Circle of Hope Chitungwiza – OPHID decentralization initiative of HIV Care and Treatment Services through health posts facilitating improvement in service delivery for PLHIV.
Chitungwiza District has a total number of people living with HIV (Tx-Curr) of 32 883. These clients are serviced at 6 health facilities, which are St Mary’s, Seke North, Seke South, Zengeza, Chitungwiza Central hospital, and Citimed private hospital and due to the high number of clients receiving services in the facilities during this COVID-19 pandemic, devising innovations that facilitate decentralization of services and reducing the burden of work for healthcare worker whilst increasing service reach to communities is critical. With support from PEPFAR through USAID Zimbabwe under the Target Accelerate and Sustain Quality Care Program, OPHID developed the Circle of Hope Model through community mapping to identify hot spots and those embedded in a high activity and busy setting to offer convenience to clients on OI/ART services considering issues around privacy, stigma, and discrimination for People Living with HIV.
Case Study: Utano Health Post
Utano Community Health Center, is in one of the busiest neighborhoods in Chitungwiza, is strategically located to cater for Chitungwiza Central Hospital, Zengeza Clinic, CitMed Hospital, and reaches marketplaces like Chikwanha Market Place, Chitungwiza Arts Center (with almost) 200 or more artist operating in the Center, informal businesspeople in the area, and a residency for some key populations (sex workers). It has also proximity to a major road that connects St Mary’s, Zengeza, Town Center and Makoni Shopping Center. Utano Community Health Center itself promotes initiatives and supports community-oriented programs, projects directed towards strengthening, establishing, and developing social networks and support systems that encourage self-reliance for individuals in Zengeza community.
“The center offers a diverse range of social, recreational, and educational programs through the provision of community information, foster links, and interaction between members of the community and is also a community water point, where an average of 50-60 households fetch water on daily bases and we attend to 20+ clients per day accessing different services”
– Sostain Moyo (Community Outreach Agent Coordinator)
The Community Health Services Nurse, Community Outreach Agents and Coordinator are responsible for manning the health posts to mobilize and navigate clients for services with the COA’s being responsible to spread community awareness on the Differentiated Services Delivery initiative and clients’ names are obtained from the clinic facility registers (line listed) for tracking and tracing on services as: Index contact tracing, ART refill or ART refill, Viral Load sample collection and mobilizing for cervical cancer screening, even reminding clients for cervical cancer treatment.
“When I was diagnosed with HIV in 2017, my greatest fear was to disclose to my family, friends and have been exposed to discrimination at some point and I believe that privacy for PLHIV is key to ensuring our dignity and respect in the community, Utano Health Post has allowed me to interact with the team and access other related services such as mental health counselling since we have enough time to discuss unlike at facilities, - today I came for my Viral Load sample collection because I was due and received a reminder through outreach agents – Olinda Taka ( Client)
Differentiated models of care benefits both the recipient of care and the health system since they reduce waiting time at facility, reduce contact with health facility freeing up time for other activities and opportunities for peer support e.g., CARGS, Family refills. As the country moves towards reaching Epidemic control, decentralization of OI/ART services into the community will enhance community involvement and subsequently increase advocacy for an accelerated and comprehensive HIV response.
“Our community outreach agents have established good relations in the community and are going beyond line-listed clients shared from facilities and this has allowed the health post to initiate new clients especially key polulations (sex workers, vendors, youth) and set up of ART refill groups at family level, to date the health post have 2 refill groups established through the community cadres” – Alice Nyahumo (Community Health Services Nurse)