The Fast-Track approach – including in Fast-Track Cities – is centred on the dual focus of population and location: providing the right services where they are needed, for those who need them most. In Maputo, data are being strengthened for a better understanding of the dynamics of the epidemic in the city and its surrounding area, and to reach young people who have been left behind in the response.
Interpreting the data
Maputo faces a complicated situation in terms of data collection and analysis. In terms of administration, Maputo City is its own province (distinct from Maputo Province) but also belongs to the Maputo Metropolitan Area, together with the nearby areas of Matola and Marracuene. There is a great deal of daily and otherwise regular movement between these cities, with people living and working in different places. As a result, for reasons of convenience, stigma and discrimination, cost and time, they do not necessarily access HIV and other health services in their city of residence.
This creates challenges for collecting and interpreting HIV-related data, both in terms of prevalence and of uptake/use of HIV services, and in understanding the dynamics of Maputo’s epidemic and the needs of its population. For example, the data show that service coverage exceeds population estimates – presumably because people are accessing services in Maputo City when they live in Maputo Province. It has therefore been difficult to identify the people and places that merit specific interventions, and to plan an HIV response that addresses real needs.
To address these challenges and to more accurately inform programme planning, Maputo initiated a major data exercise in 2021 to create a more reliable picture of its HIV epidemic. Provincial-level epidemiological data were merged using the Spectrum software, to allow the city to generate robust HIV estimates. Correction factors were applied to adjust for previous over-estimation of service coverage in the city and under-estimation in the province. Corrected estimates showed ART coverage of 80% in Maputo Province and 78% in Maputo City. These estimates have been used to develop strategic information products to support policymakers in taking evidence-based strategic decisions. These include “know your HIV epidemic” and “know your HIV prevention response” profiles and analysis, as well as geographic information system (GIS) maps of prevention facilities. A new analysis is being undertaken to produce HIV estimates for 2022.
Maputo is also creating its own Prevention Scorecard, similar to the Mozambique national card, with HIV data collected for all three cities in the Maputo Metropolitan Area. This refined and more accurate information will be used to ensure that appropriate HIV services are available where they are needed by people living with HIV, members of key populations and others affected by HIV.
Reaching those left behind
A new initiative is using the existing evidence to ensure a targeted response. The data are clear: young people aged 15 to 24 are being left behind in the city, in part because they have distinct needs – particularly for differentiated services. They also have different expectations from services, and specific challenges, including peer and community stigma about young people accessing HIV services.
Recognizing this gap, Maputo is piloting a Higher Education Initiative (HEI), the results of which will inform a national programme. The HEI uses the population/location approach, focusing on increasing uptake of HIV services among young adults in specific locations, notably higher education campuses. The initiative has garnered high-level political commitment, with a formal launch in September 2021 by the Minister of Higher Education, Science and Technology and the Minister of Health. Rectors of higher education establishments and the National AIDS Council Executive Director also participated in the launch.
Under the HEI, a first cohort of teachers and students who will act as focal points and peer educators, respectively, has received training on peer-to-peer health conversations. The sessions prepared trainees for their roles while also educating them on the importance of caring for their own health. The trainees are currently mobilizing students and peers to create demand for HIV services, and to assist them to access these services as necessary. HIV prevention and treatment services will be provided by implementing partners, including PEPFAR, on campuses. These partners will measure the impact of the project on uptake of services and will report on progress against specific targets.
Ultimately the programme will be expanded to the communities around campuses, with trained students reaching out to their non-student peers. These peers will be able to access the services provided by partners.
The HEI pilot provides an excellent example of leveraging Fast-Track City successes to influence wider programmes and initiatives. Not only will the pilot have real impacts on uptake of services for the target beneficiaries – young adults both in and outside higher education – but the results and lessons learned from its implementation can be applied to broadening the scope of the programme. It also provides evidence of the ways existing resources – partner-provided services and trained staff and students – can be used to reach a new, potentially more inaccessible group of beneficiaries.
