The role of dental practitioners in provider initiated HIV counseling and testing (PITC) for patients attending dental practices in Harare, Zimbabwe

A CAJM research article on HIV/AIDS counseling from a dentist' perspective in Zimbabwe.The Ministry of Health and Child Welfare, Zimbabwe introduced voluntary counseling and testing (VCT)in 1999 and the HIV counseling and testing services have since expanded to include provider initiated testing and counseling (PITC) as recommended by the Centers for Disease Control (CDC).1'2 There should be routine offering of HIV testing and mandatory screening for HIV and diagnostic HIV testing unless the patient opt outs, in hospital locations such as emergency departments where persons who do not otherwise access HIV testing seek health care services.3 Thus it is imperative that health care workers who have initial contact with the patient are equipped with HIV testing and counseling skills so as to limit the referral of patients from one provider to another within the same health facility

Association between fertility and HIV status: what implications for HIV estimates?

Background: Most estimates of HIV prevalence have been based on sentinel surveillance of pregnant women which may either under-estimate or over-estimate the actual prevalence in adult female population. One situation which can lead to either an underestimate or an overestimate of the actual HIV prevalence is where there is a significant difference in fertility rates between HIV-positive and HIV-negative women. Our aim was to compare the fertility rates of HIV-infected and HIV-uninfected women in Cameroon in order to make recommendations on the appropriate adjustments when using antenatal sentinel data to estimate HIV prevalence Methods: Cross-sectional, population-based study using data from 4493 sexually active women aged 15 to 49 years who participated in the 2004 Cameroon Demographic and Health Survey. Results: In the rural area, the age-specific fertility rates in both HIV positive and HIV negative women increased from 15-19 years age bracket to a maximum at 20-24 years and then decreased monotonically till 35-49 years. Similar trends were observed in the urban area. The overall fertility rate for HIV positive women was 118.7 births per 1000 woman-years (95% Confidence Interval [CI] 98.4 to 142.0) compared to 171.3 births per 1000 woman-years (95% CI 164.5 to 178.2) for HIV negative women. The ratio of the fertility rate in HIV positive women to the fertility rate of HIV negative women (called the relative inclusion ratio) was 0.69 (95% CI 0.62 to 0.75). Conclusion: Fertility rates are lower in HIV-positive than HIV-negative women in Cameroon. The findings of this study support the use of summary RIR for the adjustment of HIV prevalence (among adult female population) obtained from sentinel surveillance in antenatal clinics

Decline in HIV Prevalence among Young Women in Zambia: National-Level Estimates of Trends Mask Geographical and Socio-Demographic Differences

Background: A decline in HIV incidence has been reported in Zambia and a number of other sub-Saharan countries. The trend of HIV prevalence among young people is a good marker of HIV incidence. In this study, different data sources are used to examine geographical and sub-population group differentials in HIV prevalence trends among men and women aged 15–24 years in Zambia. Design and Methods: We analysed ANC data for women aged 15–24 years from 22 sentinel sites consistently covered in the period 1994–2008, and HIV data for young men and women aged 15–24 years from the ZDHS 2001/2 and 2007. In addition, we systematically reviewed peer-reviewed articles that have reported findings on HIV prevalence and incidence among young people. Findings: Overall trends of the ANC surveillance data indicated a substantial HIV prevalence decline among young women in both urban and rural areas. However, provincial declines differed substantially, i.e. between 10 % and 68 % among urban women, and from stability to 86 % among rural women. Prevalence declines were steeper among those with the highest educational attainments than among the least educated. The ZDHS data indicated a significant reduction in prevalence between the two survey rounds among young women only. Provincial-level ZDHS changes were difficult to assess because the sample sizes were small. ANC-based trend patterns were consistent with those observed in PMTCT-based data (2002

Age-specific mortality patterns in Central Mozambique during and after the end of the Civil War

<p>Abstract</p> <p>Background</p> <p>In recent years, vigorous debate has developed concerning how conflicts contribute to the spread of infectious diseases, and in particular, the role of post-conflict situations in the epidemiology of HIV/AIDS. This study details the age-specific mortality patterns among the population in the central provincial capital of Beira, Mozambique, during and after the Mozambican civil war which ended in 1992.</p> <p>Methods</p> <p>Data was collected from the death register at Beira's Central Hospital between 1985 and 2003 and descriptively analyzed.</p> <p>Results</p> <p>The data show two distinct periods: before and after the peace agreements in 1992. Before 1992 (during the civil war), the main impact of mortality was on children below 5 years of age, including still births, accounting for 58% of all deaths. After the war ended in 1992, the pattern shifted dramatically and rapidly to the 15-49 year old age group which accounted for 49% of all deaths by 2003.</p> <p>Conclusions</p> <p>As under-5 mortality rates were decreasing at the end of the conflict, rates for 24-49 year old adults began to dramatically increase due to AIDS. This study demonstrates that strategies can be implemented during conflicts to decrease mortality rates in one vulnerable population but post-conflict dynamics can bring together other factors which contribute to the rapid spread of other infectious diseases in other vulnerable populations.</p

Steep HIV prevalence declines among young people in selected Zambian communities: population-based observations (1995–2003)

