The 2016-2021 Zanzibar National HIV and AIDS Strategic Plan III (ZNSP III) on HIV and AIDS call for scale-up of coverage and equality of services in order to meet the 90-90-90 targets. In response to this, the Revolutionary Government of Zanzibar (RGoZ) has continue to expand HIV/AIDS services in order to bring services closer to those in need. By the end of 2016,there were a total of 12 health facilities providing care and treatment services country-wide.
As of 2020, two public health facilities were certified to provide HIV care and Treatment services, increasing the number of 14 service delivery sites.
Additionally, the Ministry of Health Zanzibar (MOH) has continue to roll out community – based outreach services to key population (KP) hotspots so as to increase accessibility and availability of services for treatment services in Zanzibar.
The provisional of HIV Prevention, Care and Treatment services, including ARVs, can take place at the community and/or health care facilities, including primary health care (PHC) sites as long as the trained staff is available, and sites have been assessed and registered. Once enrolled, these Care and Treatment services can be provided at a stand-alone CTC, or integrated with general services such as dispensary, small health Centre level, or integrated as a “One Stop Shop” service at TB/HIV clinic or PMTCT sites. In case of established need, it is vital to ensure effective linkages to a wide range of other services across the continuum of care, including TB, Sexual and Reproductive Health, Family Planning, Prevention of Mother to Child Transmission (PMTCT), Social welfare, and spiritual support, legal support and HBC services.
In order to address the needs of specific groups such as children, adolescents, pregnant women, and Key Population (KPs), care and treatment clinics will be improved to provide friendly services to the groups by building the capacity of health care providers and peers. The following core elements of HIV prevention, treatment, and support need to be available within CTC services:
- Education about behavioral risks and condom use for infected people.
- Orientation on care and treatment services available in hospital and district.
- Education and regular counselling on life-long diseases management, and in particular on treatment adherence.
- Education and counselling on actions that may delay the progression of the disease and reduce co-morbidities; for example, addressing nutrition, food safety, clean water, and use of insecticide-treated bed-nets.
- Early identification and management of comorbidities such as TB and Viral Hepatitis.
- Prophylaxis for opportunistic infection (OIs) including Cotrimoxazole. TB preventive therapy, and cervical cancer screening.
- Adherence sessions.
- Assessing readiness for ART or Pre-Exposure Prophylaxis initiation.
- Effective referrals to essential hospital services such as antenatal clinics for PMTCT, family planning advice before and while on ART, STI or other specialized clinics.
- Recording and reporting according to the established electronic and paper-based system.
- Registration and appointment systems for effective treatment continuation and preventing missed appointments.
- Referral to community-based services, social welfare, and legal support.
In order to effectively provide quality HIV and AIDS Care and Treatment, service delivery needs to be organized in a manner to ensure efficiency, user-friendliness and standardized follow -up. Quality Improvement (QI) initiatives are a helpful tool in this regard.