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Treatment Optimisation

Purpose

The Treatment Optimization (TO) Initiative was a partnership between WHO, UNAIDS, and Pangaea Zimbabwe, funded by the Bill & Melinda Gates Foundation. It aimed to maximize the utility of existing HIV therapeutics, diagnostics, and delivery systems, improve health outcomes within existing planned and committed resources, and reduce costs while mobilizing communities. The initiative also supported Zimbabwe’s national HIV treatment priorities, including antiretroviral therapy, and works to strengthen community systems and integrate them into national HIV treatment cascades.

Target Population

  • People living with HIV

  • Adolescents, young people & children affected by HIV

  • Women and girls facing treatment barriers

  • Men with high attrition and mortality rates

  • Community-based caregivers and counsellors

  • Community health workers

  • Policy makers, researchers, service providers & HIV activists

  • Zimbabwe (National focus)

  • Meetings hosted in Harare

  • Participants from across sub-Saharan Africa
    (40 stakeholders at the first meeting, 100 participants in second meeting, 30 from outside Harare)

Geographical Location

Key Strategies

  • Decentralization of HIV treatment delivery systems

  • Community-oriented HIV service delivery models

  • Integrating community systems with health care systems

  • Strengthening linkages between public sector & community systems

  • Enhancing demand, access, linkage, treatment initiation, adherence & retention

  • Supporting WHO guideline development through evidence & practice

  • Addressing gender, youth and service delivery gaps

  • Advocating for costed and sustainable community mobilization

  • Task shifting — with fair remuneration & training

Major Activities

  • National consultative meetings led by Ministry of Health, WHO & Pangaea

  • Stakeholder engagement with activists, researchers, policy analysts, community providers

  • Plenary discussions on testing, linkage, ART initiation, adherence & retention

  • Review and documentation of community-centered HIV models

  • Integration dialogue between HIV prevention, treatment & primary health care

  • National meeting on decentralization of HIV prevention, care and treatment

  • Follow-up consultations to define integration frameworks

  • Development of an Operational Plan for strengthening community-public sector linkages
    (led by NAC with Pangaea as Secretariat support)

Identify effective community models that support HIV care and treatment, including HIV testing, linkage to and retention in care, with the goal of achieving universal access to HIV services by 2015.

Recognize critical success factors and barriers to integration of community interventions with the health care system.

Strengthen linkages between the community and health system at the different levels of health care delivery. There was broad agreement that community systems have the potential to be more responsive to certain needs and priorities of beneficiaries (allocative efficiency) and comparatively cost effective (productive efficiency) because of lower levels of bureaucracy and better knowledge of local costs. The key is identifying how best to link the public sector and community systems to optimally meet the needs of the clients. It was also recognised that service integration and linkages can improve care and reduce missed opportunities for key interventions such as HIV testing, provision of ART, PMTCT, and adherence support. Integration of care is an important strategy to improve patient retention in long-term HIV care and treatment.

NAC, with secretariat support from Pangaea, will convene a steering Committee drawing from various stakeholders appointed to develop an Operational Plan for Strengthening Linkages between public sector and community Systems, leveraging existing policies and documents that respond to the recommendations that were brought forward in this meeting.

Outcomes

  • Influenced the WHO 2013 HIV treatment & prevention guidelines

  • Strengthened Zimbabwe’s decentralization of HIV treatment services

  • Identified best-practice models of community-based HIV service delivery

  • Built evidence on impact of community engagement in HIV treatment cascades

  • Elevated importance of:

    • Women & girls’ treatment barriers

    • Men’s poor adherence and high mortality

    • Youth & adolescent treatment access

    • Community health worker support & fair compensation

  • Affirmed community systems as essential to:

    • HIV testing

    • Linkage to care

    • Treatment initiation

    • Lifelong retention

  • Set in motion the development of a national Operational Plan
    to institutionalize public–community HIV service integration

Resources

  • MOHCC 2011 Decentralization Guidelines

  • WHO 2010 HIV/AIDS Treatment Guidelines

  • Alma Ata Declaration on Primary Healthcare (1978)

  • Ouagadougou Declaration on Primary Healthcare (2008)

  • UNAIDS Strategic Investment Framework

  • IEC Materials for decentralization and ART guidelines

  • Community models and operational research shared by stakeholders

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