Is a new era of HIV and SRH integration dawning in Zimbabwe?

A national rollout of integrated HIV and sexual and reproductive health (SRH) services for women is happening in Zimbabwe after integrated clinics reported a major increase in HIV and sexually transmitted infection (STI) testing.

What is this story about?

Integration is when HIV and SRH services are provided together rather than separately. The aim of integrating services is to increase uptake by making it easier for people to get a wider range of services in one place.

With support from the World Health Organization, Zimbabwe’s Ministry of Health and Child Care opened four integrated SRH and HIV clinics for women in 2020. Two of the clinics are in Harare and two are in Bulawayo, and they are run by the Zimbabwe National Family Planning Council. Each is a ‘one-stop-shop’ that provides comprehensive family planning services alongside HIV prevention, testing and treatment.

Why is this important?

The one-stop-shop project was developed to address the high rate of HIV infections among women in Zimbabwe, particularly adolescents and young women (ages 15-24).

In Zimbabwe, and other east and southern African countries, many adolescent girls and young women with HIV and other STIs do not get diagnosed until they are pregnant and attend an antenatal clinic. This alone suggests that providing HIV and STI services as part of family planning services could reduce infections. Doing this could also ensure more young women with HIV get antiretroviral treatment (ART) earlier. This is essential for young women’s health and the health of any babies they may go on to have. It could also reduce onward transmission.

What has happened?

Of the 18,756 women who came for family planning services between October 2020 and December 2022, 16,298 (or 87%) were screened for STIs. This is almost six-times more than the number of women who screened for STIs the previous year. All women diagnosed with an STI were treated at the clinics.

Over one-third (36%) of women who came for family planning services tested for HIV. This equates to 6,680 women testing for HIV, of whom 448 were diagnosed HIV positive. All those diagnosed with HIV were referred for ART. Around 5% began ART at the clinics.

Among those women who tested HIV-negative, 2,114 were screened for HIV risk and qualified for PrEP. Of these, 133 began PrEP at the clinics. The rest were referred to other clinics to take PrEP if they wanted to.

Around 2,000 HIV self-testing kits were given to women who visited the clinics. Just under three-quarters (73%) of these kits were used by the women themselves and the rest were shared with a partner.

Most women who reported their self-testing results to one of the clinics had a reactive result (suggesting a positive result). All women with a reactive result came to the clinic for an HIV test to confirm their result.

Most women (95%) who came for family planning got the contraceptive pill. Far fewer got injectables or implants.

What does this mean for HIV services?

It is very effective to integrate HIV and SRH services. Due to these results, the Zimbabwe government is planning to make the remaining seven ZNFPC sites in the country SRH/HIV one-stop-shops. Plans are also underway to turn all public sector family planning clinics and all family planning clinics in central and provincial hospitals in Zimbabwe into integrated SRH/HIV clinics.