Clarice Pinto, Technical Officer, DSD for HIV Treatment, at the World Health Organization (WHO) writes:
Significant progress has been made toward achieving the UNAIDS 95-95-95 targets. Nevertheless, treatment interruptions, which are common, challenge these gains: studies show that in central, eastern, southern and western Africa, 20-50% of ART clients have previously interrupted treatment.
Supporting tracing and re-engagement in HIV treatment services is crucial. Disengagement from HIV care can lead to advanced HIV disease, increased mortality, higher rates of transmission and drug resistance. WHO’s 2021 consolidated guidelines on HIV include a strong recommendation for tracing people who have disengaged from care and providing support for re-engagement to reduce the chance of future disengagement.
A recent systematic review examining reasons for disengagement during the “treat-all” era showed that the reasons for disengagement are multifaceted, encompassing individual, interpersonal, health system and structural factors.
WHO’s upcoming Supporting Re-engagement in HIV Treatment Services: Policy Brief is, therefore, timely and essential. This brief consolidates existing WHO recommendations and summarizes evidence-based strategies to address barriers to sustained engagement in HIV treatment and care. By focusing on person-centred solutions, it emphasizes understanding the diverse needs and challenges faced by individuals who disengage from treatment.
We spoke with Chiedza Mupanguri, National Antiretroviral Therapy Coordinator in Zimbabwe’s Ministry of Health and Child Care (MOHCC) about national policies and measures to support sustained engagement in HIV care.
Algorithm for the management of a recipient of care re-engaging in care, Operational and Service Delivery Manual for the Prevention, Care and Treatment of HIV in Zimbabwe (2022)
Chiedza, please could you describe the policy frameworks that guide HIV service delivery in Zimbabwe?
In 2022, the MOHCC updated its HIV prevention, testing and treatment guidelines in line with WHO guidance and launched a revised Operational and Service Delivery Manual for the Prevention, Care and Treatment of HIV in Zimbabwe (OSDM) with the aim of increasing retention at all steps of the cascade. Re-engagement in care is one of the updates in the national HIV guidelines and OSDM.
Can you share details of how the new OSDM supports sustained engagement and re-engagement in care?
The OSDM defines what re-engagement in care is, describes the re-engagement cycle across the whole cascade, provides algorithms for the management of recipients of care re-engaging in care, and assists healthcare workers on how to approach and counsel this group of recipients of care.
What are some of the priorities around HIV service delivery more specifically?
We need to leverage technology, such as mobile health applications, telemedicine and text messaging, which can help overcome geographical barriers and improve access to care. Such innovations can facilitate appointment reminders, medication adherence support and access to health information.
Lastly, addressing the issue of community engagement and support is critical. Involving people living with HIV and their communities in the design, implementation and monitoring of HIV programmes has proven effective and can help reduce stigma, improve access to care and ensure the relevance and acceptance of interventions.
