A woman getting her family planning pills at Mpilo Hospital in Bulawayo. 2021. © WHO/Kudzai Tinago
By Tatenda Chimbwanda
Bulawayo, Zimbabwe – The Ministry of Health and Child Care (MoHCC) has made it more convenient for women accessing Family Planning (FP) services to get tested for HIV. Clients no longer have to see different nurses in different rooms or locations to access HIV services. Several services such as HIV Self-testing (HIVST) are now being provided under one roof by the same healthcare provider. The integration of different services under one roof by the same health provider is known as “the one-stop-shop” approach. The introduction of HIVST kits in the one-stop-shop will also help increase the uptake of both HIV and FP services. This will also help ensure that at least 90% of all people living with HIV know their status. In addition, 90% of those diagnosed with HIV infection receive antiretroviral (ARV) therapy.
“I had only come here for my FP pills. However, l ended up learning about other services they provide which l was unaware of. I was educated about HIV and asked if l knew my status. I was given the option to either self-test at home or at the clinic,” explains Nyasha Ndanga a 20-year-old woman from Bulawayo.
“I found this service extremely convenient as it was all done by one nurse in the same room for free. If l had been referred somewhere for testing l was not going to go because l would not have the time to,” added Nyasha.
Nyasha receiving her family planning pills at ZNFPC clinic Mpilo Hospital in Bulawayo.2021.© WHO/Tatenda Chimbwanda
The one-stop-shop project
Nyasha is one of many women who are benefiting from the one-stop-shop integration of HIV and FP Services project. The initiative was launched on 5 November 2020 in Harare and Bulawayo. The project is led by the MoHCC through the AIDS and TB Programme, in collaboration with Reproductive Health Department and Zimbabwe National Family Planning Council (ZNFPC).
This project is serviced at four ZNFPC clinics (Spilhaus and Avenues in Harare, and Lister House and Mpilo Hospital in Bulawayo) with support from WHO.
The project provides FP, Sexually Transmitted Infections (STI) screening and treatment, HIV Testing Services (HTS). Including HIVST in the same room and by the same health care service provider. Furthermore, the project provides Pre-Exposure Prophylaxis (PrEP) per HIV result and risk profile at the ZNFPC Spilhaus clinic in Harare. This service is yet to be rolled out to other ZNFPC sites.
Importance of service integration
“There is merit in integration. Instead of primarily focusing on FP as the four ZNFPC clinics did, we realized there were missed opportunities. Integration of these services entail ensuring access to both family planning and HIV services,” said Dr Owen Mugurungi, MoHCC, AIDS and TB Unit Director.
Traditionally, ZNFPC clinics incorporated services within the same geographical location. It was done through multiple service providers in different rooms for different services. However, this approach was extremely time-consuming for clients. Since they would have to see different nurses for each service. Thus, the one-stop-shop has made it convenient for clients to access different services under one roof by the same healthcare provider.
“This project aims to generate critical evidence to inform WHO policy and guidance on service integration and to guide scaling up to other FP sites. This will drastically improve access to health services for men and women in Zimbabwe. And reduce opportunity costs such as time and transport fares, associated with seeking these services separately. It will also increase the number of individuals who are aware of their HIV status especially amongst young women and men,” explains Dr Trevor Kanyowa, WHO Family and Reproductive Health Specialist.
Increase in uptake of HIV testing
The one-stop-shop project was informed by the high rate of HIV infection amongst women under 25 and especially younger women. This reinforced the need to strengthen HIV prevention integration within contraceptive and other sexual and reproductive health services. Furthermore, according to the statistics released by Zimbabwe’s National Aids Council in 2020, 13.2% of adults living with HIV were unaware and are not on antiretroviral treatment. Therefore, integrating HIV testing services in family planning settings provides an opportunity to expand HIV testing services. Henceforth, contributing to the global goal to end the HIV/AIDS epidemic as a public health threat by 2030.