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Zimbabwe
The following provides a summary of specic guidelines from the countrys national guidance strategy. Use
the jump links in yellow to access details on rst-, second-, and third-line treatment regimens by patient
population, in accordance with the WHO guidelines. This summary can be downloaded or e-mailed to
yourself or a colleague. The original country guidance document can also be found below the jump links for
download.

Patient Population Download summary page as PDF E-mail this page

Suggest Updates
Adults, Pregnant Women, Breastfeeding Women, and Adolescents 10 - 19 Years and Greater Than or
Equal to 35kg
Pregnant Women and Breastfeeding Women - PMTCT
Children Less Than 10 Years
Infants Birth to 6 Weeks - PMTCT
Infants Greater Than 6 Weeks - PMTCT

Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV in Zimbabwe -
Updated (PDF / 2 MB)

Adults, Pregnant Women, Breastfeeding Women, and Adolescents 10 - 19

Years and Greater Than or Equal to 35kg
Year Issued:
2016

HIV/TB Co-Infection Addressed:

Yes

Criteria for Treatment:

All individuals with a conrmed HIV diagnosis are eligible for anti-retroviral therapy (ART) irrespective of
WHO clinical stage and CD4 count level, i.e. TREAT ALL.

As a priority, initiate ART in all individuals with severe or advanced HIV clinical disease (WHO clinical stage
3 or 4) or CD4 count less than or equal to 350 cells/mm3.

It is also recommended to initiate ART, as a priority, in the following categories of patients regardless of
CD4 cell count:

Active TB disease
Pregnant and breast-feeding women with HIV
Individuals with HIV in sero-discordant relationships
HBV co-infection with severe chronic liver disease
Regimen Options:

First Line:
Preferred rst line regimen: TDF + 3TC + EFV

Alternative Regimens:
TDF + 3TC + NVP
AZT + 3TC + EFV
AZT + 3TC + NVP

Second
Line:
If TDF was used in rst line ART: AZT + 3TC + ATV/r or LPV/r

If AZT was used in rst line ART: TDF + 3TC + ATV/r or LPV/r

Third Line:
Those failing second-line therapy will need to be referred for Specialist assessment which includes
viral load and may be genotype testing prior to recommending the third-line medicines.

In adolescents greater than 12 years and adults, the preferred 3rd line ART regimen is
Dolutegravir (50mg) and Darunavir (600mg)/Ritonavir (100mg) twice daily (for PI-experienced
patients). Raltegravir (400mg) twice a day can be used when DTG is not available. (Safety and
ecacy data on the use of DTG in adolescents younger than 12 years and pregnant women are
not yet available.)

Reference:
Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV in Zimbabwe
Pregnant Women and Breastfeeding Women - PMTCT
Year Issued:
2016

HIV/TB Co-Infection Addressed:

Yes

Criteria for Treatment:

All HIV positive pregnant and breastfeeding women should initiate lifelong ART as soon possible after their
HIV positive status is conrmed irrespective of their CD4 count or WHO clinical stage; and continue ART
throughout the breastfeeding period and beyond.

Regimen Options:
 First Line:
TDF + 3TC + EFV600

Alternative options:
AZT + 3TC + EFV600
AZT + 3TC + NVP
TDF + 3TC + NVP

Second
Line:
If TDF was used in rst line ART: AZT + 3TC + ATV/r or LPV/r

If AZT was used in rst line ART: TDF + 3TC + ATV/r or LPV/r

Third Line:
Those failing second-line therapy will need to be referred for Specialist assessment which includes
viral load and may be genotype testing prior to recommending the third-line medicines.

In adolescents greater than 12 years and adults, the preferred 3rd line ART regimen is
Dolutegravir (50mg) and Darunavir (600mg)/Ritonavir (100mg) twice daily (for PI-experienced
patients). Raltegravir (400mg) twice a day can be used when DTG is not available. (Safety and
ecacy data on the use of DTG in adolescents younger than 12 years and pregnant women are
not yet available.)

Reference:
Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV in Zimbabwe
Children Less Than 10 Years
Year Issued:
2016

HIV/TB Co-Infection Addressed:

Yes

Criteria for Treatment:

ART should be initiated in ALL children living with HIV, regardless of WHO clinical stage and at any CD4
count. Children less than 5 years old or with WHO clinical stage III/IV or CD4 less than 25% (less than 5
years) or less than or equal to 350 (greater than5 years) should be a priority.

Early ART initiation in infants as soon as birth PCR results are available. ALWAYS retest and conrm results
with repeat PCR but retesting should not delay ART initiation.

Babies who test negative at birth (birth PCR) or were not tested MUST be tested at 6 weeks.

