Expanding Critical HIV/AIDS Care to Marginalized Groups in Zambia

Challenge

Zambia has been hard hit by HIV. The nation’s overall HIV prevalence is in the double digits – and that percentage is twice as high in urban areas such as Lusaka. The Government of Zambia’s efforts to curb the spread have focused on the reduction of new HIV infections, primarily through preventing sexual transmission of HIV among heterosexual partners and vertical transmission from mother to child. Key populations (KPs) – including gay, lesbian, and transgender people; sex workers; people who inject drugs; discordant couples; and other marginalized groups – have largely been left out of Zambia’s HIV/AIDS epidemic response. These critical groups are often unable or unwilling to access HIV prevention, care, and treatment services because of stigma and discrimination by healthcare providers and a prohibitive legal environment for disclosing their status. 

For Zambia to curb its HIV epidemic, comprehensive HIV prevention, care, and treatment services must be available and accessible to all. Critical populations that have been marginalized by past HIV response require appropriate, respectful, and confidential health services, to build trust in the public health system and to complement and reinforce peer-based interventions.

Solution

Under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020), Zambia was identified as one of ten high-HIV burden countries on course for achieving epidemic control by the end of 2020. Resonance – in collaboration with the University Teaching Hospital (UTH), Zambia’s largest hospital network – spearheaded the rollout of a comprehensive, KP-friendly sexual health and HIV services clinic through its Adult Center of Excellence. The clinic provides regular medical, testing, prevention, and psychosocial support for patients by a roster of specially trained physicians and medical support personnel. 

The PEPFAR-funded, 20-month USAID Access for All Activity responded to pillar number three of the PEPFAR Strategy: “Key Populations: Ensuring Human Rights and Leaving No One Behind.” Through Access for All, USAID/Zambia aimed to increase the number of KPs in Zambia receiving HIV/Sexually Transmitted Infection (STI)-related health services from the UTH Adult Center of Excellence by developing the capacity of UTH to provide high-quality KP services.

To lead Access for All, Resonance drew on our experience providing targeted capacity building, developing community engagement and outreach strategies, conducting critical procurements to improve service delivery, and coordinating human resource management of quality healthcare service providers. 

Access for All’s key activities included:

• Staffing of Healthcare Providers at UTH: Access for All recruited five full-time medical and support staff charged with managing and providing healthcare services to UTH in Zambia, as well as a roster of 17 part-time medical professionals and one Program Manager to provide KPs with comprehensive and specialized health services at the UTH Adult Center of Excellence and the UTH infectious disease clinic.
• Organizational and Technical Capacity Development: We organized two professional development study tours for select UTH clinic personnel to learn from the successes and promising practices of neighboring South Africa’s ANOVA Health Institute – a recognized network of KP-friendly clinics and outreach services. During these learning exchanges, UTH developed KP clinic Standard Operating Procedures, created improved intake protocols, and received training-of-trainers capacity development to better cater medical services to KPs. The newly trained UTH staff then led several internal trainings for UTH medical staff, support staff, and admin/intake staff on confidentiality, sexuality, KP service delivery, and HIV/AIDS prevention. Resonance also coordinated participation of two UTH HIV/AIDS experts in the International Conference on AIDS and STIs in Africa in Cote d’Ivoire. In addition, Resonance provided ongoing capacity building for UTH staff in the areas of procurement, staff administration, USAID compliance, and monitoring & evaluation. 
• Community Outreach: Under Access for All, Resonance developed and implemented a Community Outreach and Mobilization Strategy to encourage and support KPs to seek services at the UTH clinic. This strategy included training champions identified within KP communities as Peer Promoters responsible for identifying and engaging KPs, increasing their awareness on HIV/AIDS and KP services offered at the UTH Adult Center of Excellence, and leading monthly sensitization meetings and trainings on critical health topics. The strategy was a tremendous success, nearly tripling the target number of KP patients receiving services from UTH.

• Facility Refurbishments: Resonance successfully managed refurbishment for two UTH clinics, improving the safety and sanitary capabilities of the clinics. This work was completed on time and under budget and under strict environmental compliance. 
• Procurement of Medical Equipment and Supplies: At the request of USAID and UTH, Resonance procured necessary medical supplies and equipment, ranging from STI test kits and office supplies to sophisticated, specialized medical equipment procured from abroad, including a Genetic Analyzer and a High Performance Liquid Chromatography machine to analyze HIV and other viral infection compositions and detect HIV drug resistance in patients. 
• Knowledge Management for Health Impact: Access for All forged linkages with donor-funded projects in Zambia, the Zambia National AIDS Council, and other key stakeholders to share resources, knowledge, and best practices to improve key population service delivery and outreach in Zambia.