BACKGROUND: Key Populations (KP) bear a disproportionate burden of HIV in Zimbabwe. 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. A hotspot mapping is an initiative to assess and quantify the needs of this population subgroup to scale up needed health and prevention services in the context of HIV, while reducing unnecessary burdens on the health system.
DESCRIPTION: From March 2022 to April 2022 PZAT supported the mapping of hotspots in Harare. Hot spots are geographic areas of high burden of the disease that continues to fuel the epidemic, and these include bars, brothels, hotels, sex dens, casinos, lodgings among other makeshift spots. Hot spot mapping is a systematic cognitive approach to identify these locations where they can be reached with services. PZAT adapted the FHI360/LINKAGES hotspot profiling and listing tools. Community Facilitators (sex workers, men who have sex with men, transgender people and people who inject and use drugs) were trained to implement the activity. Data collection was done through small group dialogue sessions.
LESSONS LEARNED: There was a significant improvement in the uptake of HIV prevention, care, and treatment services after hotspot mapping as compared to the period before. Between October 2021 and April 2022, a total of 555 KPs were initiated on pre-exposure prophylaxis (PrEP) to prevent HIV infection representing an average of 93 initiations monthly. Following the hotspot mapping exercise, between May and September 2022 a total of 1067 KPs were initiated on PrEP with a monthly average of 177 initiations.
Engaging the KP community is crucial in gaining an understanding of barriers and enablers to care among KP. Hotspot mapping informs interventions and preferred HIV services delivery models at community and facility levels.
CONCLUSIONS: Hotspot areas are places of choice for the KP community as indicated by high numbers reached with interventions following the mapping exercise. Mapping outcomes allowed data driven programming to improve case finding and provides an excellent basis to implement HIV interventions. Designing HIV interventions for KPs that have built-in routine hotspot mapping is a high-impact action.