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'Delivery of clinical HIV prevention care and treatment services for Key Populations through safe spaces in Harare'

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BACKGROUND: Key Populations (KPs) bear the burden of HIV yet have poorer access to HIV services. Pangaea Zimbabwe AIDS Trust (PZAT) is building the capacity of public health facilities to provide KP-friendly services to improve uptake of HIV prevention, care, and treatment services. KPs experience barriers to care due to stigma, discrimination, criminalization, and socio-economic challenges. COVID-19 worsened access to comprehensive HIV services. PZAT conducted differentiated service delivery services at safe spaces to ensure access for KPs in areas around 18 high-burden public health facilities in Harare.
DESCRIPTION: From October 2020 to September 2021, PZAT supported the delivery of comprehensive HIV services for KPs at safe spaces, including secluded outdoor spots. KPs identified safe spaces based on privacy, convenience, safety, and accessibility to many KPs. Thirty Community Facilitators (female and male sex workers, men who have sex with men, transgender and people who use drugs) identify and mobilize KPs ahead of the visit, link them to services, and follow-up. A multidisciplinary team provides services including HIV testing, Pre-Exposure Prophylaxis, Antiretroviral Therapy, condoms and lubricants, intimate partner violence screening and referral, sexually transmitted infections (STI) screening, and management.
LESSONS LEARNED: KPs prefer accessing services where they feel safe and comfortable. A total of 640 KPs were reached with HIV services through safe spaces, among these 547 (85%) were tested for HIV, 524 (96%) were negative, and were all screened for PrEP. 357 (68%) were initiated on PrEP. All 23 KPs that tested HIV positive were initiated on ART. Of the 609 KPs screened, 163 (27%) were diagnosed with STIs and 157 received treatment on site.


CONCLUSIONS: The involvement of KPs in designing, planning, implementation, and monitoring of HIV services provision is important and can improve uptake and utilization of services. Peer-to-peer support is essential for identifying eligible clients, mobilizing for services, and supporting adherence and retention.