BACKGROUND: Understanding the epidemiological HIV context is critical in building effective setting-specific preventive strategies. We examined HIV prevalence patterns in selected communities of men and women aged 15–59 years in Zambia. METHODS: Population-based HIV surveys in 1995 (n = 3158), 1999 (n = 3731) and 2003 (n = 4751) were conducted in selected communities using probability proportional to size stratified random-cluster sampling. Multivariate logistic regression and trend analyses were stratified by residence, sex and age group. Absence, <30% in men and <15% in women in all rounds, was the most important cause of non-response. Saliva was used for HIV testing, and refusal was <10%. RESULTS: Among rural groups aged 15–24 years, prevalence declined by 59.2% (15.7% to 6.4%, P < 0.001) in females and by 44.6% (5.6% to 3.1%, P < 0.001) in males. In age-group 15–49 years, declines were less than 25%. In the urban groups aged 15–24, prevalence declined by 47% (23.4% to 12.4%, P < 0.001) among females and 57.3% (7.5% to 3.2%, P = 0.001) among males but were 32% and 27% in men and women aged 15–49, respectively. Higher educated young people in 2003 had lower odds of infection than in 1995 in both urban [men: AOR 0.29(95%CI 0.14–0.60); women: AOR 0.38(95%CI 0.19–0.79)] and rural groups [men: AOR 0.16(95%CI 0.11–0.25), women: AOR 0.10(95%CI 0.01–7.34)]. Although higher mobility was associated with increased likelihood of infection in men overall, AOR, 1.71(95%CI 1.34–2.19), prevalence declined in mobile groups also (OR 0.52 95%CI 0.31–0.88). In parallel, urban young people with ≥11 school years were more likely to use condoms during the last casual sex (OR 2.96 95%CI 1.93–4.52) and report less number of casual sexual partners (AOR 0.33 95%CI 0.19–0.56) in the last twelve months than lower educated groups. CONCLUSION: Steep HIV prevalence declines in young people, suggesting continuing declining incidence, were masked by modest overall declines. The concentration of declines in higher educated groups suggests a plausible association with behavioural change

Lost opportunities in HIV prevention: programmes miss places where exposures are highest

Background: Efforts at HIV prevention that focus on high risk places might be more effective and less stigmatizing than those targeting high risk groups. The objective of the present study was to assess risk behaviour patterns, signs of current preventive interventions and apparent gaps in places where the risk of HIV transmission is high and in communities with high HIV prevalence. Methods: The PLACE method was used to collect data. Inhabitants of selected communities in Lusaka and Livingstone were interviewed about where people met new sexual partners. Signs of HIV preventive activities in these places were recorded. At selected venues, people were interviewed about their sexual behaviour. Peer educators and staff of NGOs were also interviewed. Results: The places identified were mostly bars, restaurants or sherbeens, and fewer than 20% reported any HIV preventive activity such as meetings, pamphlets or posters. In 43% of places in Livingstone and 26% in Lusaka, condoms were never available. There were few active peer educators. Among the 432 persons in Lusaka and 676 in Livingstone who were invited for interview about sexual behaviour, consistent condom use was relatively high in Lusaka (77%) but low in Livingstone (44% of men and 34% of women). Having no condom available was the most common reason for not using one. Condom use in Livingstone was higher among individuals socializing in places where condoms always were available. Conclusion: In the places studied we found a high prevalence of behaviours with a high potential for HIV transmission but few signs of HIV preventive interventions. Covering the gaps in prevention in these high exposure places should be given the highest priority

Track E Implementation Science, Health Systems and Economics

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138412/1/jia218443.pd

The health care seeking behaviours of patients diagnosed with oral and maxillofacial tumours, Harare

Background: Patients were presenting on their index visit at the University of Zimbabwe Oral Health Centre oral and maxillofacial clinic with tumours with durations of onset varying from months to years. Oro-facial tumour is characterized by poor treatment outcomes if the patient presents for treatment late. Health care seeking behaviour of patients at the maxillofacial clinic was therefore assessed.Broad objective: To determine the health care seeking behaviours of patients diagnosed with oro-facial tumours attending University of Zimbabwe Oral Health Centre Oral and Maxillofacial clinic.Study Design: A cross-sectional study was conducted at University of Zimbabwe Oral Health Centre oral and maxillofacial clinic. An interviewer administered questionnaire was used to collect data. Consenting adult patients attending the oral and maxillofacial clinic with histopathologic diagnosis of oro-facial tumour were enrolled.Results: Sixty five patients participated, 53.8 % (35) males. Fifty four percent (35) had benign tumours. Squamous cell carcinoma was the prevalent malignancy. Fifteen percent (10) of participants with benign tumours delayed seeking medical care by a year after onset of signs and symptoms. Fifty percent (33) of  participants sought medical care because of pain. Twenty six percent (17) of patients attempted self medication before seeking professional care. Having access to a health facility encouraged health care seeking, and 62% (40) of participants sought initial medical care at a clinic, where 22% (14) were referred to the specialist, (58%) were given medication on index visit. More than 2 repeat review visits to the primary health care facility increased delay in seeking specialist care.Conclusion: Patients with oral and maxillofacial tumours delayed seeking medical care. Primary health care facilities are the initial facilities where these patients sought health care services. Attendance at specialist was delayed by the practice of recalling patients for reviews to primary health facilities