HIV PREVENTION TARGETS FOR ZIMBABWE Presented by: Tapuwa Magure National AIDS Council

Presentation Outline Background: Discussion Paper 2 National Prevention Target Setting Process in Zimbabwe National Impact and Programme Targets for 2020 Zimbabwe Score Card

Discussion Paper 2 National Prevention Targets and Improved Accountability

Issue Statement Establishing targets and then monitoring progress remains a powerful motivating tool in the global AIDS response ‘What gets measured gets done’ Monitoring progress against targets & accountability: used successfully for HIV treatment and to achieve major reductions in new HIV infections in children

Moving from Global to National Targets Achieving national targets will require a supportive environment that encourages and allows for the adoption of safer behaviours and the use of prevention services and commodities.

KEY GAPS Gaps in baseline data Gaps in routine monitoring of prevention programmes Gaps in national and international accountability

Key Considerations for a Strengthened Response Defining priority locations and populations Establishing effective systems for monitoring HIV prevention Prevention cascades

Recommendations from Discussion Paper 2 Set national HIV prevention targets that reflect the global targets and the local epidemic Designate or re-confirm the entity responsible for coordinating and implementing prevention programmes, and hold the entity accountable for achieving the targets Establish routine monitoring systems to track programme performance Review progress against key national and global targets, using information provided to UNAIDS by Global Prevention Coalition Member Governments Key prevention programme performance indicators should be harmonized between partners

National Prevention Target Setting Process Review of ZNASP III results 2015 (programme & survey data) Development of extended ZNASP III to 2020 Development of GF Concept Note 2018-2020 Prevention target setting Regional Meeting Participation – GoZ multi-sectoral, civil society, funders, development partners Review of Global Targets – against ext. ZNASP III & GF concept note Consultation – national, all stakeholders

Targeted reductions by 2020 Impact indicators (1) Baseline, 2010 & 2015 Source: HIV Estimates & ZIMPHIA, 2015 Global Target Against 2010 Baseline National Target (ZNASP III against 2015 baseline) Targeted reductions by 2020 75% 50% Number of new infections 2010: 63,000 (15-49) 2015: 32,000 (15-64)

Impact indicators (2) 2. HIV incidence among women 15-24 2010: 1% 2010: 1% Baseline, 2010 & 2015 Source: HIV Estimates, 2016 Global Target Against 2010 Baseline National Target (ZNASP III) against 2015 baseline Targeted Reductions By 2020 75% 50% 2. HIV incidence among women 15-24 New infections reduced by 50% by 2020 against 2015 baseline Target 2020 3. Number of new infections in children (0-14) 2015: 0.56% New infections in KP: Methodology for tracking under development (UNAIDS)

Coverage Key Populations: Sex Workers Baseline, 2015 Global Target Against 2010 Baseline National Target (ZNASP III) Targeted Coverage 2020 90% of FSW reached with combination prevention interventions (outreach & condoms) 5. Reached in last 3 months + given condoms 4. Pop Size Sex Workers 48,000 (population size estimate - draft) Baseline 2015 Same as 2015 (expected to be more accurately measured) Target 2020 33 % of FSW

Service availability (1) 7. No of dedicated sites providing services to sex workers 40 dedicated sites for FSW (36 NAC/UNFPA/CeSHHAR and 4 FACT) Baseline 2015 40 sites (maintain coverage, intensify services & mobilisation Target 2020 10 static clinic sites (Harare, Karoi, Bulawayo, Masvingo, Gweru, Mutare,Nyamapanda, Chirundu, Victoria Falls and Beitbridge) and 20 outreach clinic sites GF Performance Framework/ Concept note MSM – Very low coverage in 2016 with less than 200 reached through prevention interventions. GF support aims at increasing reach to 7,000 in 2018 and 10,000 in 2020. Funding Gap for 10 current outreach sites from 2018

GF Performance Framework/ Service availability (2) 11. Number of PrEP sites 7 outreach sites for PrEP (Sex workers – CeSHHAR, PSI) Baseline 2015 No. of districts offering PREP 62/62 (100%) by 2020 Target 2020 10 fixed sites for sex workers as well as up to 20 outreach sites. 6 fixed sites for MSM (Harare, Bulawayo, Masvingo, Gweru, Mutare and Victoria Falls) GF Performance Framework/ Concept note PreP initiation among FSW and MSM by Dec 2016:

14. No. of condoms distributed/sold (millions) Consistent with needs estimate for Zimbabwe from Global Condom Fast-Track tool (38 condoms per man aged 15-64) 34 pcs per sexually active male 40 pcs per sexually active male

Voluntary medical male circumcision 16. No. of VMMC conducted (all age groups) Cumulative 636,911 (2009-2015 VMMC Programme Data) Baseline 2015 Target of 1,420,065 (2016-2020) Target 2020

Coverage : Adolescent girls and young women Indicator Baseline 2015 Target 2020 GF Performance Framework/CN 17. No. of high-incidence districts  26 ( source: Hotspot mapping report,2015) Reduce by 50% the number of high incidence districts.   18. % high-incidence districts covered with comprehensive programmes  0% 50% (need to define comprehensive programs) 30 hot spot districts covered with DREAMS (4 districts), Sista2sista (30 districts), SASA Model (4 Districts) and One Stop Centres (6 Districts). 19. % girls completing lower secondary education 63.1 % MICS, 2014,  80% 20. % condom use at last sex with non-regular partner  50% female 15-24, 81% male 15-24 (Source: ZDHS 2015)  90% Mention prevention financing – national and global target 25%, Reality in GF 2018-2020 is around 10%

Engaging with the draft global score card Scorecard was shared with the country in preparation of prevention coalition Inputs were found to be based on country data & reporting (minor updates required) Reviewed trends emerging from the scorecard

Identified strengths areas for improvement data gaps

Insights from score card Provided a snapshot of HIV prevention situation Incidence reduction largely on track for 2020 Good progress in condom promotion, SW programs Despite scale up of VMMC, 2011-15 progress relatively slower at population-level than in some other countries Data gaps on some key populations Potential for country-to-country support within the region Sharing of country practices on condom programming, sex work programs Learning from progress in VMMC in highest-performing neighbouring countries

Summary National target setting is possible - even in resource constrained environment (participatory & evidence-based) Challenges: Data gaps for some baselines and key populations (Size estimates & IBBSS only done for FSW) Translation of global targets into national targets requires balance between ambition and resources / capacities What get’s measured gets done! Response not possible without sustained partner support

Thank You!!!