Title

Prioritizing advanced HIV disease screening for treatment interruption in PLHIV: early learnings from implementation of new guidelines in Zimbabwe

Presenter

Rumbidzai Dhliwayo

Authors

R. Dhliwayo¹, L. Dziva¹, T. Ngwenya¹, C. Mupanguri², B. Mushangwe¹, G. Gonese¹, T. Apollo², O. Mugurungi², T. Maphosa³, H.J. Cham³, K. Thomson⁴, S. Wiktor⁴, B. Makunike-Chikwinya¹

Institutions

¹Zimbabwe Technical Assistance, Training & Education Centre for Health (Zim-TTECH), Public Health, Harare, Zimbabwe, ²Ministry of Health and Child Care, Medical, Harare, Zimbabwe, ³Centre of Disease Control and Prevention, Public Health, Harare, Zimbabwe, ⁴University of Washington, Public health, Seattle, United States

BACKGROUND: People living with HIV (PLHIV) who experience treatment interruption are at high risk for mortality caused by advanced HIV disease (AHD), including tuberculosis (TB) and cryptococcal meningitis. In 2022 Zimbabwe introduced a new national guideline to facilitate immediate AHD screening of PLHIV reengaging in care.
DESCRIPTION: A total of 70 public sector facilities across five provinces implemented the new guideline for PLHIV returning to care. PLHIV returning to care were categorized based on time disengaged from care (<3 months or =3 months). PLHIV with treatment interruption =3 months are indicated for immediate AHD screening, starting with VISITECT CD4 point-of-care testing, and then further same-day screening with cryptococcal antigen lateral flow assay (CrAg LFA), and tuberculosis lipoarabinomannan antigen assays (TB-LAM) for those with CD4<200. Here we present data on PLHIV reengaging in HIV care in the first twelve months of implementation, from Oct 1, 2022, to Sept 30, 2023.
LESSONS LEARNED: A total of 1,821 PLHIV were reengaged in care between October 1, 2022, and September 30, 2023. Among these, 81.4% (1,484) were reengaging in care after = 3 months treatment interruption. Of these 23.2% (345/1,484) received CD4 testing and 41.2% (142/345) had CD4 count <200 cells/µL. Of those tested, 12.4% (25/202) were positive for TB-LAM and 5.9% (11/187) were positive for CrAg. Of the total receiving CD4 testing 15.1% (52/345) were reached on subsequent visit. Health-care workers reported that guidelines specifying which laboratory test to prioritize for PLHIV returning to care was helpful, although client flow and staff shortages were cited as additional challenges to implementation. Additionally, there is need to close the gap and ensure that recipients of care get AHD screening on point of re-engagement into care as it becomes difficult to offer the package on subsequent visits.
CONCLUSIONS: Re-engaging in care guidelines have reinforced the importance and execution of pro-active clinical review and testing for clients at high risk of AHD. However, efforts to secure adequate staffing, establishing client flow, and consistent stocks of commodities are needed to improve comprehensive implementation of these guidelines at scale.

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