Integrating HIV Services into Mobile Primary Health Care Clinics Transforms Rural Care in Zambia
By Sarah Hatchard
Mininga, a remote area in Lufwanyama District, Zambia, is a flat, expansive, and quiet place, except during peak agricultural seasons. The community, comprising a few hundred residents, forms a close-knit farming neighborhood. As with many public services, health care is not readily accessible for the families living in Mininga. The nearest health facility is 30 kilometers away in Minshingashi — a roughly 14-hour round-trip on foot, and the journey can be challenging depending on seasonal conditions. The community works hard and prioritizing time and resources for lengthy and costly trips to the health facility is difficult.
Grace has lived in Mininga for just over a year with her husband Mastern and their eight children. Mastern, who is HIV positive, and Grace, who is HIV negative and on PrEP, face significant barriers in accessing care. “Our biggest problem is the distance and cost to access health care,” Grace explains. “Without the money to hire a bike or car to get to the nearest hospital, it’s not an option. If we can’t afford it, then our health suffers.” Grace also notes a lack of health information in Mininga: “People in our community don’t know enough about HIV and the options available to them. Lots of people take the medication for a short time and they don’t see an improvement, so they stop taking it. There is a real need for health education here.”
Upon arriving in Mininga, Grace worked to find ways to collect Mastern’s ART (antiretroviral therapy) refills. “I really wanted to help improve my husband’s health. We had been in this situation before, where because we couldn’t access the drugs, he would drop off ART for months and he would start getting ill.” Since discovering Mastern’s HIV status during her first pregnancy, Grace has prioritized his health through consistent use of medication. “Where we lived in Kabwe before, I trained as a health counselor. I’ve always been passionate about health and motivated to help improve the lives of others. My father and stepmother both died from HIV when I was very young. I cared for myself and my younger brother. He is also HIV positive, and it dawned on me that he brought none of this on himself. We suffered a lot, but I always made sure I took good care of him and he took his medication, so he could grow up healthy and strong, which I am proud to say he did!”
The USAID DISCOVER-Health project, led by JSI, is designed to expand the reach of the health system to underserved areas like Mininga. Emily Chomba, one of the project’s team leads and a trained nurse, oversees the team working at Minshingashi. “For our clients accessing services at Minshingashi, they face a host of challenges. Some of the recurrent issues we see are poor ART adherence and viral load coverage because the distance to the facility for lots of these rural communities is a real challenge.”
In February 2023, Emily met Grace after hearing about her interest in supporting Mininga’s healthcare needs through a relative.
“I was put in touch with Grace, and we arranged to meet in-person halfway, where we had a long conversation about the challenges and the needs of the people of Mininga,” Emily explains. “I came away sure we had to work together in a way to help solve some of these issues.”
With Grace’s input and support, Emily and her team launched a mobile direct service delivery model (DSD) for Mininga in April 2023. Each month, the Ministry of Health sends a health care team to host a pop-up clinic in Mininga. Expanding on the clinic’s reproductive, maternal, newborn, and child health services, Emily was able to incorporate HIV services such as testing, prevention, and treatment. This mobile clinic offers a flexible, efficient, and person-centered approach to HIV care.
While Emily worked to integrate services with the Ministry of Health, Grace mobilized the community. “I visit people in their homes,” she says. “I know who everyone is and their specific circumstances. I am trusted and one of them. I encourage them and counsel them to access services and then to keep at it. We try and make it as straightforward as possible for people to get and then stay healthy.”
The integration of HIV services with the mobile primary health clinic was an immediate success. “When I first announced to the people in the village that Emily and her team would be coming to provide different health services, such as HIV testing and treatment, about 30 women came to meet her on that first day. It just shows if you bring the services closer to the people, they will access them! This new model has really lifted the burden for those who could not travel the long distances to the nearest health facility.”
A year later, Emily highlights Grace’s role in achieving better health outcomes through community connections: “A big challenge we faced was people falling off treatment, and then we couldn’t contact or find them. Grace can pick up the phone and direct the [pop-up clinic] team to someone who urgently needs treatment but doesn’t have transport. Or we meet her at a central place by the roadside to deliver the drug refills, and then she personally delivers them to the community members. It’s a model centered on people and trust, and we have seen a tremendous impact on the community.”
Grace shares this sentiment, believing that her strong and positive working relationship with Emily is essential to the model’s success.: “I work very closely with Emily. She and her team have been so helpful to us. I meet up with her to collect ART refills for my family and community members.”
Grace is overjoyed at the impact this model has had on the people in Mininga: “I am so happy that the community is now being educated about how they can protect themselves from HIV and more broadly live a healthier life. Now that these health services have been brought closer to our community, we are going to see great improvement and healthier friends, family, and neighbors.”
The USAID DISCOVER-Health Project aims to improve the lives of Zambians by providing them with better access to quality health care. By investing in overall health care quality — including modernizing facilities and introducing person-centered service delivery models — the project has improved the client experience and retention, with the percentage of clients continuing their ART treatment rising from 97 percent in 2020 to 99 percent in 2024. Viral suppression rates have also increased from 93 percent in 2020 to 98 percent in 2024, indicating that clients receiving treatment are achieving improved health outcomes overall.
Learn more about the DISCOVER Health project.
