Digital tools help Zimbabwe’s HIV migrants stay in care

[NAIROBI, SciDev.Net] As droves of Zimbabweans return home from South Africa in a wave of deportations and anti-immigrant sentiment, health experts warn that disruptions to HIV treatment could leave many at risk unless returnees are quickly reconnected to care.

The South African government says more than 53,000 foreign nationals have been processed for deportation or repatriation as part of a crackdown on “irregular migration” following weeks of violent anti-immigration protests. Most of the returnees are from Malawi, Zimbabwe and Mozambique.

According to Statistics South Africa, Zimbabweans constitute one of the country’s largest migrant communities, with an estimated one million living there.

“We know that displacement, whether planned or sudden, can disrupt treatment, resulting in missed medication, poor health outcomes and increased risk of opportunistic infections.”

Tatenda C. Makoni, executive director, ZNNP+

Research in South Africa’s Gauteng province, which carries the country’s largest HIV burden, found HIV prevalence among international migrants to be around 10 per cent.

For many migrants living with HIV, sudden displacement presents immediate risks. Medication may be left behind, treatment records lost, and patients may struggle to navigate health systems on their return.

“The disruption is not just about the medicines,” Efison Dhodho, research coordinator at Zimbabwe’s Biomedical Research and Training Institute, told SciDev.Net.

“Many returnees may have lost their treatment records, some fear accidental disclosure of their HIV status when they return to their communities, while others are dealing with the psychological stress of suddenly losing their livelihoods.”

Health authorities in Zimbabwe, which has one of Southern Africa’s largest HIV treatment programmes, say they are responding through a combination of digital health and patient-centred care models designed to prevent treatment interruptions among mobile populations.

Owen Mugurungi, director of the AIDS and TB unit in Zimbabwe’s Ministry of Health and Child Care, said the ministry was working with the Zimbabwe National Network of People Living with HIV (ZNNP+) and others to make sure everyone who needs antiretroviral drugs can accesses them.

The Zimbabwe National AIDS Council (NAC) urged returning migrants with HIV to enrol immediately into Zimbabwe’s HIV treatment programme upon arrival.

“What I know, and what I want to encourage, is for people living with HIV who are returning, when they get to their respective homes, to go to the nearest health facility and be absorbed into the very robust HIV treatment programme which we have in Zimbabwe,” said NAC chief executive officer Bernard Madzima.

“We have capable health workers at every facility in the country, from clinic level up to the highest referral hospitals, so there should be no problem in terms of them being integrated into this system.”

‘Omalayitsha’ network

Madzima noted that many Zimbabweans working in South Africa had been accessing six-month supplies of antiretroviral medicines from Zimbabwe through an informal cross-border transporter network known as “omalayitsha”, allowing them to remain on treatment while living abroad.

However, he said more people are now returning permanently and need to be fully integrated into local HIV services.

Mental health challenges, stigma and the practical realities of displacement can all affect adherence to treatment, said Dhodho, who has worked on Zimbabwe’s HIV care strategies for migrant populations.

“If your life is suddenly disrupted and you’re forced to leave, your medicines may be left behind,” he explained.

“Even a short disruption in routine can affect adherence. HIV treatment works best when people maintain viral suppression, which protects both their own health and helps prevent onward transmission.”

Dhodho said the country had already developed approaches, including the omalayitsha model, which could help returning migrants reintegrate into care more effectively.

However, he added that omalayitsha depends on predictable travel patterns and stable living arrangements, both of which have been disrupted by the recent wave of deportations.

Telehealth solutions

To bridge that gap, ZNNP+ has expanded the use of Kutabila, a virtual health platform that links returning migrants with HIV treatment and care services.

“The recent increase in the number of Zimbabweans returning home from South Africa, coupled with reports of deportations and heightened anti-foreigner sentiment, raised concerns about the continuity of HIV treatment among people living with HIV,” said Tatenda C. Makoni, executive director of ZNNP+.

“We know that displacement, whether planned or sudden, can disrupt treatment, resulting in missed medication, poor health outcomes and increased risk of opportunistic infections.”

Through telephone-based counselling and referral services, trained counsellors assess callers’ treatment needs, direct them to the nearest health facility and provide adherence counselling and psychosocial support.

Between 1 June and 8 July, the platform received more than 300 calls from returning migrants, according to Makoni. He said most were seeking help on restarting treatment, replacing lost medical records, transferring HIV care from South Africa or accessing medicines after treatment interruptions.

Since its launch, Kutabila has handled more than 10,500 client interactions and successfully linked over 7,300 people living with HIV to treatment and care services, he added.

Empathy approach

Zimbabwe is also applying lessons from Uzwelo, meaning empathy, a person-centred approach developed after the COVID-19 pandemic to re-engage people who had interrupted HIV treatment.

Rather than focusing only on tracing people who miss clinic appointments, Uzwelo encourages healthcare workers to understand the individual circumstances that caused treatment interruption and develop care plans tailored to each patient’s situation.

According to Dhodho, who helped develop the approach, Uzwelo helped recover nearly a quarter of patients who had fallen out of care within just three months after being introduced in pilot districts.

“The health worker meets the client with empathy instead of judgement,” he explained.

“The question becomes, ‘How do we make treatment work for your circumstances?’ rather than ‘Why did you default?’”

Makoni believes such innovations offer lessons that extend beyond Zimbabwe.

“Migration is a regional issue, and ensuring continuity of HIV treatment requires regional solutions,” he said.

“Continuity of HIV treatment should not stop at national borders.”

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.