The HIV epidemic in Zimbabwe has evolved over the years. The overall HIV prevalence for adults aged 15-49 has fallen to 14.0% in 2016, from 18.1% in 2005 (source: Zimbabwe Demographic and Health Survey). Over the years the Ministry of Health and Child Care (MOHCC) with the support of its partners has implemented multiple interventions including HIV Testing Services, Voluntary Medical Male Circumcision, Pre-Exposure prophylaxis for HIV, Sexually Transmitted Infections, Elimination of Mother to Child Transmission of HIV and Syphilis, Paediatric and Adolescent ART, ART for adults and Key populations.
As the country aims to end AIDS by 2030 and achieve epidemic control there is need for the country to better understand the epidemic and therefore have tailored interventions for local geographical areas and population sub-groups. For example, evidence in the country has shown that new HIV infections continue to happen in adolescents and young people, key populations and other population sub-groups. There is need to understand the factors that put these groups at increased risk of HIV infection and the factors that affect their adherence to treatment.
To enable this, the MOHCC with support from WHO started implementing HIV Cased Based Surveillance (CBS) in a phased approach in August 2017. Two districts Mutare and Umzingwane were chosen as the initial learning district. The system for surveillance included a case reporting form which was completed for all new patients diagnosed with HIV. On this form possible risk factors are explored which gives the service provider and the patient the most likely route of infection. This will help the program to understand the commonest modes of transmission for each geographical area and therefore enable implementation of tailored interventions.
In addition, the system enables for tracking of patients over the lifetime. Using both an electronic and paper-based system, sentinel events such as enrollment in care, Viral Load and CD4 count results and opportunistic infections are entered and monitored in the system.
After implementation in the two districts for two years, WHO engaged on behalf of MOHCC and international expert to evaluate the system. Among the main findings from the evaluation were that the system was adequately designed for Zimbabwe's context, riding on existing systems at the facility level. However, its utility could be improved by having geocoordinates and a mapping module to enable mapping of hotspots and high viral load patient locations. This will enable to program to design and implement interventions for those hotspots based on their unique characteristics. In the two districts, the system is being used to track the HIV positive clients in their catchment area and simple analyses are being done and facility cascades being developed. It was recommended that the use of data at the local level could be strengthened by training of Data Entry Clerks to be able to do more analyses and health care workers on how to use the data for decision making at the local level.
MOHCC and all its partners agree that case-based surveillance is important to enable better understanding of the epidemic and design interventions for local areas. As next steps the country will explore ways of scaling up the intervention to the rest of the country. This is expected to accelerate Zimbabwe's progress towards implementation of tailored interventions.