ZNSP

History of HIV in Zambia

The HIV epidemic has been a significant public health concern in Zambia since the first case was reported in 1985. Swift action from the Zambian government led to AIDS being added to the list of notifiable diseases in 1986. To further address the challenge, the Zambian government implemented various measures, including establishing the National AIDS Surveillance Committee in 1987 to implement an emergency control plan. The committee comprised representatives from the Ministry of Health, other government ministries, and non-governmental organizations. The committee has spearheaded various preventive and control measures, including intersectoral health education, research and ethical considerations, procurement and distribution of supplies, counseling services, promotion of condom use, networking with NGOs, laboratory support, blood screening, and community engagement.

By 2002, the National AIDS Council was established as an Act of Parliament. Comprising a broad-based corporate body with government, private sector and civil society representation, it was mandated to coordinate, monitor and evaluate inputs, outputs and the impact of HIV/AIDS programmes and interventions.

By 2005, antiretroviral therapy was made freely available to all individuals.¹, ² In 2017, Zambia implemented the test and treat strategy that made it possible for all newly diagnosed individuals, regardless of CD4 count, to access treatment. By 2020, the country was using viral load as a baseline measure.

In 2018, Zambia launched the Lusaka Province HIV Treatment Surge (Surge project) to increase enrolment of persons with HIV infection. The project resulted in approximately 100,000 persons with positive test results for HIV beginning ART, with new ART clients being more likely to be persons aged 15-24 years. The number of persons with documented viral load suppression also doubled from 66,109 to 134,046.³

Since 2017, key populations including young people aged 10-19, sex workers, men who have sex with me, transgender persons, and persons who inject drugs were prioritized in the Zambia National AIDS Strategic Framework (NASF (2017-2021).

In 2018 HIV case-based surveillance (CBS) was implemented with the goal of providing longitudinal, de-identified patient-level data on all persons diagnosed with HIV. Case Based Surveillance is the systematic reporting and analysis of standardized information about cases diagnosed with HIV to the Ministry of Health for HIV prevention, control, and action.

In 2020, the Recent HIV infection Surveillance program was implemented and by the end of that year, recent infection surveillance sites were activated in Lusaka and the Copperbelt Provinces. During the same year, mortality surveillance also commenced.

References

1. Kapungwe AK. Youth and government’s fight against HIV/AIDS in Zambia: a closer look at some underlying assumptions. African Books Collective; 2009.
2. Stringer JSA, Zulu I, Levy J, et al. Rapid Scale-up of Antiretroviral Therapy at Primary Care Sites in Zambia-Feasibility and Early Outcomes. JAMA. 2006;296(7):782-793. doi:10.1001/jama.296.7.782
3. Boyd MA, Shah M, Barradas DT, et al. Increase in Antiretroviral Therapy Enrollment Among Persons with HIV Infection During the Lusaka HIV Treatment Surge – Lusaka Province, Zambia, January 2018-June 2019. MMWR Morb Mortal Wkly Rep. Aug 7 2020;69(31):1039-1043. doi:10.15585/mmwr.mm6931a4
4. National HIV AIDS STI TB Council Act No. 10 of 2002
5. Zambia National AIDS Strategic Framework 2017-2021