Key Populations
CeSHHAR’s Key Populations programming aligns with the Ministry of Health and Child Care’s National HIV Response Strategy and the Zimbabwe National HIV/AIDS Strategic Plan (ZNASP) led by the National AIDS Council. The KP programme offers differentiated combination prevention and HIV care and treatment services to support HIV epidemic control in key populations in their diversity and male sexual partners of sex workers across all 10 provinces in Zimbabwe. Targeted interventions are led by 927 community cadres, who are the vital link between community and services. In the past year, CeSHHAR made significant strides in increasing its reach and delivery of services to key populations through increased coverage from 86 sites to 140 sites across Zimbabwe. The program also increased coverage for young women selling sex by expanding DREAMS programming to 4 new districts from 1 October 2023.
Prevention
In condom programming, 6,034,958 male condoms and 263,009 female condoms were distributed across all 140 sites. 12,540 persons were initiated on HIV Pre-Exposure Prophylaxis (PrEP) supported by expanded community-level demand creation and DSD models.
Care and Treatment
Substantial progress in providing care and treatment services were made with 11/12 static sites and 5/6 drop-in centres providing on site initiation of persons testing positive on antiretroviral treatment (ART). By the close of 2023, 97% (2101/2160) of newly identified positives had been initiated on ART
Between 1 October 2023 and 30 September 2024
MALE SEXUAL PARTNERS DEMONSTRATION PROJECT
The programme successfully implemented this demonstration project in Gweru, Bulawayo, and Beitbridge delivering a minimum standard package for male sexual partners (MSPs) of young women selling sex (YWSS) through male mobilisers. A total of 1658 MSPs were referred by 35 Male mobilisers to clinics in the 3 districts, 74% (1226/1658) of referred MSPs were reached with various services including HIV testing, condoms, STI treatment, self-tests and PrEP. 79% (972/1226) tested for HIV with a positivity rate of 3% (26/972), 89% (803/946) were offered PrEP and 89% (715/803) were initiated on PrEP while 86 were treated for STIs and 406 HIV self-test kits distributed among the MSPs
THE SAFETY NETWORK
The Safety Network (SN) model collectivised sex worker-led self-help groups (SHGs) in Makoni district to address stigma and discrimination and empower sex workers to address their health-related needs by fostering active and meaningful participation in community activities. Ten self-help groups participated in implementation with a total of 72 members. The District Development Coordinator was fully involved in the model implementation and through these collaborative efforts and partnerships, the model did not only strengthen and empower sex worker groups, but also facilitated economic strengthening and the establishment of sustainable structures and processes
The Key Populations Programme
The primary focus for KP Research in 2023 was data analyses and documentation of findings having completed data collection in 2021 and 2022 for multiple studies supported by Wellcome Trust, the Bill &
Melinda Gates Foundation, WHO, UNAIDS, and PEPFAR through USAID. The Wellcome Trust-funded AMETHIST trial primary outcome paper and process evaluation papers are under review at journals. Quantitative and qualitative data working groups continued to meet regularly to progress analyses and manuscript writing.
The quantitative team continued analysing respondent-driven sampling (RDS) and other process data to evaluate the cost effectiveness of the Adapted Microplanning to Eliminate Transmissible HIV in Sex
Transactions (AMETHIST) trial and understand condom and PrEP use, and STI prevalence among female sex workers (FSWs) while on the other hand the qualitative team were working on the analysis of life course studies and life narratives, as well as exploring the contextual factors that affected the implementation of
the AMETHIST intervention.
For BMGF supported studies, we submitted a paper for the Recent Infection Testing Algorithm (RITA) study to the Journal of Acquired Immune Deficiency Syndromes (JAIDS). We also convened a national Priorities for Local AIDS Control Efforts (PLACE) Stakeholders’ meeting and developed a consolidated slide deck for key stakeholders. Findings from the implementation of the UNAIDS funded Safety Network pilot project in Makoni district were presented at the ECRI symposium. Additionally, in the draft stages is a paper on community-led delivery model for PrEP.
The study was funded by USAID as an HIV response model targeting high-risk men to reduce HIV acquisition and was implemented through a peer-led approach. Also in the draft stages are two papers focusing on values and preferences for Long-acting Cabotegravir (CAB-LA) in female, male and transgender sex workers for the study that was funded by WHO.
We successfully launched and completed field activities of the USAID funded Population Size Estimation study. We collected RDS data among FSWs in Bulawayo (N=1005) and Harare (N=2001) and leveraged on data that we collect as part of programme service use and data that was collected during the AMETHIST trial and the PLACE surveys to update the national-level population size estimate for FSW. Findings were presented at a national stakeholder workshop in October and the main report was finalised and shared.