IT is past midday and Portia* (22) arrives at a local Clinic in Filabusi, Matabeleland South, after a seven-kilometre walk from her homestead. Winter is fast approaching, and it is windy, she bends down to wipe the dust off her feet using a cloth and fixes her mask as she walks briskly towards the gate. From a distance, she sees the clinic is not as busy as she had anticipated.
By Tariro Mhute and Osiah Chinemo
She quickly washes her hands with the soapy water at the entrance and cheerfully waves at the other clients as she sits at the very end of the wooden bench, placing her feet on the social distance sticker on the floor. She waits patiently in the queue to collect her Antiretroviral Therapy (ART) medicine.
The Results and Acceptance: The Journey
I tested positive for HIV and was initiated on ART in February 2019 while I was eight weeks pregnant with my second child. I had visited the Antenatal Clinic when the nurse did the routine HIV test and I found out about my status. Although at that time I was very ill, I just assumed it was pregnancy-related sickness. It came as a shock. After being initiated on ART, the nurse took me through adherence counselling, and I was handed to the Point of Contact (POC) – a Pathways volunteer stationed at the clinic for continued adherence support at community level.”
Pathways is a project funded by the US government’s President’s Emergency Plan for AIDS Relief (PEPFAR), through the United States Agency for International Development (USAID). The project is implemented by Catholic Relief Services (CRS) in partnership with Insiza Godlwayo Aids Council (IGAC) in Matabeleland South and other implementing partners across Zimbabwe.
The primary aim of the Pathways project is to revitalize community and facility linkages so that orphans vulnerable children (OVC) living and affected by HIV become healthy, stable, safe, and schooled. Pathways supports OVC and their caregivers to sustainably mitigate the impact of the virus on themselves and their communities. At the same time ensuring that pregnant and lactating mothers living with HIV do not transmit the virus to their children.
“The volunteer enrolled me into the Pathways Orphans and Vulnerable Children (OVC) Project. At first, I was a bit hesitant but the POC clarified the stages for Prevention of Mother to Child Transmission (PMTCT) until I felt determined – I didn’t want to transmit HIV to my child. Later, I started Integrated Mother Baby Course (IMBC) sessions being facilitated at the clinic by the POC as well. I did IMBC sessions with other pregnant and breastfeeding mothers where I learnt a lot about taking care of my baby. The IMBC platform also allowed me to meet other women who are in the same situation and share ideas to support each other,” said Portia.
The IMBC model provides a platform for postpartum depression prevention support for pregnant and lactating mothers living with HIV and on ART treatment. Additionally, it also provides pregnant and postpartum mothers with skills to manage their mood, recognize how depression and stressors (including HIV) can affect their parenting efficacy, their relationship with others and adherence to ART treatment.
The Intervention: A worthy cause
“IGAC through the POC and Health Officers assisted me with disclosure and psychological support as well. My first viral load sample was collected 3 months after I was initiated on ART and it was very high because I had issues with disclosing my status at home. At that time, I was so stressed and failing to cope, I didn’t adhere to my prescribed ART medicines at all. However, the POC continued offering treatment literacy service. She did not lose hope but kept encouraging me and she was my pillar of strength. She even conducted home visits when I failed to show up at the clinic for my adherence support sessions.”
Portia’s viral load sample was collected upon completion of adherence counseling and there was great improvement – her viral load had dropped. The viral load results came out “target not detected’ – TND meaning the HIV level is so low that the virus can no longer be detected in normal blood tests. Seven months later she gave birth to a bouncing baby girl and after Early Infant Diagnosis (EID) she tested negative for HIV at 6 weeks. Her baby was commenced on a course as she continued with IMBC sessions. Her last viral load test was done on February 5, 2021, and the results are still TND.
“I am so grateful to the Pathways project; my baby tested negative for HIV because adherence counselling I got from the nurse and the POC” said Portia with a huge smile.
Pathways Project: Journey towards epidemic control
Since 2018 the PEPFAR, through USAID Zimbabwe has been supporting the CRS Pathways Project to offer child-centered, family-focused, community-based, and evidence informed interventions to 61 385 OVC and their caregivers. The project is implemented in nine districts; Guruve, Mazowe, Harare, Gweru, Nkayi, Lupane, Bulawayo, Matobo and Insiza and focuses on HIV epidemic control ultimately contributing to the UNAIDS 95-95-95 global goals.
Although Zimbabwe has made significant progress towards achieving epidemic control, it is of paramount importance that these positive gains are sustained. This can only be achieved through rigorous efforts aimed at tracking the remaining undiagnosed HIV+ children and adults like Portia and at the same time facilitating testing and linking them to treatment for comprehensive epidemic control. As such, the Pathways Project through community-facility linkages (bidirectional referral) plays a critical role in facilitating diagnosis, enrolment into ART and retention on treatment for highly at risk OVC and their caregivers.
*Name has been changed
Tariro Mhute is the (CRS-Pathways) Communication and Documentation Officer and you can get hold of her at firstname.lastname@example.org Osiah Chinemo is the (CRS-Pathways) HIV Community Linkages Specialist and you can get hold of him at email@example.com