Harnessing the potential of a co-design approach to improve access to the STOP-AIDS package in rural Zimbabwe
- hivtoolkit
- Sep 4, 2025
- 3 min read
Shurugwi District, nestled in the Midlands province of Zimbabwe, around 350 kilometres southwest of the capital Harare, paints a picture common to many rural areas in the country. With an estimated population of around 23,000 as of the 2022 census, its economy predominantly revolves around subsistence farming, mining, and small-scale businesses. Economic opportunities are limited, and the district faces challenges of poverty and unemployment, contributing to significant health disparities.
HIV in particular is a significant concern and affects almost 15% of pregnant women. Improving access to prevention, testing, and treatment services, especially for vulnerable populations, is vital. Shurugwi has 31 public health facilities, including a district hospital, clinics, and rural health centres that offer pediatric HIV testing, pediatric ART initiation, and management of children living with HIV (CLHIV) in line with the Ministry of Health and Child Care (MoHCC) national guidelines on HIV management.
Despite substantial efforts to prevent vertical HIV transmission, paediatric HIV continues to be a major concern across Africa, where over 100,000 infants and children acquire HIV every year.¹ This highlights a clear need to close these treatment gaps.
In Zimbabwe, it is estimated that only 63% of CLHIV have been diagnosed and initiated on treatment, and only 56% of children have a suppressed viral load.¹
Unfortunately, information on the implementation and uptake of the STOP-AIDS package of care in this setting is limited. Shurugwi has not had targeted STOP-AIDS implementation activities, and Zvitambo, a Zimbabwe-based research institute with extensive experience in maternal and child health, does not run HIV clinical services in the district. As such, Shurugwi is likely to be representative of other predominantly rural districts in Zimbabwe.
It is against this backdrop that THRIVE-Zimbabwe aims to evaluate the STOP-AIDS package across an entire rural Zimbabwean district of Shurugwi. The project seeks to identify and overcome barriers to its implementation at the community and primary care levels. This will be achieved through a co-design process involving key health and community stakeholders, with the ultimate goal of improving the coverage and quality of care for children with AHD.
Co-design represents an inclusive and collaborative approach that places those most affected at the center of solution creation, ensuring that interventions are not only evidence-based but also tailor-made to address the unique needs and lived experiences of affected populations.²
This methodology brings multiple benefits, including fostering community ownership and buy-in of not only the process and the product. It also enhances the potential of designing contextually relevant solutions, particularly in culturally and economically diverse contexts. Throughout the process, it is always important to reduce any risk of imbalanced power dynamics among participants, which may result from external facilitators or organizations dominating discussions, unintentionally silencing grassroots voices. Additionally, existing hierarchies such as gender norms or tribal affiliations can skew participation, excluding the voices of marginalized groups like women, youth, or people living with HIV.
To fully harness the potential of the co-design approach, THRIVE-Zimbabwe proposes to make deliberate efforts to ensure that marginalized groups, such as caregivers for CLHIV and community health workers, are not only actively involved but are leaders in the process alongside clinic staff. Using learning gained from quantitative and qualitative data gathered from observations, in-depth interviews, and focus group discussions at primary care clinics, we will host two interactive workshops. These workshops will bring together a wide range of participants, including healthcare workers, HIV experts, and community members and leaders. Together, they will co-design an intervention to be delivered to all children and adolescents with AHD in Shurugwi.
To achieve this aim, workshop participants will engage in dynamic exploration of creative solutions, led by a social scientist. Building upon the identified barriers, participants will channel their collective expertise to generate a wide array of potential solutions. With support and resources provided by the study, collaborative brainstorming will be encouraged to foster innovation and idea development. Each solution will undergo thorough scrutiny, considering its feasibility, potential impact, and alignment with stakeholder needs. The workshops will culminate in the creation of tangible prototypes, showcasing the most promising solutions, and paving the way for further refinement and decision-making. The selected intervention will be piloted and evaluated for feasibility and sustainability in the real-world setting.
The Zvitambo Institute for Maternal and Child Health Research is excited to begin this study alongside our partners at the Ministry of Health and Child Care, Penta, CHAI and AFROCAB.
Authors: Dr Innocent Chingombe, Study Lead at Zvitambo, Zimbabwe & Dr Ceri Evans, Co-Investigator at Zvitambo and University of Liverpool, UK
References:
UNAIDS, “UNAIDS Data Estimates: Global data on HIV epidemiology and response 2023.” 2023.
Brown. P et al., “Understanding the use of co-design methods for research involving older adults living with HIV: A scoping review protocol,” PLoS One, vol. 19, no. 5 May, 2024, doi: 10.1371/journal.pone.0303580.
Through the generous support of Unitaid, the Clinton Health Access Initiative (CHAI)-led THRIVE Project is enabling access to critical prevention, screening, and treatment commodities for advanced HIV disease to dramatically reduce mortality among adults and children living with HIV. The THRIVE project is conducted in partnership with Afrocab and Penta.
Disclaimer: The views expressed are those of Penta and do not necessarily reflect those of Unitaid or other partners.
