Improving the health of children living HIV with pDTG

Improving the health of children living HIV with pDTG

Caption: The paediatric formulation of dolutegravir is being praised as a game changer in managing HIV in children as it makes treatment easier and cheaper. PHOTO | CHAI

DOLUTEGRAVIR in paediatric formulation (pDTG) – a drug recommended as first-line anti-retroviral for HIV treatment, is being hailed as a game changer in managing the virus in children as it makes treatment easier and cheaper.

The new drug is a strawberry-flavoured tablet that can be dissolved in clean water, making it easier to give to children too young to swallow tablets.

An estimated 1.8 million children worldwide live with HIV, but only half are receiving treatment, due to the complexities of being hard to administer due to the bitter taste or incorrectly dosed by crushing adult pills (UNAIDS, 2021).

UNAIDS notes that treatment coverage among children living with HIV in 2020 was just 54 percent, representing a global failure to provide life-sustaining care to almost 800,000 of the 1.8 million children living with HIV.

According to UNAIDS, treatment coverage among children living with HIV lags adult treatment coverage in most of the sub-Saharan African countries with large HIV epidemics. And about 100,000 children die from AIDS-related causes annually.

HIV/AIDS is a leading cause of child mortality contributing about 21 percent of deaths, followed by pneumonia, diarrhoea, measles, and malaria in Zimbabwe (ZDHS, 2015). And approximately two thirds of childhood deaths occur during infancy, with more than one third taking place during the first month of life (MICS, 2019). In the year 2020, 79 000 children (0-14 years) were living with HIV and 3 500 succumbed to the disease in Zimbabwe (UNAIDS, 2021).

Data shows that the lowest suppression is amongst the younger children. The lack of options when it comes to effective drugs and formulations has made treating paediatric HIV challenging. The current choices include syrups that are unpalatable and require cold chain storage, and solid formulations that are extremely bitter, hard to swallow and must be taken multiple times per day.

These barriers have compromised adherence to treatment, resulting in poor outcomes in children and significant premature death.

Paediatric dolutegravir is now the first-line HIV treatment that is recommended by the World Health Organisation (WHO) from the age of four weeks and three kilogrammes, but it had been out of reach for babies because of the lack of appropriate formulations.

pDTG belongs to a class of ARVs called HIV integrase inhibitors and is the WHO’s recommended first-line drug to treat HIV. It is said to be more effective, easier to take, has fewer side effects than alternatives, and has a low chance of one developing drug resistance when taken correctly and consistently.

The flavouring renders the drug more palatable to children compared with current options, paediatric HIV experts attest. The availability of pDTG film-coated tablets will foster improved adherence among the children living with HIV thereby improving treatment outcomes in children and adolescents.

The pDTG 10mg dispersible tablet is targeted for children between three kilogrammes and 20kg. Thereafter, children above 20kg are treated with DTG 50mg. The new pDTG 10mg dispersible formulation – when coupled with other available dispersible ART treatments – provides treatment that is easy to administer, has better taste and can ultimately improve viral suppression for the youngest and most vulnerable children.

In Zimbabwe, the phased transition from the use of Nevirapine and Efavirenz then to (DTG) 50 mg and now to pDTG 10mg kicked off in June 2021.

Dosing for pDTG is determined by the weight of the child, caregivers are therefore encouraged to bring the child is weighing at all clinic/hospital visits and medicine dioses are adjusted as the child grows.

Zimbabwe Association of Church-Related Hospitals (ZACH) with funding from the U.S President’s Emergency Plan for AIDS Relief (PEPFAR) through Centres for Disease Control and Prevention in Zimbabwe (CDC), is supporting Ministry of Health and Child Care efforts to fight HIV/AIDS in children in ensuring that pDTG reaches every child who needs it.

The organisation ensures that children who are HIV positive are put on treatment early and health care workers are being regularly trained, followed by a mentoring system to increase confidence and ensuring access to paediatric treatment including adequate formulations for children.

Every child living with HIV deserves treatment for their own health!


