The Division is located at Beatrice Road Infectious Disease Hospital (BRIDH) in Mbare.
Tuberculosis (TB) - Objectives
- Increasing TB support and supervision.
- Increasing knowledge on TB tools and case management.
- Decentralising TB miscopy laboratory services to all polyclinics.
- Reducing TB among the high burden areas.
- Promoting operational research.
Tuberculosis was on the decline in the early 1980s but the trend changed with the advent of HIV/AIDS. The numbers in the City started to rise and around 2005 the trend stated to take a downward trend, in tandem with the HIV trend. The disease has affected the 20-50 age-group, which is the reproductively and economically productive.
The terrible duet is so inter-twined that nearly 100% of those TB patients who are admitted are HIV positive and 70-80% of those TB patients visiting the TB out patient department are HIV positive. The most common opportunistic infection among those with HIV is tuberculosis . Mortality and morbidity of HIV infected tuberculosis is higher and this puts a strain on the limited healthcare resources. Tuberculosis is the third highest commonest cause of death within the City. The TB programme which has been in existence for over thirty years is part and parcel of the National Tuberculos is Programme. The City adopted the DOTs and the STOP TB strategies to fight TB. It is the vision of the programme to reduce TB to a level where it is no longer of public health importance by 2025. TB should be non existent in the City by 2050. TB/HIV collaborative activities have now become an integral part of the TB program. The ideal is to have TB detected and treated among the HIV positive TB patients and HIV detected and treated among the TB patients.
The programme has relied on quality drugs supplied by the the NTP and there has been no interruption of supply in the last four years. Fixed Dose Combinations were introduced more than one and half years ago. There has however been a challenge in the supply of paediatric formulations. The City has a TB focal person who reports directly to the Director of
Health Services. Case detection is through quality assured microscopy. The City currently has one central laboratory which processes all specimens from all health institutions. Treatment is through the standardized short course therapy. Monitoring and evaluation is through cohort analysis annually. Drug resistance monitoring, that is, MDR/XDR has been non existent and operational research has been very minimal despite the abundance of data.
- The TB programme has limited support and supervision.
- Knowledge gap in new TB tools and case management.
- Centralized TB laboratory services to the community.
- Centralised TB registration and initiation.
- There is need to reduce TB among the high burden areas.
- Limited Operational research.
- Poor data quality.
- Limited resources to deal with TB among the high burden areas.
- Limited TB/HIV collaborative activities.
- High TB/HIV co infection rate.
- Unknown number of cases of TB drug resistance.
HIV and AIDS - Objectives
- Reducing the impact of STI, HIV and AIDS on the individual, community and society.
- Preventing and controlling HIV and STI transmission.
- Providing access to treatment, care and psycho-social services for PLWHA.
- Monitoring and improving the quality of HIV care services at all sites.
- Promoting operational research and development.
- Implementing a holistic approach to HIV care.
HIV and AIDS remains a significant public health problem in Harare and is arguably the single most important health challenge facing the city. Given the national prevalence of HIV infection of 13.6% (source) and Harare urban population of 1 559 502 residents it is estimated that Harare urban has about 212 100 people who are living with HIV. It is also estimated that 42 420 people (20%) are in urgent need of antiretroviral therapy (ART). However it is also of note that the population that falls under Harare’s jurisdiction goes beyond just the residents of Harare. This brings an extra demand for opportunistic infections (OI) / ART services on Harare City Health department.
As at December 2009 there were 33 500 people registered in Harare City OI Clinics. Out of these 23 000 people were initiated on ART. As a proportion of those in urgent need of ART in Harare urban 54% are currently accessing ART. This then leaves a gap of at least 46% of ART demand among those in urgent need. Harare City Health department responded to the call by the Ministry of Health and Child Welfare to roll out ART services by establishing two initiating sites – Wilkins and Beatrice Road Hospital. These were established in 2004 and 2006 respectively. As the demand for OI/ART service increased the two initiating sites became congested. This resulted in the decentralization of ART follow up services to primary care clinics starting in 2005. Currently there are 15 clinics that are managing ART patients who are stable. Besides decongesting the initiating sites, decentralization has helped by bringing treatment closer to where patients stay thereby cutting down on transport costs for the patients. It has also been observed that that patient retention in care and adherence to treatment has also improved because of decentralization.
Several other services are important f or the holistic management of a patient living with HIV besides just the prescription of antiretroviral drugs. Holistic management would include counselling, nutritional support, screening of cancer, prevention of TB and prevention of STI. Counselling plays an important role. It is offered at varying levels, that is, before and after an HIV test, it is also offered continuously for psychosocial support and adherence as well as disclosure.
Nutrition is a critical component in the management of HIV infection. HIV infection does not only affect the nutritional status of the individual but of the family as well as it tends to rob families of their economically productive members.
Cervical cancer has been classified as an opportunistic cancer. Women with HIV infection have a higher risk of developing cervical cancer than those who are HIV negative. This then calls for an intensified cervical cancer screening program in HIV positive women who are accessing other OI/ART services in Harare City health facilities. It has been shown that HIV positive women develop cervical cancer faster than their negative counterparts hence the need for more frequent PAP smears.
Non Communicable Diseases - Objectives
- Developing district hospitals in Harare.
- Improving management for non communicable disease.
The burden of non communicable diseases in the city has not been properly quantified but is very significant and comparable to that caused by HIV/AIDS and TB. It consumes a lot of time of healthcare workers in terms of outpatient consultations. These diseases are increasing in number with even those with HIV/AIDS also equally affected.
The diseases in this category are hypertension, diabetes mellitus, cardiovascular disorders such as CCF and IHD, respiratory disorders such as asthma, chronic obstructive pulmonary disorders (emphysema, bronchitis) and pneumoconioses, as well as various musculoskeletal disorders and malignancies. These diseases have traditionally been taken care of by the central hospitals. However due to brain drain at these institutions, the special clinics that used to cater for this class of patients, have long since disappeared, with the consequent unintentional dumping of the affected patients to the city clinics, where neither the expertise nor the special drugs are avail able.
The City Health Department is therefore faced by the following challenges when it comes to dealing with non communicable disorders:
- An unquantified disease burden.
- Lack of diagnostic and monitoring expertise.
- Lack of monitoring equipment.
- Lack of appropriate drugs.
- Lack of standard case management guidelines.
- Lack of special chronic disease clinics in any of the districts.
- Lack of support and supervision in case management.
- Lack of a casualty or emergency treatment centre.
- Lack of district hospitals.