^{By Vivian Mugarisi}

Harare, Zimbabwe - Zimbabwe has increased demand for integrated sexual and reproductive health (SRH) and HIV services through centers of excellences created as models for integrated service delivery. Through the one-stop-shop concept introduced in 2020 by the Ministry of Health and Child Care (MoHCC), women in Zimbabwe are receiving a comprehensive package of quality family planning services such as contraceptives and HIV prevention and treatment services, in an environment free of stigma and discrimination. The one-stop-shop project for HIV and SRH services, supported technically and financially by the World Health Organization (WHO), is being championed at four Zimbabwe National Family Planning Council (ZNFPC) clinics which are Spilhaus and Avenues in Harare, and Lister House and Mpilo Hospital in Bulawayo.

HIV and SRH service integration has led to improvements in the quality of health care provided by facilities and improved health outcomes for clients. Evidence shows that of the 18,756 women who presented for family planning services between October 2020 and December 2022, 16,298 (86.9%) were screened for sexually transmitted infections (STIs). This is a huge jump from merely around 2,730 per year recorded in the previous years. All diagnosed STIs were treated on-site according to national treatment guidelines. A total of 6,680 clients (35.6%) were tested for HIV, of which 448 were diagnosed with HIV. All those diagnosed with HIV were referred for treatment, 4.7% (21/448) of whom were initiated on antiretroviral treatment (ART) on-site.

Furthermore, of the 6,232 people who tested negative, 2,114 were screened and deemed eligible for pre-exposure prophylaxis (PrEP) and 133 were initiated onsite whilst the rest were referred externally. In addition, a total of 2,010 HIV self-testing kits were distributed, with 1,453 (72.3%) used directly by the individual and the remainder were shared with a partner. Among those who shared their results, most of them were reactive and all indicated they confirmed their result with provider-delivered testing. Most family planning clients (94.8%) received oral contraception (progestogen-only pills and combined-oral-contraceptives), whilst fewer received injectables and implants.

“In the past 2 years, the project has demonstrated improved access, uptake and outcomes of all integrated programmes as reflected through the data we collate and analyze annually for the project,” said MoHCC Director for HIV and TB programmes Dr Owen Mugurungi.

He added “The One-stop-shop model of integration has become the new normal of service provision at all ZNFPC.  This is a critical milestone in going beyond learning lessons on the model to adopting it as the permanent way of service provision.”

The one-stop-shop project was informed by the high rate of HIV infection among women below the age of 24, particularly adolescents and young women. The recent report by MoHCC also show high numbers of adolescents (10-19 years) testing positive for HIV upon booking for ante-natal clinics. The integration efforts by the Government of Zimbabwe (GoZ) are also in alignment with the Sustainable Development Goals (SDGS) targets which seeks to end AIDS and ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes, by 2030.

To sustain and build on the gains, GoZ is currently implementing capacity building initiatives to rollout the model to the remaining 7 sites run by the ZNFPC. Plans are also underway to transition the model from being donor dependent to sustainable where the support for implementation will be minimal while extending the model to public sector family planning clinics as well as central and provincial hospitals that have dedicated Family Planning clinics.  

This is one of WHO flagship projects that has demonstrated the impact of implementing a one-stop-shop model in Family Planning clinics. WHO recommended introduction or scale up of HIV testing and linkage to HIV prevention, sexually transmitted infection, and antiretroviral therapy services in family planning to improve access particularly for young people. WHO also released new guidelines recently on integrating the prevention and control of noncommunicable diseases in HIV/AIDS, tuberculosis, and sexual and reproductive health programmes to maximize the impact of health services and smart resource utilization.

“We are pleased that following the successes of the project in the four sites the MoHCC has decided to roll-out the project to 7 other sites with plans for further rollout,” said WHO Zimbabwe Technical Officer for HIV and TB Dr Mkhokheli Ngwenya.