  • The paediatric formulation of dolutegravir has been hailed as a game changer in managing the virus in children.
  • The new drug comes as a tablet that can be dissolved in water, making it easier to give to children too young to swallow tablets.
  • DTG belongs to a class of ARVs called HIV integrase inhibitors and is the WHO’s recommended first-line drug to treat HIV.
  • Works fast to suppress the virus and has fewer side effects than other ARVs.
  • Dolutegravir (DTG) should not be taken alone. DTG should be taken with two other anti-retroviral medications

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Continuity of TB services during COVID-19 pandemic

Continuity of TB services during COVID-19 pandemic

THE current COVID-19 pandemic has been a test for countries, health systems, key stakeholders, and those delivering health services at the front line. When COVID-19 was declared a pandemic, there was concern that TB services in Zimbabwe would be severely affected.

Though service delivery was abruptly disrupted by COVID-19 lockdowns, the Zimbabwe Association of Church-Related Hospitals (ZACH) had to act swiftly to ensure provision of and access to essential TB services.

With support from the U.S. President’s Emergency Plan For AIDS Relief (PEPFAR) through the Centre for Disease Control (CDC) in Zimbabwe, ZACH came up with ways to continue providing health services in a country with strict stay-at-home measures and transport restrictions.

“When COVID-19 struck, we had to think outside the box to maintain TB continuity of care,” said Sihlobo Fuyana, St Luke’s Mission Hospital OI/ART nurse.

Due to disruptions in the provision of and access to TB diagnostic and treatment services due to the COVID-19 pandemic, TB testing and notification rates declined. This has implications on TB mortality among those with delayed diagnosis, increased prevalence as more people with TB are not diagnosed and treated on time.

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Caption: OI/ART nurse Sihlobo Fuyana explaining TB regimen to a client at St Luke’s Mission Hospital in Lupane, Matabaleland North province.

TB remains one of the world’s biggest public health threats and now ranks alongside HIV as the world’s leading infectious cause of death. In 2020, there were an estimated 29 000 people diagnosed with TB in Zimbabwe, of whom 2 100 died from the disease in the same year (WHO, 2020). TB is however preventable and treatable and efforts to combat TB must be continuously accelerated.

In COP20, ZACH screened 37 960 ART clients for TB and 230 of those diagnosed with TB and initiated on treatment.

To ensure continuity of TB service delivery in the 75 PEPFAR-supported sites, ZACH scaled up Differentiated Service Delivery (DSD) Models like Community ART-refill groups (CARGS), Family ART-refill groups (FARGS), Outreaches and Adolescent Support Refill Groups based on their unique needs. The outreach initiative, saw testing and medicines dispensing in the community reaching very hard-to-reach areas.

People with impaired immunity, such as people living with HIV, children under five years, and those on certain medications that affect the immune system have a much higher risk of developing TB disease. And the key to TB prevention is reaching people with preventive therapy before the infection develops into an active, infectious disease.

Though still below the Ministry of Health and Child Care recommended 80% of the TB preventative therapy (TPT) coverage ZACH is currently sitting on approximately 75 % TPT coverage. Between April 2020 and March 2021, 11 960 ART clients were screened for eligibility for TPT and by September 2021, 10 139 clients had completed the TPT course.

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CDC in Zimbabwe has offered technical assistance to remove bottlenecks in TB/HIV programming to address cross-cutting issues like demand creation, capacity building through training HCWs, supply chain management to ensure uninterrupted testing and medicines and improving data quality. This also includes supporting the rollout of strategies to enhance TB case detection.

“In the face of COVID-19, it has become even more critical to protect the gains achieved to date and ensure continuity of care for ongoing epidemics like TB while keeping the health care workers and the most vulnerable safe. This is a time for resilience, rapid learning, adoptive innovations, and urgent action to save lives,” said Dr. Chidzewere Nzou, ZACH program manager.

“At the forefront of these efforts, we applaud the health care heroes who are tirelessly dedicated to save lives. And we are grateful to CDC in Zimbabwe’s technical assistance in ensuring continued service delivery.”


ZACH receives four ambulances

ZACH receives four ambulances to boost health service delivery in Manicaland province

Harare – Four new and fully equipped ambulances, donated to the Zimbabwe Association of Church-Related Hospitals (ZACH) with funding from World Bank in partnership with the United Nations Office for Project Services (UNOPS), under the Zimbabwe Idai Recovery Project (ZIRP) are a vital boost to the Government’s efforts to increase access to health care services for its most vulnerable populations, especially women and children.


