“I knew I was sick.
I’ve known it for the last year but I was too scared, no – too petrified – to have a test. My husband is a miner in the Copperbelt and he only comes home once in a month. It’s my duty to look after our three children. I couldn’t make the shift in my head to admit that I was sick. My work at the hotel keeps us alive, the money is little but it is stable. I couldn’t admit that my body was unstable. But the more I ignored my ailing body, the louder it spoke. I started missing shifts at the hotel, getting in trouble. Two months ago, I almost lost my job, but I pleaded, promised to be stronger. I couldn’t ignore it any longer – I had to go for the test. I went to a clinic on my day off – far away where nobody would recognize me. I couldn’t tell my husband, my mother, my sisters because stigma about HIV is still bad in Zambia. It’s the silence virus – it silences too many people living with it. I tested positive. I knew I would. I just couldn’t admit it to myself before I went to test. I got my results immediately. The counsellor talked me through every detail, said that I would be put on treatment immediately. I took the leap. Decided to start treatment right away. Why wait? I’ve been waiting for the courage to come to me to test for so long. The information I received at the clinic opened my mind. It made me realize that I must fight my own internal stigma first. The stigma of being positive. The stigma of being on medication for the rest of my life. But I am fighting it. I am fighting the stigma with each part of my heart and mind.
I’ve been on treatment for 5 weeks now. The side effects haven’t been bad. Some mornings I woke up with a headache that lasts for a couple of hours. Sometimes I feel nauseous. But I can live with this. I see the side effects as a reminder that I am not going to die. That it’s part of being stronger, that my body can get back to where it was all those years ago when I was young and healthy. My husband is coming home from the mines this weekend. I know he gave me the virus. I cannot be silent anymore. I will use the same courage that brought me to this day to speak to him about HIV testing and treatment.” – Mildred, 36, Lusaka.
The story of Mildred is not an unfamiliar one in Zambia where 1.4 million people live with HIV and only 48% of the population know their status. Stigma is widespread and HIV is a taboo topic in many households. There is considerable effort to turn the tide on HIV – with the support of USAID and PEPFAR and collaboration with MOH, NGOs like EQUIP are rolling out the country’s first test and treat programme.
Zambia adopted the World Health Organization’s recommended approach of treat-all HIV-positive persons with antiretroviral therapy (ART). This approach, commonly known as “Test & Start” or “Test & Treat”, has been implemented in Zambia since December 2016 and officially launched by Zambian President Edgar Lungu on 15 August 2017.
The aim is to initiative patients on treatment as soon as they test positive, irrespective of their CD4 count. Test and treat is a major step towards achieving UNAID’s goal of 90-90-90 by 2020, It’s a critical intervention supported not only clinically but through community dialogues, radio listener’s groups and social mobilization by community health care workers to motivate every member of the Zambian population to know their status and to initiate those who have tested positively before onto treatment immediately.
According to UNAIDS, Zambia has an HIV prevalence of 13.3 percent with around 700,000 people on ART.
EQUIP’s mandate of test and treat spans across nine countries – Burundi, Dominican Republic, the Democratic Republic of Congo, Ghana, Haiti, Lesotho, Malawi, Zambia, and Zimbabwe – either through technical support to in-country NGOs or as direct service deliverers through demonstration projects. Lessons from the field have shown us that many HIV patients suspect their status but fear testing because of deep rooted stigma – often self-stigma. Test and start brings an urgent mandate to initiate treatment immediately, no matter what the CD4 count is. Initiating immediately treatment has proven challenging in some areas – HIV patients often see treatment as a part of the stigma and shy away from being on treatment for the rest of their lives. Adherence is critical many patients are hesitant to make this commitment.
Says Dr. Thembisile Xulu, Chief of Party, EQUIP: “Our mission is to help countries expedite their UNAIDS 90-90-90 targets. With programmes such as the rapid scale up of test and treat in Zambia, we are moving towards that shared goal. It’s only through partnerships and in close alliance with the Zambian Ministry of Health, community partners and civil society that we are achieving the goal —crossing that elusive ‘last mile to achieve 90-90-90.’
To enable the roll-out of Test and Treat in Zambia, EQUIP’s Rapid Response Clinical (SWAT) Team conducted an implementation capacity assessment, gathering insights on staffing, logistics and training requirements for a swift and successful transition to Test & Treat.
Eight teams across five provinces and 18 districts, to visit 200 health facilities ranging from hospitals, large urban clinics to remote rural health centres. SWAT teams were compiled of EQUIP clinical, social mobilization, GIS, finance, travel and IT teams, as well as M&E employees from the Zambian Department of Health in different provinces. EQUIP’S rapid implementation capacity assessment is providing a host of critical insights into potential bottlenecks and interventions to ensure the seamless delivery of the universal Test & Treat program.
Between August and September, EQUIP in collaboration with the MOH, FHI360 and JSI will start a two-month turn-around strategy to initiate 65,0000 people living with HIV onto treatment. This rapid scale-up project will be conducted in 43 USAID supported districts in 2 months. Out of the 43 districts, 18 districts represent nearly 75,000 – 80,000 of the target population.
The turnaround strategy will be implemented from 7th August 2017 to 30th September 2017. It coincides with the HIV Counselling Day under the theme Test and Treat which will be commemorated on the 15th August 2017 at a national launch in Lusaka.
The turnaround strategy is specifically aimed at populations often left behind for testing and treatment in Zambia and include pregnant and breastfeeding women, adolescents, key populations, men and those who may be at risk of contracting HIV but may be not be aware of HIV testing services.
Test and Treat has several important benefits:
- Treatment prevents HIV transmission by reducing viral load in the body;
- The counselling provided during test and treat sessions helps minimize complications of HIV;
- Provides timely linking of people who are positive to care that promotes better health outcome
- It provides people an opportunity to go for other tests such as for TB and STIs at a timely manner.
- Encourages individuals to continue the treatment by giving them moral support and confidence in the available health services.