CDC in Zimbabwe

Zimbabwe Pepfar CDC

The Centers for Disease Control and Prevention (CDC) established an office in Zimbabwe in 2000, with an initial focus on HIV interventions and health systems strengthening through the Leadership and Investment for Fighting an Epidemic (LIFE) Initiative. CDC’s support expanded in 2011 to include interventions for malaria under the U.S. President’s Malaria Initiative. CDC works with Zimbabwe and local organizations to support health systems strengthening and increase access to and quality of HIV and malaria interventions.

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CDC Impact in Zimbabwe

HIV

CDC has supported the Zimbabwe HIV Care and Treatment program since 2004. With support from the President’s Emergency Plan for AIDS Relief (PEPFAR), antiretroviral (ART) coverage has increased nationally. By the end of 2019, ART coverage among all HIV positive adults was 82% for adult men and 88% for adult women. Coverage for children was slightly lower at 78%.

Zimbabwe has adopted the ambitious Joint United Nations Programme on HIV and AIDS (UNAIDS) Fast Track strategy for ending the AIDS epidemic by 2030. To meet this goal CDC helped Zimbabwe implement different strategies to increase convenience and access for patients, reduce out-of-pocket expenditure, and decongest clinical facilities.

One example is the integrated HIV Testing Services (iHTS) strategy that was fully implemented in 2019 to scale up index testing for newly diagnosed PLHIV and roll out of HIV self-testing.

Targeted testing strategies will remain important towards finding the remaining undiagnosed PLHIV to achieve 95-95-95 targets (95% of people living with HIV knowing their status; 95% of people who know their status are on treatment; and 95% of people on treatment with suppressed viral load).

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Implemented integrated HIV Testing Services (iHTS) strategy in 2019 in response to a need for differentiated testing models to find undiagnosed People living with HIV (PLHIV). The proportion of new positives identified through index testing increased over time.

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>50,000 PLHIV offered index testing in 2019 by CDC supported HIV programs. Of those, 96% accepted index testing and >70,000 contacts were obtained. Through index testing efforts, >10,000 new positives were identified.

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Data suggests that adolescent girls and young women are most likely to have a recent HIV test result across all districts. CDC Zimbabwe plans to scale up the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) program that provides counseling and PrEP provisions.

Cervical Cancer Screening and Treatment

HIV remains an important risk factor for cervical cancer. HIV-positive women are 4-5 times more likely to develop cervical cancer compared to HIV-negative women. Many women are surviving HIV but dying from cervical cancer, a condition that is both preventable and curable. In 2019 CDC Zimbabwe collaborated with local partners to start new screening and treatment approaches. After the meeting Zimbabwe updated national guidelines to scale up TPT to reduce burden on TB among People Living with HIV (PLHIV) and include ART and TPT same day initiation for new HIV patients.

Tuberculosis

PEPFAR and CDC have prioritized TB Preventive Treatment (TPT) scale-up as a strategy to end TB. A target of 100% TPT coverage among all eligible patients over 2019 and 2020 was set. Zimbabwe has had great success with their TPT program, where an estimated 85% of PLHIV have received TPT.

A TPT international learning session was conducted in May of 2019. Participants included representatives from the ministries of health of Zimbabwe, Uganda and Zambia that came to learn from Kenya’s experience.

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PEPFAR and CDC have prioritized TB Prevention Treatment (TPT) scale-up as a strategy to end TB.

Laboratory Capacity Building

CDC has provided technical support and funding to the laboratory services of the Ministry of Health and Child Care (MoHCC) since 2004. In 2019, CDC laboratory program supported Viral Load scale up in 11 laboratories from the six laboratories in 2016. This was accomplished through a robust mentorship program, integrated sample transportation system, optimizing the Laboratory Integrated Management System (LIMS). CDC has provided technical assistance to laboratories across the country to attain ISO 15189 accreditation for quality diagnostic services.

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Viral Load testing capacity scaled up in 11 laboratories in 2019 from the 6 laboratories in 2016, with support from CDC laboratory program through a robust mentorship program, integrated sample transportation system, optimizing the Laboratory information management systems (LIMS).

Surveillance and Health Information Systems

CDC Zimbabwe supported the MoHCC’s strategic information activities in 2019.  Activities included providing technical leadership and programmatic guidance for routine monitoring and reporting, newly diagnosed HIV & recent infection surveillance, and health management information system support. The long-term goal is to build integrated and interoperable electronic data collection systems that will feed into the District Health Information System (DHIS-2) national repository.

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Transition from paper-based to electronic systems towards developing a comprehensive EHR and LIMS continued in 2019. The long-term goal is to build integrated electronic data collection systems that will feed into the District Health Information System (DHIS-2) national repository.

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Conducted the first Integrated Biobehavioral Survey (IBBS) among MSM and transgender women/gender queer individuals (TGW/GQ) in Zimbabwe between March and July 2019 through a partnership with ICAP at Columbia University.

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Released ZIMPHIA 2015-2016 in August 2019. This PEPFAR initiative, implemented in collaboration with CDC, showed the face of the epidemic has changed in Zimbabwe. ZIMPHIA 2020 began data collection in November 2019.