Caption: Four (4) Ambulances being handed over to ZACH

“In the health sector, the capacity to transfer patients swiftly and safely is a key priority. We are therefore happy to complement Government efforts to restore and improve health services by reinforcing the capacity of the mission hospitals’ referral network,” said Marjorie Mpundu, World Bank Country Manager.

In response to the devastating impact of Cyclone Idai, these ambulances have been deployed to increase access to key underutilized services that are recognized as having the capacity to save the lives of people

In March 2019, the unprecedented Cyclone Idai hit Zimbabwe, leaving behind a trail of disaster directly affecting 270 000 people including 60 000 forced out of their homes and farmlands.

UNOPS Monitoring and Evaluation Specialist, Sheila Omom said they recognize the impact of Cyclone Idai mostly in Zimbabwe’s Eastern Highlands, and these ambulances will go a long way in serving the lives of people in the hard-to-reach areas.

Caption : The Executive Director, Mrs Chitimbire handing over keys to Mission Hospitals

St Peters, Mt Selinda, Mutambara, and Rusitu mission hospitals from Chimanimani and Chipinge districts benefited from the donation to facilitate them to provide the first line of treatment to critical patients, hence saving lives.

Receiving the ambulances, ZACH executive director, Mrs. Vuyelwa Chitimbire said the ambulances will help to strengthen the health system to provide the highest quality of care and empower communities to utilize health services appropriately.


Caption : The Executive Director, Mrs Chitimbire giving a speech of gratitude

“The donation of the ambulances will help address patient transfer challenges, especially maternity transfers, and other related emergencies to reduce preventable and premature deaths. ZACH will ensure that the ambulances will be utilized to full capacity,” said Mrs. Chitimbire.


Let’s fight against TB & HIV!

“TB ANYWHERE IS TB EVERYWHERE”. It spreads from person to person and can move across borders.

Fighting TB ensures a safer world.

Keeping the Promise to END TB
The clock is ticking!

In the race to ending tuberculosis (TB) by 2030, the disease remains one of the world’s fatal infectious killers. Each day, nearly 4 000 lose their lives to TB, and close to 28,000 people fall ill with this preventable and curable disease (WHO, 2020).

Sadly, TB is the primary cause of mortality in people living with HIV (PLHIV) worldwide, with 79 percent of the estimated 1.37 million new cases of TB/HIV occurring in sub-Saharan Africa (WHO, 2019).

The close relationship between TB and HIV/AIDS poses a significant burden on Zimbabwe’s health system. About 60 percent of TB patients are also living with HIV. WHO cites Zimbabwe as being among the 14 countries with a triple burden of TB, TB-HIV co-infection, and drug-resistant TB (DR-TB).

In Zimbabwe, approximately 1,4 million people are living with HIV (National HIV Estimates). And TB continues to be the leading cause of death among people living with HIV with 60 percent of Zimbabweans suffering from TB are co-infected with HIV.

According to the Global TB Report of 2019, Zimbabwe recorded a total of 25 775 cases, and of those 15 062 were in PLHIV.TB is an infectious disease caused by Mycobacterium tuberculosis bacteria. While TB typically affects the lungs, it can affect any part of the body. TB spreads from person to person through the air when someone sick with the disease coughs, sneezes, or spits. Another person needs only to inhale a few of these germs to become infected.

Photo credit: istockphoto

Human Lung with Tuberculosis illustration

The crucial question to ask is what needs to be done to end TB?
Prevention, prevention, and prevention!

People with impaired immunity, such as people living with HIV, children under five years, and those on certain medications that affect the immune system have a much higher risk of developing TB disease. The key to TB prevention is reaching people with preventive therapy (TB preventive therapy) before the infection develops into an active infectious disease.

