BACKGROUND: Key populations (KPs) bear a disproportionate burden of HIV in Zimbabwe. HIV prevalence among KPs (sex workers, men who have sex with men (MSM), and transgender individuals) ranges from 21-42%, much higher than the 12.7% among the general population. Working with KP communities in the design, planning, implementation, and monitoring of KP interventions is key to optimizing Zimbabwe’s goal to ending AIDS by 2030.
DESCRIPTION: Pangaea Zimbabwe AIDS Trust (PZAT) established Key Populations Health Facility Monitoring Committees (KPFMCs) integrated into existing Ministry of Health and Child Care Health Center Committees at 17 supported facilities between July-August 2021. A consultative process was conducted to develop terms of reference which listed the constituencies represented on the KPFMCs, including health care workers, the Zimbabwe Republic Police Victim Friendly Unit, networks of KP members, and their roles and responsibilities. At each of the supported facilities, 11-13 nominated KPFMCs members were trained on monitoring quality of services and mobilization to reach and enroll additional KPs. Members are volunteers and only receive transport reimbursements for attending meetings. Peer KPs (MSM, female sex workers, transgender, and people who inject or use drugs) were responsible for linking the KP community to facility-based services. From October 2021 to September 2022, all 17 facilities met quarterly to review performance and develop action plans to scale-up utilization of HIV prevention services.
LESSONS LEARNED: KPFMCS were successful in linking the KP communities to services, with improvement in access to services. Satisfaction levels remained high, even when client volume increased.

Performance on key program indicators before and after setting KPFMCs
IndicatorPerformance before KPFMCPerformance after KPFMCRelative increase
Number of KPs reached with HIV prevention messages2,6706,462142%
Number of KPs initiated on PrEP1,6222,27242%
Overall client satisfaction with quality of prevention services94%98%4%

CONCLUSIONS: his intervention, which capitalizes on existing structures and KP-trained health experts, is a potential low-cost, sustainable strategy for effectively linking KPs to HIV services. Our results demonstrate KP-led facility monitoring groups increase the utilization of HIV prevention services and satisfaction among KPs. KPFMCs give communities ownership of primary health care service delivery points and that may have high impact if this model is scaled up to all public health care facilities in Zimbabwe.

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