The Sunday Mail
Catherine Murombedzi
A localised research on barriers to accessing viral load testing (VLT) and other health services for women living with HIV in Zimbabwe was recently conducted.
The research is set to inform policy direction on VLT in Zimbabwe.
It was guided by consulting experts New Dimensions Consulting (NEDICO) and was led by Pan African Positive Women’s Coalition Zimbabwe (PAPWC-Zim) — under country coordinator Ms Tendayi Westerhof.
The program was in conjunction with the Zimbabwe Women Living with HIV National Forum (ZWLHNF), which is also chaired by Ms Westerhof.
It covered seven districts.
The research’s findings will feed into concept note-writing, which, in turn, will shape the application to the Global Fund (GF) early next year.
The application is for the next round of funding from the GF.
Zimbabwe depends on donor funding which contributes about 90 percent of the support, with the remainder coming from the Aids Levy.
According to the research findings, the knowledge gap on VLT varied, with young women aged 18 to 30 proving to be more informed compared to older women.
Women above 50 showed limited knowledge. They only knew they were HIV positive and had to take medication for life.
Young women had vibrant support from many organisations such as Zvandiri+ and Young Positives.
Many programmes seemed to target the young, hence their knowledge on the subject.
Of older women who had taken the VLT, most did not know why they were required to take the test.
VLT assesses the amount of HIV in the blood. With medication working well, the HIV virus is suppressed. When this happens, the virus is said to be undetectable.
A person with an undetectable viral load does not pass the virus, hence the statement ‘undetectable is untransmittable ( U=U).
This is one of the pillars to ending AIDS by 2030.
Most young women were well-informed that stopping medication would result in the virus replicating. If this occurred, stronger medication than the one used would be required.
Most older women did not know this.
They only knew that antiretrovirals (ARVs) were to be taken for life.
There are 1,3-million people on antiretroviral therapy (ART), of which 200 000 are children.
Of the remaining 1,1 million, 53 percent are women.
The number of women living with HIV who had VLT done and had received results stood at 70 percent.
In border areas such as Chirundu and Beitbridge, it was difficult to follow up on some of the women.
Some of them no longer reported at the facility, while others were hard to reach owing to the high mobility in border areas.
In Chirundu, there were no support groups. Yet, support groups offer safe spaces and share knowledge.
The women did not know what this was; all they had heard of were Community Art Refill Groups (CARGS).
In CARGS, one member travels to collect ART for, say, 10 members.
This saves time and money on travel. The representative gets three months’ refill for the rest of the group.
On getting home, the members get their medication.
A family can also have a refill group catering mainly for the family if they are living with HIV.
In Glendale, young people refilled on Saturday.
A support group run by a peer from Zvandiri+ disseminated information.
However, the clinic did not offer 100 percent service on Saturday. At one time, the peer supporter had to offer ART to her colleagues, a line she is not trained to handle.
With most clients on ART now living a near-normal life, there is no need to congest health centres, hence the beauty of CARGS.
However, Chirundu issues were peculiar to the area.
The women said they stopped CARGS last year after discovering that a representative was withholding cotrimoxazole for her own use or resell.
Cotrimoxazole is an antibiotic mostly used to ward off infections in people with a compromised immune system.
Clients in malaria-prone areas are advised to remain on the antibiotic to fight malaria.
Most women reportedly became increasingly susceptible to colds after failing to access cotrimoxazole.
At national level, cotrimoxazole is reported to be in short supply. CAPS used to be the main supplier of the drug.
With regards to VLT, the program needs to be scaled up in all districts.
With facilities in Mazoe, Concession and other districts sending samples to Bindura, turnaround time is usually long.
In some instances, some results never come back.
Health officials said power failure was the reason for most samples getting discarded.
A similar trend was noted in most of the seven districts.
Only one centre used dry blood samples (DBS).
In DBS, blood is dried on a special paper. DBS are easy to transport and do not spoil.
With obtaining power supply constraints, it is surprising why DBS is not widely used.
The World Health Organisation (WHO) regards VLT as the golden standard to managing HIV. The recent research will, therefore, inform the country on the way forward on VLT.
The full report will be available by year-end.
It will help in coming up with the Zimbabwe National AIDS Strategic Plan (ZNASP) IV as well as the 2020 GF Concept Note.
Most importantly, the research was made possible by the Global Fund, PITCH, Aidsfonds, Frontline AIDS, ASAP and the National AIDS Council in conjunction with the Ministry of Health and Child Care.
A suppressed viral load is a pillar to ending AIDS.