There are no scenarios in which we can end the global TB epidemic without a much greater focus on TB prevention. But there is still an opportunity to substantially reduce the death toll by prioritizing the most critical services: antiretroviral therapy for HIV and timely diagnosis and treatment of TB.
There is a need to ensure that people have access to diagnosis and appropriate care at the earliest stage after exposure to TB. This is critical to reducing TB transmission and ending the epidemic.
And as the world comes together to tackle the COVID-19 pandemic, it is important to ensure that essential services and operations for dealing with long-standing health problems continue to protect the lives of people with TB and other diseases or health conditions.

Health services, including national programmes to combat TB, need to be actively engaged in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are maintained.

Each year, we commemorate World TB Day on March 24 to raise public awareness about the health, social and economic consequences of TB and to step up efforts to end the global TB epidemic.


  • People can live with latent TB infection where they are infected with the TB bacteria but are not presently ill with TB disease and are not infectious (passing from one person to another). In some instances, however, latent TB infection can develop into TB disease. When this happens people become sick, and the bacteria are then able to be passed to others.
  • About one-quarter of the world’s population is living with TB infection.
  • Individuals in close contact with someone who is sick with pulmonary TB disease are at higher risk of TB infection versus individuals who have more casual contact.
  • Among people living with TB infection, those with weakened immune systems are at higher risk of developing TB disease – particularly children under five years and people living with diabetes or HIV.
  • People are at the highest risk of developing TB disease one to two years after acquiring TB infection.
  • Those living with TB infection who receive TB preventive treatment are 60 to 90 percent less likely to develop TB disease (The Union, 2018).

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Let’s Stop HIV, Together!!

Zimbabwe remains one of the countries burdened by HIV/AIDS globally with 1.4 million people living with HIV (PLHIV). Annually,12.8 percent of adults are living with HIV between the ages of 15-49, and 40,000 new HIV infections are being realized (UNAIDS 2020). People are still dying of HIV/AIDS-related diseases with an estimated number of 20,000 people while 86 percent of adults in Zimbabwe living with HIV are on life-saving antiretroviral treatment. Children as well are not being spared as 71 percent of children living with HIV, are on antiretroviral treatment. (UNAIDS Data 2020)

“My people are destroyed for lack of knowledge”-Hosea 4:6, There is hope for everyone living with HIV and communities should help fight HIV. According to AIDSinfo (UNAIDS), a third of all new HIV infections in people above the age of 15 in Zimbabwe were among young people (under the age of 24). 9,000 new infections among young women, and 4,200 were realized in 2018. Young men are still less likely to get tested, as 52 percent of young men had tested for HIV compared to 65 percent of women. (ZIMPHIA 2016).

In Zimbabwe, of the 1.4 million PLHIV, 97 percent are on the antiretroviral therapy (ART) program. Among PLHIV (15-64 years) who self-report current use of ART, 90.3 percent are virally suppressed (ZIMPHIA, 2020).

Though HIV/AIDS is nearing epidemic control, some sections of the population still lag in terms of accessing services, thereby derailing the gains achieved so far in the fight against HIV/AIDS. Globally, young people are more likely to engage in risky sexual behaviors than older adults, making them vulnerable to HIV, and yet some fear testing positive and eventually disclose their status. However, new choices of HIV/AIDS diagnostic tests have been brought up in healthcare systems to address the challenges of fear of discrimination, and concerns about confidentiality. Through the use of HIV self-testing kits, one can test in the privacy of their own homes. HIV self-testing is very safe, accurate, and easy to use. There are different kinds of HIV tests which include blood tests and saliva tests, and some are performed by healthcare workers. HIV Self-test kits are offered for free in all health facilities (clinics and hospitals).

Unprotected sex is the most common route of HIV infection among young people and some this is the result of being forced to have unprotected sex or to inject drugs, and for some, it may be a lack of having the correct knowledge about HIV and how to prevent it. (WHO 2013). Though still experiencing a low uptake, Pre-exposure prophylaxis (PrEP) and Post-exposure prophylaxis are among the HIV/AIDS prevention strategies for high-risk populations as well as for adolescent girls and young women as they are among the HIV prevention strategies priority list. Both PEP and PrEP are daily dose courses of antiretroviral drugs (ARVs) taken by an HIV-negative person to protect themselves from infection.

