In Zimbabwe: Engaging Private Practitioners to End AIDS in Children
Agnes Mahomva and Piya Smith
In countries hit hardest by the HIV epidemic, more than 97 percent of HIV/AIDS programs and services are government-led and donor-supported. As a result, very little is known about how the private sector provides and manages HIV/AIDS care and treatment services, including how they counsel patients on adhering to antiretroviral therapy (ART).
While donor and government-supported facilities offer their services free-of-charge, a large proportion of women – especially women in urban settings – continue to seek services at private health facilities for obstetric and antenatal care (ANC).
In order to reach the end of AIDS in children it is critical that all physicians, including those engaged in private care, become well-versed in the World Health Organization (WHO) 2013 guidelines on HIV/AIDS prevention and treatment.
In Zimbabwe, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) is partnering with the Ministry of Health and Child Care (MOHCC) and the Zimbabwe Medical Association (ZiMA) to disseminate the 2013 national ART guidelines through workshops that meet the national physician continuing medical education requirements.
The workshops cover HIV/AIDS care, treatment, and prevention services based on the 2013 WHO treatment guidelines. Topics include HIV testing and counseling, pediatric ART guidelines, and lifelong ART treatment for all HIV-positive pregnant and breastfeeding women (also known as Option B+). There is also a special session on counseling HIV-positive women about breastfeeding while taking ART.
Many of the physicians attending the workshops said they left with stronger statistics and approaches to HIV counseling. The session on breastfeeding with ART was reassuring for many practitioners, who often felt hesitant to advise their patients to breastfeed while they were taking antiretroviral medications. But one physician said the workshops really helped him understand why breastfeeding is important:
“This is the kind of evidence we needed to quote when counseling our patients,” he said following the session. He then stressed that it is critical to know this information because Zimbabwe is a breastfeeding culture.
So far three workshops have been held in Harare, Mutare, and Bulawayo. Turnout at each of the workshops has grown steadily as the MOHCC and EGPAF employ new approaches to communications, such as SMS messaging to private practitioners through ZiMA, ensuring that the events reach a wider audience of private physicians. More than 300 private practitioners have attended thus far.
The workshops reinforce the benefits of public-private partnerships and also serve as a platform for private practitioners to offer input on the new national HIV guidelines. Dr. Angela Mushavi, coordinator for the Ministry of Health’s National Prevention of Mother-To-Child Transmission (PMTCT) and Pediatric HIV Care And Treatment, says these public-private partnerships are essential to “ensure that every pregnant woman in Zimbabwe, regardless of where she is seen, receives the latest evidence-based HIV regimen for her health and for the benefit of her unborn child.”
Zimbabwe has witnessed a significant decline in adult HIV prevalence in recent years from a peak of 29.3 percent in 1997 to 15 percent in 2012. The drop in new infections has been attributed to strong commitment from the Ministry of Health in building effective prevention programs aimed at behavior change; scale up of the antiretroviral treatment program (which also acts as a prevention strategy) and a successful PMTCT program.
In early 2013, the MOHCC adopted the 2013 WHO guidelines, which provide lifelong ART for all HIV-positive pregnant and breastfeeding women. Following the launch in November 2013, the MOHCC began the transition to Option B+ by rolling out sensitization workshops to ensure that all relevant healthcare workers in the public health sector were updated on the new guidelines.
It is critical that private practitioners are knowledgeable on Option B+ to insure all HIV infected clients in the country are being managed according to established national guidelines.
EGPAF will continue to work with the Ministry of Health in Zimbabwe to address this education gap and ensure that physicians throughout the country have the skills and support they need to help us reach our goal of ending AIDS in children.
Agnes Mahomva is EGPAF-Zimbabwe’s Country Director, based in Harare, Zimbabwe. Piya Smith is EGPAF-Zimbabwe’s Country Officer, based in Washington, D.C.