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MSF in Zimbabwe, 2010
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After years of political and economic crisis, the situation in Zimbabwe has stabilised. However, the HIV/AIDS epidemic and outbreaks of disease continue to overwhelm the weakened healthcare system.
In 2010 MSF responded to an outbreak of measles alongside the Ministry of Health and other organisations, and five million children were vaccinated in total. Staff also supported the national health authorities’ response to an outbreak of the H1N1 virus in Tsholotsho district, providing treatment and care to more than 14,000 patients.
An estimated 1.2 million adults and children are living with HIV in Zimbabwe. Only 55 per cent of the almost 600,000 people in urgent need of life-prolonging antiretroviral (ARV) treatment are receiving it. MSF operates HIV/AIDS programmes in health clinics in Bulawayo city, Beitbridge, Epworth, Gweru, Tsholotsho and Buhera. Each programme provides comprehensive HIV/AIDS care, offering counselling, testing, treatment and the prevention of mother-to-child transmission of the virus. In 2010, more than 34,000 patients were receiving ARV treatment through MSF’s presence in Zimbabwe.
The cost of transport restricts access to the few functioning hospitals providing ARV treatment, which puts patients at risk of interrupting their treatment, especially those living in remote areas such as Buhera and Tsholotsho. MSF seeks to remedy this by decentralising services from hospitals to rural clinics, bringing free HIV care closer to patients’ homes. MSF has also implemented task-shifting and clinical mentoring – training nurses in routine HIV care, including the administration of ARV drugs, so that more staff are able to treat more patients in more locations.
In Bulawayo, the MSF team focuses on tailoring services to meet the special medical needs of children and adolescents with HIV. Children who are in a stable condition can now be treated in local clinics rather than hospitals. Staff have also piloted specific medical and psychological support programmes for adolescents.
Improving tuberculosis care
Tuberculosis (TB) is the leading cause of death among people living with HIV/AIDS in sub-Saharan Africa, and there is growing concern over the spread of drug-resistant TB (DR-TB) through the southern African region, in part due to high levels of migration. DR-TB is difficult both to diagnose and to treat, and the Zimbabwean national TB programme is already stretched. The MSF team in Harare is providing support and technical assistance to Zimbabwean health authorities in the implementation of a national DR-TB strategy. The number of people infected with DR-TB in Zimbabwe is not yet known. In December 2010 MSF enrolled its first patient on treatment, and the team has expanded service provision in Epworth through a community-based model of care. The aim is for 60 patients to start treatment by the end of 2011.
Impact of the international HIV funding retreat
In December 2010 the Global Fund to Fight HIV, Tuberculosis and Malaria rejected Zimbabwe’s application for US$ 220 million to finance the expansion of its HIV and TB programmes. Such a cut in funding may limit the number of new patients that can receive treatment, and it will further prevent the Zimbabwean health authorities from starting to implement the new, more progressive World Health Organization guidelines on ARV treatment.
All of MSF’s HIV programmes also offer care for victims of sexual violence. In 2010 teams in Bulawayo, Epworth, Gweru, Beitbridge and Tsholotsho treated a total of 1,325 patients for sexual violence. Teams worked to increase the number of people who seek assistance, establishing a support group for victims of sexual and gender-based violence, and campaigning for education about the issue.
MSF has worked in Zimbabwe since 2000.