HIV disease in BULAWAYO

Photo: WHO 2007

Dr. Paco TrinchánMedical Officer BCCAugust 2013

ZIMBABWE

POPULATION:

12,619,600 (July 2012)

HIV / AIDSHIV / AIDS

HIV adults prevalence

Prevalence of HIV – 15% (Dec 2012)

HIV and AIDS in Zimbabwe December 2012_ NAC

Estimated number of people living with HIV – 1,242,768Prevalence of HIV – 15% (in BYO 18 %)

Estimated number of new infections – 58472Estimated annual HIV deaths – 45621Number of adults in need of ART – 657178 (CD4 < 350)

Number of adults on ART: 565675 Adult ART coverage – 86 % ( 565675 / 657178 )

Children ART coverage – 41% (39825 children, Dec 2011 est.)

Estimated AIDS Orphans – 941024 (25% of all ZW children)

Life expectancy at birth: 52 years (2012), declining from 62 years in 1990

BULAWAYO

Bulawayo Public Health System

Bulawayo: 749.569 people

2 regional Hospitals (MoH): • Mpilo Htal• UBH Htal

1 Psychiatric hospital (Ingutsheni Htal) MoH

19 BCC city clinics1 infectious diseases hospital (TB)• Thorngrove Htal

August 2013

ART in BYO

BCC Mpilo Htal

UBH Htal

Ingutsheni Htal

CITY TOTAL

ADULTS

on ART 26849 9931 9461 352 46593

CHILDREN

on ART 460 ? 2188 399 0 2633 ?

TUBERCULOSISTUBERCULOSIS

TUBERCULOSISTUBERCULOSIS

Notification rate of TB cases in Zimbabwe:

603/ 100 000 population (2011 est.)

Bulawayo notified 2797 cases of TB in 2012

( 500 cases in 1985!!)

TB / HIV co-infection rate: 79.5 % (2012)

Many Challenges !Many Challenges !

Some of them (in BYO):

Challenges – HIV programme (1)

Staff shortage: • Clinics have only 60 % of nurses

• Only 4 doctors visiting BCC clinics

The challenge of running multiple programmes at the same time: HIV/TB, non-communicable diseases, EPI, IMCI…, with few staff !!

Therefore, the challenge of quality follow up in a congested OIC without adequate staff

Challenges – HIV programme (2)

BUT, there is pressure for an increase of our ARVs cohorts without increasing the staff at the clinics

• The difficult balance: quantity vs quality ?

• One solution: ART decentralization

• Also: Empowerment of OIC nurses

Other Challenges – HIV programme

Early identification of patients in need of ART (before they get too sick!)The challenge of TB diagnosis, PTB (-) or EPTB

Insufficient access to VL test

Follow up of patients living across the border (SA, BTW)

Data capture and entry: • Frequent changes in M & E tools. • Too many data to record and follow up.

Others…

THANK YOUMERCI