Issues:

1. Psychosocial support model for community - based ART initiatives: Zimbabwe experience. Sostain Moyo • G.Kadzirange, L. S. Zijenah, T. Kufa. L. Gwanzura, T.Chirenge, N.A. Gona, C. Maponga, G. Musingwini, E. Matsikire,E. Mbizvo (ZAPP-University of Zimbabwe), DA.Katzenstein (Stanford University)

2. Issues: • Comprehensive community based services important for achieving optimal effectiveness of anti-retroviral treatment (ART) include not only aspects of voluntary counselling and testing (VCT), prevention of mother to child transmission (PMTCT) of HIV, laboratory monitoring, management of toxicities and opportunistic infections, but equally important integrated psychosocial support interventions.

3. Program Description (1) • In 1999 a feasibility study providing short course AZT to HIV positive pregnant women for prevention of MTCT was conducted at two clinics in Chitungwiza. The study enrolled 200 women and their infants, and encouraged involvement/participation of women’s partners. • The Batanai Family Support Network emerged in response to the felt psychosocial needs of these individuals infected with HIV and their families.

4. Program description (2) • ZAPP is providing a medical response to AIDS at primary health care level • Batanai Family support Network (BFSN) is providing counselling continuum . • In 2002 the same cohort was offered enrolment into the Doris Duke-ZAP cotrimoxazole prophylaxis treatment (CTX) study.

5. Program description (3) • 262 subjects were enrolled, 101 initiated CTX prophylaxis, based on the WHO criteria. • The CTX cohort was offered rollover enrolment into the MSF-ZAPP highly active antiretroviral therapy (HAART). Between July 2003 and March 2004, 79 patients were receiving generic HAART.

6. Program description (4) • Mean adherence to HAART is >95 %. • This high level of adherence may have been achieved through involvement of community adherence supporters • These are themselves living with HIV/AIDS and some of whom are on the HAART program. • 32 of BFSN members are employed as PMTCT community mobilizers and HAART adherence support counsellors by ZAPP.

7. Lessons learnt: • Psychosocial support should be given equal importance as bio-medical aspects when implementing ART programs • PLWH/A can make valuable contribution in HIV/AIDS prevention and treatment interventions • Support groups address potential barriers to adherence, including lack of treatment education and social support • Support groups need to be facilitated separate from income generating projects to fulfill the purpose of providing mutual support

8. Recommendations: • Models of this psychosocial support (PSS) can be built upon and expanded in order to replicate this good example • Sustainability must be included in such PSS, in order to keep the group motivated and with some income • An evaluation for quality of life/health is recommended to measure the impact of PSS on people taking HIV/AIDS-related treatment.

9. Acknowledgements • MSF Spain donates the ARVs and drugs for opportunistic infections, and supports a Clinician and Pharmacist (each spend 50%) on the ZAPP-MSF study • The Doris Duke Charitable Trust, USA • The ZAPP staff for the hard work • Batanai Family Support Network • Chitungwiza Health Department