Outreach points fill HIV service gaps while health facilities were closed in Harare, Zimbabwe, August-December 2020

BACKGROUND: COVID-19 related travel and other restrictions, compounded by a health-worker strike in Harare, Zimbabwe, reduced access to antiretroviral therapy (ART) refills and other critical HIV services. In July 2020, 27 of 43 Harare facilities, serving 54,605 (50%) patients on ART, closed. We describe the results of a community outreach program to provide ART and other HIV services while reducing COVID-19 exposure to health workers and clients.
DESCRIPTION: ZimPAAC provides human resources and technical assistance to the Zimbabwe Ministry of Health and Child Care (MOHCC) to support HIV services in 43 Harare facilities. Starting in August 2020, with input from PLHIV-association members, we identified 23 community sites, primarily open spaces, community halls and schools as outreach locations. ART patients were notified of the outreaches by phone calls, text messages and through PLHIV organisations. Outreach points were staffed by nurses, primary counsellors, and data-entry assistants. Sites adhered to COVID-19 prevention measures and provided services outdoors. Based on number of clients on ART, outreach points operated 1-3 days per week. Program outputs were captured from MOHCC registers.
LESSONS LEARNED: From 17 August to 18 December 2020, 29,330 ART clients (64% women) were seen at 406 outreach sessions (mean 72 clients/session; range 5-170). Of the clients supplied, 95% were registered at the host facility. In line with increasing multi-month dispensing, 15,679/29,330 (53%) of clients received 3-5 months of medicines and 10,376/29,330 (35%) received 6 months. Of clients eligible 3,741 (99.6%) received TB preventive treatment and 8,656 (99.9%) had viral load testing. Among clients issued viral load results, 335/3,357 (10%) had high viral load and all received adherence counselling. Of 302 HIV tests done, 15% were confirmatory for reactive HIVST, 88 (30%) were positive and all were initiated on ART. Prophylactic medicines were supplied to 642 HIV exposed infants and 77 samples collected for early infant diagnosis.
CONCLUSIONS: Community-based outreach can be an effective approach for providing HIV services while reducing COVID-19 risk, even in urban settings. Engaging PLHIV in selection of sites can optimize utilization. Communication through mobile phones is an important mechanism for informing PLHIV of the availability of outreach services.