Programming for HIV has achieved remarkable success in scaling up treatment as prevention strategies across the African region. Yet, despite these efforts, the decline in new infections hasn't met expectations, and crucial objectives for HIV elimination by 2030 seem increasingly out of reach. Countries like Zimbabwe have progressed, but challenges persist, particularly in high-need populations. To address these challenges, a strengthened focus on primary prevention programmes is essential.
The Zimbabwe Experience: Applying the Harare HIV Combination Prevention Cascade
Zimbabwe showcases an exemplary case through its development of the Harare HIV Combination Prevention Cascade. This innovative approach provides a comprehensive overview of the challenges and gaps in HIV prevention, guiding policymakers and program managers towards effective interventions.
The Harare cascade framework, combining the 'main' and 'expanded 'versions, identifies barriers at different stages – from motivation to access to effective use – and pairs these gaps with targeted interventions. Notably, this cascade framework has been tested in Zimbabwe's Manicaland province, revealing valuable insights and guiding local prevention strategies.
The Importance of National Population Surveys
To truly leverage the potential of HIV prevention cascades, we must incorporate their measurement into national population surveys. These surveys, such as the Demographic and Health Surveys(DHS), provide vital data that can inform and transform national HIV prevention strategies. By including additional questions in the DHS, countries can build a unified and comprehensive view of their HIV prevention efforts and compare progress with regional targets.
A Unique Opportunity for Global Input
Significantly, there is an immediate opportunity for countries to contribute to the DHS indicator set at the start of this year. This is a chance to align countries’ data collection with the best practices illustrated by the Harare cascade. By participating in this process, countries can ensure that their national surveys collect the necessary data to inform HIV prevention strategies effectively.
The Next Steps
As advocates for HIV prevention, we must seize this moment to advance the inclusion of prevention cascades in national data collection efforts. This involves:
- Participating in the DHS questionnaire review process by submitting feedback and advocating for the inclusion of cascade-related questions.
- Encouraging multilateral organizations like UNAIDS to set ambitious, cascade-based targets analogous to the successful '90-90-90' treatment targets.
- Further promoting the sharing of knowledge and experience through webinars and collaborative networks like the South-South Learning Network (SSLN)
The forthcoming year offers a critical window for action. Let's work together to replicate the treatment cascade's success with a unified prevention cascade, propelling us towards an AIDS-free generation.
