Dr. Prosper Chonzi MBChB, MPH, MBA Director of Health Harare City 30 November 2015 Harare – A Fast Track City

Background Harare Province Population size approx , 33.3% under 15 years HIV prevalence stabilized after sharp decline Declining incidence, estimate 2013: 0.68% Estimated number of PLHIV 2014: 170,754 – highest caseload among provinces Generalized heterosexual epidemic 56% of PLHIV are female

Evolution of HIV Care Services, Harare, YearOI/ART SitesPMTCT Sites

Trends in HIV Testing, Harare, 2010 – 2014 Variable Total offered HTC Total tested for HIV (80.2%) (91.4%) (93.7%) (96.9%) (98.9%) HIV positive (32.5%) (22.3%) (21.0%) (17.0%) (12.3%)

ART Coverage of eligible PLHIV (85% of PLHIV) Harare,

ART Coverage for Key Population Groups Women Children People living with disability Sex workers LGBTI community

ART Coverage in ANC Women, Harare,

ART Coverage in Children, Harare,

Viral Load Coverage in Harare Viral load services introduced in April 2015 Very small number of patients have been doing VLs in the private labs Doing targeted viral load monitoring: Suspected immunological failure Suspected clinical failure Estimated people (5% of those on ART) are failing and therefore in urgent need of VL To date 333 (8.4% of the above) viral loads have been done Of the viral loads done 54% have been virally suppressed

Strategies Used In the ART Programmes, Harare

Task shifting and task sharing

Decentralisation of ART to all council clinics

Adolescent Friendly Clinics

Challenges so far Legal framework that is not so friendly to some key populations and therefore lack of data on these groups VL not readily accessible for Harare City Long viral load turnaround time

Moving forward…

Towards HIV COUNSELLING AND TESTING

Initiatives to increase HTC High yield testing initiatives Key populations Men Long distance truckers Self testing Couple testing Enhanced and strengthened PITC at every contact Community testing – lay counsellor testing Outreach HIV Counselling and testing services Health facilities in new settlements

Towards ART COVERAGE

Initiatives to increase ART Coverage Test and treat approach Integration of ART services into all other clinic activities Integration of SRH / HIV services for KPs Integration of SGBV / HIV services HIV services in peri-urban settlements

Towards VIRAL SUPPRESSION

Initiatives to Increase Viral Suppression Strategies to enhance adherence and retention in care Community ART Groups ART Clubs More support groups 6 monthly ARV medicine refills for stable patients Adolescent friendly clinics Routine viral load monitoring Point of care VL platforms at clinics

Conclusion For Harare City targets are achievable but: There is need to think outside the box There is need to provide services for the ordinarily neglected and marginalized population groups Resources need to be provided

THANK YOU