A Place of Trust: How Refill Centers Are Improving HIV Care in Zanzibar.

A Place of Trust: How Refill Centers Are Improving HIV Care in Zanzibar.

At the heart of Mwembeladu Health Center in Zanzibar, Chiku Haji Machado stands as a calm and caring presence. As a healthcare provider working with the Zanzibar Association of People Living with HIV (ZAPHA+), Chiku manages one of the island’s most quietly transformative services a refill center for people living with HIV who are stable on treatment.

Every day, individuals come to the center to collect their medications in a safe, welcoming, and confidential space. What may seem like a small routine picking up refills has become a lifeline for thousands. These are people who have worked hard to stay healthy and consistent with treatment. Now, they have a place that respects their time, privacy, and progress.

“The refill center gives us time to talk to people not just give medication,” Chiku explains. “We listen. We support. Sometimes, we identify others who may not yet be in care and help them get the support they need.”

The center was opened in 2020 to ease the burden on larger hospitals like Mwembeladu and Mnazi Mmoja. Instead of long lines and crowded wards, people who are stable on antiretroviral treatment (ART) can now receive their medications efficiently and return to their daily lives with dignity and discretion.

Chiku and her team have created a space that not only improves care but also strengthens trust.

“When people from the community stop me to say thank you, I feel proud,” she says. “Sometimes I don’t even recognize them it’s been months or years since they came in. But they remember. That means a lot.”

The refill center has also proven essential during the COVID-19 pandemic. With smaller crowds and quicker services, it helped reduce risk of exposure while ensuring continued access to lifesaving treatment.

But its impact goes beyond logistics. Chiku has witnessed a shift in attitudes both in clients and in the community.

“People used to be afraid,” she says quietly. “Now, I see more openness. People living with HIV are coming forward, asking questions, taking ownership of their health. That’s real progress.”

Still, Chiku knows more can be done. She hopes for expanded space at the refill site, and a dedicated medical officer who can support clients who come in with urgent needs so that no one has to be referred away during a moment of vulnerability.

“It’s a good system,” she says. “But with more space and staff, we can serve people even better.”

The refill center at Mwembeladu was one of several supported through the Afya Kamilifu project, a five-year initiative funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC) in Tanzania. The project was implemented by Amref Health Africa in Tanzania, in partnership with the University of Maryland Baltimore (now CIHEB) and the Tanzania Communication and Development Center (TCDC), in close collaboration with the Ministries of Health in Tanzania Mainland and Zanzibar, and the President’s Office for Regional Authorities and Local Government (PO-RALG).