EQUIP welcomes Test & Treat initiative by Ministry of Health
30th August 2017, Lusaka, Zambia – The Ministry of Health in partnership with the United States Agency for International Development (USAID) has mandated EQUIP Health to assist with rolling out a Test & Treat programme targeting 65,000 HIV-positive individuals in five provinces in Zambia, namely: Central, Copperbelt, Luapula, Muchinga and Northwestern provinces. This is on the back of His Excellency President Edgar Chagwa Lungu’s speech at the HIV Testing, Counselling and Treatment Day event on 15th August 2017.
The HIV and AIDS scourge continues to be one of the biggest threats to Zambia’s development agenda. Since the first reported case of HIV was confirmed in Zambia in 1984, approximately one million citizens have died of AIDS-related illnesses. Despite the availability of free HIV counselling and testing services, only about 60% of Zambians living with HIV know their status.
In his speech, President Lungu emphasised the importance of people knowing their status, stating: “Let’s not wait for people to fall sick before they can start life-saving treatment. Let’s take integrated health services including HIV testing and treatment to the communities. I look forward to a Zambia where all her people know their HIV status and are taking appropriate steps to protect their health and that of their families and fellow Zambians.”
Zambia adopted the World Health Organisation’s recommended approach of treat-all HIV-positive persons with antiretroviral therapy (ART). This approach, commonly known as Test & Start or Test & Treat, has been implemented in Zambia since December 2016 and to date, 40,000 patients have been initiated onto ART in all of the abovementioned five provinces.
During August 2017, EQUIP, in collaboration with FHI360 and JSI Discover, embarked on a turn-around strategy to initiate 65,000 people living with HIV onto treatment. This rapid scale-up project is being conducted in 43 USAID-supported districts; 18 of which represent nearly 80% of the target population. The turnaround strategy is specifically aimed at populations often left behind for testing and treatment in Zambia and include pregnant and breastfeeding women, adolescents, men, key populations and those who may be at risk of contracting HIV but may be not be aware of HIV testing services.
According to Dr. Thembisile Xulu, EQUIP Chief of Party: “Our goal is to help countries expedite their UNAIDS 90-90-90 targets. With programmes such as the rapid scale up of Test & Treat in Zambia, we are moving towards that shared goal. It’s only through partnerships and in close alliance with the Ministry of Health, community partners and civil society that we are achieving that elusive ‘last mile to achieve 90-90-90.”
Data from the 2016 Zambia Population Based HIV Impact Assessment (ZAMPHIA) shows Zambia has an HIV prevalence of 12.6 percent with around 800,000 people on lifelong ART. To ensure that individuals living with HIV are on treatment as soon as they test positive, irrespective of their CD4 count, Test & Treat is a major step towards achieving the UNAIDS’ 90-90-90 global targets by 2020. This critical intervention is not only supported clinically, but also through community dialogues, radio listener groups and social mobilisation by community health care workers to motivate every member of the Zambian population to know their status and to ensure they get initiated immediately upon testing positive.
To enable the roll-out of Test & Treat in Zambia, EQUIP’s Rapid Response Clinical Team conducted an implementation capacity assessment, gathering insights on staffing, logistics and training requirements for a swift and successful transition to Test & Treat. To achieve this eight teams covered five provinces, 18 districts and nearly 200 health facilities ranging from hospitals, large urban clinics to remote rural health centres.
EQUIP Zambia Country Director, Dr. Crispin Moyo, commented: “Lessons from the field have shown that pockets of individuals living with HIV patients suspect their status but fear testing because of deep rooted stigma. Sadly, the stigma is widespread and HIV is still a touchy topic in many households. Initiating treatment immediately has proven challenging in some areas - HIV patients often see treatment as a part of the stigma and shy away from being on treatment for the rest of their lives hence late presentation. Adherence is another critical factor; many patients are hesitant to make a lifelong commitment to taking ARVs. EQUIP’s commitment to test and start is multi-faceted. Our intensified advocacy and community mobilization to initiate treatment will assist to turn the tide against the HIV pandemic in Zambia.”
EQUIP’s mandate of Test & Treat spans across nine countries - Burundi, Dominican Republic, the Democratic Republic of Congo, Ghana, Haiti, Lesotho, Malawi, Zambia, and Zimbabwe – either through technical support to in-country NGOs or as direct service deliverers through demonstration projects.
Founded in October 2015, EQUIP is the first Africa-led global consortium designed to deliver rapid scale-up of innovative HIV treatment and prevention solutions across 17 PEPFAR countries. Right to Care serves as the prime partner for the EQUIP consortium; Anova Health Institute, Maternal Adolescent Child Health (MatCH) and Kheth’Impilo, all based in South Africa, and Partners in Hope based in Malawi. Additional academic support was brought in to strengthen the operational research component of EQUIP, from partners at the Health Economics and Epidemiology Research Office (HE2RO) of Witwatersrand University, the National Health Laboratory Service in South Africa (NHLS), Boston University (BU) and the University of California Los Angeles (UCLA) in the United States. Combined, the consortium brings decades of experience delivering high quality HIV prevention, treatment and care services.