preventive therapy (IPT) was introduced at three PSI ART sites (Harare, Bulawayo, and Masvingo) for HIV positive clients. This has not only reduced TB infection among ART clients but also decreased mortality rates. PSI/Zimbabwe reports all TB cases to the National TB Programme.

Contraception and Family Planning Services

Family planning counseling and services are offered through all 13 New Start sites and their associated mobile outreach teams. The New Start centers offer a wide range of short-acting and long-acting reversible contraceptives: oral contraceptives, injectables, implants (Jadelle and Implanon), intrauterine contraceptive device (IUCD), and emergency contraceptive (EC) pills. PSI/Zimbabwe family planning services are branded ProFam. ProFam services are offered through the New Start network and through a partial social franchise (PSF) of 28 public sector health facilities. The ProFam public sector PSF in family planning was launched in 2014, through the United Kingdom’s Department for International Development (DfID)-funded program Sexual and Reproductive Health and HIV Prevention in Zimbabwe. These institutions receive training in long-acting reversible contraceptives, and support in the form of equipment and quality assurance support and supervision. PSI also socially markets EC pills and injectable contraceptives to private pharmacies and clinics.

Sexually Transmitted Infection (STI) Screening and Treatment

PSI/Zimbabwe offers routine STI symptom screening through the counseling and other integrated services at New Start. At five New Start sites, PSI also

provides STI treatment services. Sites that do not offer treatment refer eligible clients for treatment.

Services for Survivors of Sexual Violence

PSI/Zimbabwe serve survivors of sexual violence through five sites in the New Start network as well as through local partner organizations. PSI offers counseling, HIV testing, HIV post-exposure prophylaxis (PEP), pregnancy testing, emergency contraception, STI screening, prophylaxis and treatment, and any other emergency treatment.

Non-Communicable Diseases

Cervical cancer is the most common cancer among women in Zimbabwe, accounting for 33.4% of all cancer cases among black women. It is estimated that more than 2,000 women are diagnosed with cervical cancer in Zimbabwe and about 1,500 die from the condition every year. In 2013, PSI/Zimbabwe launched cervical cancer screening and treatment in to fight the disease. . PSI/Zimbabwe offers cervical cancer screening using Visual Inspection with acetic acid and cervicography (VIAC) and cryotherapy services through seven New Start centers and associated mobile outreach teams. PSI/Zimbabwe also offers the loop electrosurgical excision procedure (LEEP) for more advanced precancerous lesions. Clients with lesions suspicious for cancer are referred for further management. The New Start centers offer high-quality cervical cancer screening and treatment services accessible to women including the urban poor and rural populations. The cervical cancer screening services are integrated into HIV services (HIV testing, care and treatment services), and other sexual and reproductive health services. These include family planning, and STI treatment and services for survivors of sexual violence. Women accessing the other integrated services also fall into the group of women at risk for cervical cancer, due to the associations between unprotected sex, STIs, HIV infection, and cervical cancer. In the integrated service model that New Start offers, clients for cervical cancer screening can either come in primarily for that service or are referred for it from the other services that the site offers. Clients are also offered the other services that the site offers.

Malaria

PSI/Zimbabwe has adopted the universal approach to distribute long-lasting insecticide-treated nets (LLINs) to households in medium-to-high malaria transmission districts. With support from USAID’s President’s Malaria Initiative and the Global Fund to Fight AIDS, PSI/Zimbabwe piloted continuous distribution using the expanded program on immunization, antenatal care, community and schools. Social behavior change communication activities, such as community sensitization meetings, net hang up campaigns, road shows, radio spots, wall paintings, and vehicle branding are being used to promote the correct and consistent use of the nets. PSI/Zimbabwe is also promoting the school health program. Under this program, children are trained to disseminate malaria messages to their peers, families and communities.

Donors

• U.S. Agency for International Development (USAID)
• UK Department for International Development (DfID)
• Bill & Melinda Gates Foundation
• The Global Fund to Fight AIDS, Tuberculosis and Malaria

Partners

• Zimbabwe Ministry of Health and Child Care National AIDS Council
• Zimbabwe National Family Planning Council
• Local and international based organizations