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CDC supports the Inter-Country Support Team, East and Southern Africa (ESA) based in Zimbabwe. CDC provides technical support on the elimination of measles, the control of rubella/congenital rubella syndrome and maternal and neonatal tetanus.

Global Immunization

CDC supports a secondee to the WHO African Region’s Accelerated Immunization Initiative (AII), within the Inter- Country Support Team, East and Southern Africa (IST/ESA) based in Harare, Zimbabwe. This position provides technical support and coordination for 20 member states within IST/ESA on the elimination of measles, the control of rubella/ congenital rubella syndrome and maternal and neonatal tetanus.

IST activities include promoting coordinated partner approaches, implementation of established strategies and policies, adapting guidelines to respond to country-specific needs, conducting and contributing to capacity building activities, and developing country-specific work plans.

In alignment with the Global Vaccine Action Plan (2011-2020) and the African Regional Immunization Strategic Plan (2014-2020) all member states in the ESA region have established a goal for Maternal and Neonatal Tetanus (MNT) elimination and for measles elimination by 2020.

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All ESA member states have established a goal for Maternal and Neonatal Tetanus (MNT) elimination and for measles elimination by 2020, in alignment with the Global Vaccine Action Plan (2011-2020) and the African Regional Immunization Strategic Plan (2014-2020).

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CDC supports the Inter-Country Support Team, East and Southern Africa (ESA) based in Zimbabwe. CDC provides technical support on the elimination of measles, the control of rubella/congenital rubella syndrome and maternal and neonatal tetanus.

Malaria

In 2019, malaria cases and malaria deaths increased in Zimbabwe compared to the previous year. According to DHIS2 data, approximately 310,000 malaria cases were reported in 2019, equivalent to an incidence rate of 22 cases per 1,000 population. This represented a 19% increase in the number of cases reported in 2018 (approximately 260,000). The number of malaria deaths also rose, from 236 in 2018 to 266 in 2019.

The U.S. President’s Malaria Initiative (PMI) was launched in Zimbabwe in 2011. PMI is led by the USAID and implemented together with CDC. The PMI/CDC Resident Advisor works with USAID to provide technical support to Zimbabwe’s malaria prevention and control efforts. PMI Zimbabwe provides financial and technical support for a wide range of major malaria interventions, including: entomological monitoring, vector control [insecticide-treated mosquito nets and indoor residual spraying (IRS)], malaria in pregnancy, case management, pharmaceutical and supply chain management, surveillance, monitoring and evaluation, operational research, and social and behavioral change communication.

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Malaria cases and deaths increased in 2019. The President Malaria Initiative/CDC advisor provides support for a wide range of major malaria interventions including vector control, pharmaceutical and supply chain management, surveillance, monitoring and evaluation, and social and behavioral change communication.

Extramural Management

In 2019, CDC Zimbabwe continued the transition of complex and critical portfolio from international organization to local indigenous organizations. At the start of 2019, local partner funding was 6.4% and by the end of the year it was 27%. During the year Extramural Management Branch (EMB) focused on continuing to build and improve the capacity of local partners to successfully manage cooperative agreements by providing guidance and resources for the implementation, administration, and oversight of the awards. In May 2019, the EMB collaborated with the Office of the Grants Services to conduct a Grants Management Refresher training aimed for the whole office and implementing partners to ensure compliance with law, regulation, and policy in the implementation of the cooperative agreements.

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CDC Zimbabwe increased local partner funding from 6.4% to 27% in 2019.  The Extramural Management Branch improved the capacity of local partners to manage cooperative agreements.

CDC Zimbabwe Success Stories

Site Improvement with Zimbabwe Intensive Monitoring and Support
In the past year, CDC developed a novel strategy for site improvement.

PrEP Success Story in Mazowe
A young woman learns how to prevent HIV.

Improving Access and Optimizing Client-Centered and Friendly Services for Key Populations in Harare District
Comprehensive and friendly services offered through 13 CDC-supported facilities.

The Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) Survey
Understanding the impact of Zimbabwe’s national programs on the HIV epidemic.

More Zimbabwe Success Stories

CDC Staff in Zimbabwe
  • 8 U.S. Assignees
  • 32 Locally Employed
Zimbabwe at a Glance
  • Population: >14,000,000 (2019)
  • Per Capita income: >$ 1,000
  • Life expectancy at birth: 60 M/ 63 F
  • Infant Mortality Rate: 60/1,000

Sources:
World Bank 2019, Zimbabwe
Population Reference Bureau, Zimbabwe

Zimbabwe Top 10 Causes of Death
  1. HIV/AIDS
  2. Respiratory infections & TB
  3. Enteric (intestines) diseases
  4. Neglected Tropical Disease & Malaria
  5. Other infections
  6. Maternal & neonatal
  7. Nutritional deficiencies
  8. Neoplasms (cancers)
  9. Cardiovascular (heart) diseases
  10. Chronic respiratory diseases

Source: GBD Compare 2017, Zimbabwe

Page last reviewed: January 4, 2021
Content source: Global Health