1. HIV disease in BULAWAYO Photo: WHO 2007 Dr. Paco Trinchán Medical Officer BCC August 2013

2. ZIMBABWE POPULATION: 12,619,600 (July 2012)

4. HIV / AIDS

5. HIV adults prevalence Prevalence of HIV – 15% (Dec 2012)

6. HIV and AIDS in Zimbabwe December 2012_ NAC Estimated number of people living with HIV – 1,242,768 Prevalence of HIV – 15% (in BYO 18 %) Estimated number of new infections – 58472 Estimated annual HIV deaths – 45621 Number of adults in need of ART – 657178 (CD4 < 350) Number of adults on ART: 565675 Adult ART coverage – 86 % ( 565675 / 657178 ) Children ART coverage – 41% (39825 children, Dec 2011 est.) Estimated AIDS Orphans – 941024 (25% of all ZW children) Life expectancy at birth: 52 years (2012), declining from 62 years in 1990

8. BULAWAYO

10. Bulawayo Public Health System Bulawayo: 749.569 people 2 regional Hospitals (MoH): Mpilo Htal UBH Htal 1 Psychiatric hospital (Ingutsheni Htal) MoH 19 BCC city clinics 1 infectious diseases hospital (TB) Thorngrove Htal

11. August 2013

12. ART in BYO BCC Mpilo Htal UBH Htal Ingutsheni Htal CITY TOTAL ADULTS on ART268499931946135246593 CHILDREN on ART460 ?218839902633 ?

13. TUBERCULOSIS

14. TUBERCULOSIS Notification rate of TB cases in Zimbabwe: 603/ 100 000 population (2011 est.) Bulawayo notified 2797 cases of TB in 2012 ( 500 cases in 1985!!) TB / HIV co-infection rate: 79.5 % (2012)

15. Many Challenges ! Some of them (in BYO):

16. Challenges – HIV programme (1) Staff shortage: Clinics have only 60 % of nurses Only 4 doctors visiting BCC clinics The challenge of running multiple programmes at the same time: HIV/TB, non-communicable diseases, EPI, IMCI…, with few staff !! Therefore, the challenge of quality follow up in a congested OIC without adequate staff

17. Challenges – HIV programme (2) BUT, there is pressure for an increase of our ARVs cohorts without increasing the staff at the clinics The difficult balance: quantity vs quality ? One solution:  ART decentralization Also:  Empowerment of OIC nurses

18. Other Challenges – HIV programme Early identification of patients in need of ART (before they get too sick!) The challenge of TB diagnosis, PTB (-) or EPTB Insufficient access to VL test Follow up of patients living across the border (SA, BTW) Data capture and entry: Frequent changes in M & E tools. Too many data to record and follow up. Others…

19. THANK YOU MERCI