Regimen Options:
First Line:
3 years to less than 10 years:
Preferred: ABC + 3TC + EFV

Second
Line:
AZT + 3TC + LPV/r or RAL

Third Line:
Children 0 - 10 years
RAL + 2NRTIs
DRV/r + 2 NRTIs
DRV/r + RAL +/- 1 - 2

First Line:
3 years to less than 10 years:
Alternatives:
AZT + 3TC + EFV
AZT + 3TC+ NVP
TDF + 3TC + EFV (or NVP)

Second
Line:
ABC + 3TC + LPV/r
ABC + 3TC + ATV/r

Third Line:
Children 0 - 10 years
RAL + 2NRTIs
DRV/r + 2 NRTIs
DRV/r + RAL +/- 1 - 2

First Line:
2 weeks to less than 3 years:
Preferred: ABC + 3TC + LPV/r

Second
 Line:
AZT + 3TC + RAL

Third Line:
Children 0 - 10 years
RAL + 2NRTIs
DRV/r + 2 NRTIs
DRV/r + RAL +/- 1 - 2

First Line:
2 weeks to less than 3 years:
Alternatives:
AZT + 3TC + LPV/r
ABC + 3TC + NVP

Second
Line:
ABC + 3TC + RAL

Third Line:
Children 0 - 10 years
RAL + 2NRTIs
DRV/r + 2 NRTIs
DRV/r + RAL +/- 1 - 2

First Line:
0 - 2 weeks: AZT + 3TC + NVP

Third Line:
Children 0 - 10 years
RAL + 2NRTIs
DRV/r + 2 NRTIs
DRV/r + RAL +/- 1 - 2

Reference:
Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV in Zimbabwe
Infants Birth to 6 Weeks - PMTCT
Year Issued:
2016

HIV/TB Co-Infection Addressed:

No

Criteria for Treatment:

Infants at high risk of transmission will receive dual ARVs (AZT and NVP) for 12 weeks as prophylaxis if
breastfed and for 6 weeks if formula fed.

Infants at low risk of transmission (either breastfed or formula fed) will receive daily NVP for 6 weeks.

A high risk infant is dened as follows:

1. High maternal viral load greater than 1000 copies/ml during the last 4 weeks before delivery
2. An infant born to HIV infected woman who has received less than 4 weeks of ART at the time of
delivery
3. An infant born to a newly diagnosed HIV infected woman during labor, delivery and postpartum
(Incident HIV infection)

Cotrimoxazole must be started from 6 weeks of age even in babies on longer CD4>200 copies/ml and be
at least 6 months on ART.

Regimen Options:

First Line:
For infants weighing less than 2000 g and older than 35 weeks of gestational age, the suggested
doses are: NVP 2mg/kg per dose once daily and AZT 4 mg/kg per dose twice daily. Premature
infants younger than 35 weeks of gestational age should be dosed using expert guidance.

First Line:
Birth weight: 2000 - 2499g
Dosing NVP: 10 mg once daily (1ml of syrup once daily)
Dosing AZT: 10 mg twice daily (1 ml of syrup twice daily)

First Line:
Birth weight: greater than or equal to 2500g
Dosing of NVP: 15 mg once daily (1.5 ml of syrup once daily)
Dosing of AZT: 15 mg twice daily (1.5 ml of syrup twice daily)
Reference:
Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV in Zimbabwe
Infants Greater Than 6 Weeks - PMTCT
Year Issued:
2016

HIV/TB Co-Infection Addressed:

No

Criteria for Treatment:

Infants at high risk of transmission will receive dual ARVs (AZT and NVP) for 12 weeks as prophylaxis if
breastfed and for 6 weeks if formula fed.

Infants at low risk of transmission (either breastfed or formula fed) will receive daily NVP for 6 weeks.

A high risk infant is dened as follows:

1. High maternal viral load greater than 1000 copies/ml during the last 4 weeks before delivery
2. An infant born to HIV infected woman who has received less than 4 weeks of ART at the time of
delivery
3. An infant born to a newly diagnosed HIV infected woman during labor, delivery and postpartum
(Incident HIV infection)

Cotrimoxazole must be started from 6 weeks of age even in babies on longer CD4>200 copies/ml and be
at least 6 months on ART.

Regimen Options:

First Line:
Dosing of NVP: 20 mg once daily (2 ml of syrup once daily or half a 50 mg tablet once daily)
Dosing of AZT: No dose established for prophylaxis; use treatment dose 60 mg twice daily (6 ml of
syrup twice daily or a 60 mg tablet twice daily)

Reference:
Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV in Zimbabwe

Source URL: https://aidsfree.usaid.gov/resources/guidance-data/treatment/zimbabwe