BACKGROUND: In Zimbabwe, criminalization of key populations (KPs) (female sex workers, men who have sex with men, people who inject drugs, and transgender persons) results in non-disclosure of KP status in health service settings. Pangea Zimbabwe (PZ) under the Zimbabwe Partnership to Accelerate AIDS Control (ZimPAAC) consortium supported a KP Program in 21 public health facilities in Harare and conducted a KP reclassification exercise to identify hidden KPs among persons seeking health services. The objective of the program was to facilitate safe disclosure of KP status and optimize Differentiated Service Delivery (DSD) Models for HIV care and treatment.
DESCRIPTION: Clients on antiretroviral therapy, self-administered KP Classification tool between October 1, 2022, and September 30, 2023, at their scheduled clinical visits. Trained KP-peer community facilitators (CFs) distributed the paper-based tool and offered in-person assistance to clients during health talks and while in service waiting queues. Where clients could neither read nor write, the CFs helped administer the tool.
LESSONS LEARNED: Over the 12-month period, 33,284 clients (47% of all clients on ART) were screened, of whom 3,335 (9.2%) self-identified as KP and were then classified in the clinic records as KP, offered KP friendly services, linked to CFs in their area and to other support services. 48 (1.44%) clients with unsuppressed viral load (VL) were identified and linked to enhanced adherence counselling, and 518 (15.53%) with missing VL results were linked VL monitoring programmes. The KP screening questions were also useful for identifying and tailoring services for KPs newly enrolled onto ART.
CONCLUSIONS: The process showed that most KPs were already engaged in care but had not been identified as KPs and were therefore receiving non-tailored services. A similar gap may exist amongst clients seeking HIV prevention services. Differentiated, client centered KP services within public sector health settings requires person specific tools administered in a confidential, non-judgmental manner to elicit sensitive information that is crucial for care. We recommend further exploration of the experiences leading to non-disclosure of KP status and establish linkages to other services.