The Zimbabwe Association of Church-Related Hospitals (ZACH) in partnership with Africaid – Zvandiri is expanding targeted index case testing for children and adolescents at Community Post and other health facilities through Community Adolescent Treatment Supporters (CATS). This is aimed at addressing barriers to testing access. According to WHO, index testing is when members of a household, biological children, and partners of people diagnosed with HIV are offered HIV testing services. Partner notification services are offered by asking people who have been diagnosed with HIV to list their sexual partners; a trained healthcare provider then contacts and offers those partners an HIV test.

Stigma and discrimination have for years been a stumbling block in the lives of young people living with HIV, and healthcare workers are pivotal in offering to counsel, and providing support and life skills required to cope with stigma. Most people living with HIV /AIDS who take antiretroviral drugs assume that they shall be stigmatized if seen taking many pills.

A survey by ZNNP+ established forms of stigma as ranging from exclusion from gatherings, discrimination by partners, exclusion from family activities, dismissal or suspension from work or educational institutions, exclusion from religious activities or places of worship, and sexual rejection to discrimination from among PLHIV.

Despite the rampant stigma, HIV also gave rise to resilience, courage, and willpower.

So how do we, the HIV community – affected by HIV, who are living with HIV or who are vulnerable to HIV – move beyond stigma to normalizing HIV?

It is, however, everyone’s responsibility to fight HIV stigma and discrimination!

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MILESTONES such as the decrease in HIV/AIDS-related mortality by 45 percent and a spike in antiretroviral therapy (ART) uptake; with more than 25 million people living with HIV (PLHIV) currently on ART, has inspired global confidence that the epidemic control of HIV is achievable by 2030 (UNAIDS, 2019). In Zimbabwe, there are an estimated 1.4 million PLHIV and of these, 97 percent are on the ART programme. Among PLHIV (15-64 years) who self-report current use of ART, 90.3 percent are virally suppressed (ZIMPHIA, 2020).

Despite the accomplishments, key populations are still faced with limited access to health services, increasing their likelihood of developing one or more of the HIV/AIDS-related diseases.

Key populations are sub-groups of the population at higher risk of being infected by HIV/AIDS, who play a key role in how HIV/AIDS spreads, and whose involvement is vital for an effective and sustainable response to the pandemic. Too often, people most affected by HIV/AIDS and tuberculosis (TB) are the same people who do not have access to health care.

Widespread stigma and discrimination, harassment, restrictive laws, and policies, as well as the criminalization of behaviors or practices that put key populations at heightened risk, are among the barriers that prevent them from accessing health services.

According to the UNAIDS (2019) estimates, Zimbabwe has 23 000 men who have sex with men (MSM) and 45, 000 sex workers.

In the context of HIV/AIDS, Zimbabwe considers MSM, sex workers and their clients, transgender people, and people who inject drugs as the four main key population groups. However, groups such as prisoners and people with disabilities are also acknowledged as at-risk populations as they are also particularly vulnerable to HIV/AIDS and frequently lack adequate access to health services (ZNASP3).

These populations are socially marginalized, often criminalized, and face a range of human rights abuses that increase their vulnerability to HIV/AIDS.

To overcome these barriers, the Zimbabwe Association of Church-Related Hospitals (ZACH) through the United States President’s Emergency Plan for AIDS Relief (PEPFAR)/CDC supported health sites tailor services to the specific needs of these populations, as well as invest in programs that address the underlying causes of discrimination.

ZACH offers friendly clinical and support services like HIV testing services (HTS), sexually transmitted infections (STI) screening, and treatment and management of co-infections, such as TB and viral hepatitis. On the provision of HTS, ZACH is scaling up innovative and differentiated HIV/AIDS testing models. And treatment and care support is offered to those living with HIV.

The organization is also strengthening community systems through advocacy structures, peer groups, and networks. These provide the space and opportunity for the key populations to act together, and to campaign for their rights.

ZACH also offers pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and condoms to the vulnerable groups.

The COVID-19 crisis has exacerbated the previous inequalities for key populations affected by HIV/AIDS, thereby rolling back the wins gained in the fight against HIV/AIDS. Indeed, the abuse that these populations suffer as well as stigmatization, and criminalization impacts negatively on the health of these already vulnerable populations as they will also be less willing to engage with the health services. Key populations may also be vulnerable to mental health problems and poor mental health may be a barrier to testing or treatment for HIV/AIDS, and to continue in care for those who are living with HIV.

Despite the efforts by ZACH to reach out to the key populations with health services, a lot still needs to be done.

A call is being made to development partners and the Government to develop strategies to reduce stigma and discrimination including self-stigma of the key populations, as well as conduct awareness campaigns and decriminalization to promote access to health care.

Though several behavioral, biomedical, and structural interventions operating at an individual and population/community level are being widely used for HIV/AIDS prevention and support, the best way is to involve key populations in the design, implementation, and monitoring of those health services, as well as in policy decisions that affect them.

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Celebrating World Cancer Day 2021

Zimbabwe has an estimated 2,270 new cases of cervical cancer and 1,500 cervical cancer-related deaths. The prevalence of human papillomavirus (HPV) in women with cervical cancer in Zimbabwe is 79.6% (The Zimbabwe HPV and Related Diseases Summary report). Women living with HIV are disproportionately affected by cervical cancer. About 53% of women screened for cervical cancer in 2017 received treatment which far much below the program target of 65%. Although the knowledge of cervical cancer among women is high 79% only 13% had ever had a cervical cancer screening. Under the HIV Prevention Care Treatment and Support, ZACH aims to increase progress towards HIV epidemic control (new HIV infections fall below AIDS-related death) in Zimbabwe as well as cervical cancer screening and treatment of precancerous lesions among HIV Positive Women above 25years on ART at the mission and surrounding government health facilities.

ZACH has built capacity for a few mission hospitals to offer on-site treatment services for cervical cancer clients.

Zimbabwe Association of Church-Related Hospitals (ZACH) with support from PEPFAR began offering VIAC services in October 2018. ZACH adopted 11 sites from UNFPA and expanded to 17 static and 58 outreach sites.

ZACH offers VIAC services to women living with HIV between the ages of 15 and 49 using the ‘see’ and ‘treat’ approach.   Existing treatment methods for the “see and treat” strategy include cryotherapy, loop electrosurgical excision procedure (LEEP), and thermocoagulation. Clients suspicious of cancer lesions are referred to the next level of care for biopsies.

To date, ZACH has screened over 12 000 women for cervical cancer, achieving 111 percent of its target. One of the beneficiaries Ms. Sarudzai Ndlovu from Makonde district shares her cervical cancer journey.

This year, the Zimbabwe Association of Church-Related Hospitals Joins the World in Commemorating World Cancer Day under the theme I am and I will.


Celebrating World Aids Day 2020

HIV/AIDS initiatives ZACH has been directing in Zimbabwe.

With a curriculum helping to deconstruct stigmas in faith communities around HIV/AIDS, our Faith Community Initiative (FCI) program leverages the influence of faith communities to spread vital education and resources to their communities. Dr. Mandizvidza explains how messages of hope seek to counter the “doom and gloom” often accompanying the topic of HIV/AIDS.

This is a project that has shown great promise through the establishment of community outreach posts. Borrowed from the Zambian organization, Circle of Hope, this model seeks to decongest public clinics and hospitals by increasing accessibility to testing services and ARVs, as well as providing ongoing support for individuals living with HIV/AIDS within their communities. We have placed these community outreach posts in accessible public areas, like busy markets and bus terminals, where health care staff–a nurse and a counselor–can provide a range of HIV/AIDS prevention, treatment, and supportive services. FCI workers, referred to fittingly as Champions, distribute HIV self-test kits throughout five provinces in the country and help to direct the people testing positive to the nearest community outposts or clinics available for confirmatory HIV testing and additional services.

Opening up these posts and having them work in conjunction with Champions is one significant way of decreasing the barriers people face to testing and to receiving the necessary treatment and support after diagnosis. As more community outreach posts are established in Harare, and with the FCI Champions’ continual efforts, the goal is to alleviate and remove the ever-looming burden of accessibility. These outposts exist for the many people, especially men, who lack the means or time to travel for testing or to pick up their ARVs. They no longer need to make the arduous trip to a health clinic or hospital, but instead can stop by a post on the way or near their workplaces and homes.

Credit: CCIH