Mozambique Field Epidemiology and Laboratory Training Program as responders workforce during Idai and Kenneth cyclones: a commentary

The ability to rapidly and effectively respond to public health emergencies, including outbreak investigations and natural disasters, is critical in a strengthened health system. In March and April 2019, the impact of tropical cyclones Idai and Kenneth in Southern Africa and subsequent flooding resulted in devastating consequences to the Mozambique health care system. In this article, we highlight the role of Mozambique’s Field Epidemiology and Laboratory Training Program (FELTP) graduates as first responders during one of the most significant natural disasters on the African continent. The FELTP graduates played a key role in conducting risk assessments, active epidemiological surveillance for priority communicable diseases, and outbreak investigations and supporting the laboratory diagnosis system. The cyclone emergencies in Mozambique revealed the vulnerability of the health system. It is vital to continue the investment in increasing epidemiological capacity of health human resources, staff to adequately prepare for and respond to public health emergencies to mitigate the negative health impacts associated with those events

Young people who inject drugs in Mozambique : should we emphasize them in the National Harm Reduction Plan?

Mozambique has one of the highest burdens of HIV globally, and people who inject drugs (PWID) have one of the highest HIV infection rates in Africa. After the implementation of the first Biological Behavioral Surveillance (BBS) Survey among PWID in Mozambique, the Ministry of Health started the development of a National Harm Reduction Plan. Although the findings from the BBS survey highlighted the specific needs of young PWID, the proposed Harm Reduction Plan does not explicitly focus on reducing high-risk behaviors of young PWID. We outline the importance of the inclusion of age-specific interventions focused on the needs of young PWID in Mozambique, and how a comprehensive Harm Reduction Plan can reduce the HIV epidemic in this population. There is a unique opportunity to advocate for the Harm Reduction Plan to include "youth-friendly" cost-effective and evidence-based interventions that are targeted to this important sub-group within an already vulnerable population

Comprehensive knowledge and HIV prevalence in two migrant mine workers’ communities of origin in Gaza Province in Southern Mozambique: evidence from a cross-sectional survey

Introduction: migrant mineworkers are susceptible to engage in risky sexual behaviour due to their high mobility, putting at risk their families and home communities. Because comprehensive knowledge about HIV/AIDS is a key factor in reducing HIV infections, this study aims to understand the current state of knowledge about HIV in these communities, estimate HIV prevalence and evaluate the risk behaviour associated with comprehensive knowledge. Methods: secondary data analysis of a cross-sectional survey conducted in two communities of origin of mineworkers in Gaza Province, targeting current and former mineworkers of the South African mines and their relatives. Households were selected using simple random sampling methodology. Chi-squared tests and logistic regression analysis were used to assess statistical differences between comprehensive knowledge and categorical variables. Results: from a total of 1,012 participants, only 22.0% of the respondents had comprehensive knowledge about HIV. The overall HIV prevalence in these communities was 24.2% and the HIV prevalence in individuals with comprehensive knowledge was 18.6%. Among the respondents with comprehensive knowledge, 33.1% were male, 22.0% have worked in a South African mine and the median age was 34 years old. Individuals from Muzingane were almost twice as likely (AOR 1.7; 95% IC 1.21-7.44, p=0.014) to have less comprehensive knowledge about HIV than their counterparts in Patrice Lumumba. Conclusion: the results demonstrate a low level of comprehensive knowledge about HIV amongst this population and reveal an association between comprehensive knowledge about HIV and prevalence. Therefore, it is important to improve knowledge about HIV, its transmission and prevention amongst this population

Evaluation of the suicide registration system in Maputo and Matola, Mozambique, 2016-2018

Introduction: Suicide is a major public health problem worldwide and a major cause of death in young adults. Mozambique had one the highest suicide rate in Africa with 23.2 suicides per 100 000 inhabitants. We aimed to evaluate the Suicide Registration System in the cities of Maputo and Matola (SRSMM) to have an overview of the system and to assess the suicide burden in the population. Methods: We extracted data from the “external cause” death registration system, available at the Legal Medicine Service at the Maputo Central Hospital (LMS/HCM) from 2016 to 2018.The evaluation was based on the updated CDC guidelines. Results: The SRSMM is a complex system with multiple data sources. It is a system with excellent data quality (96.2% complete), is representative (87.5% coverage) and is useful for identifying the cause of death. The system remained stable throughout the analysis period, except for 4 months in 2017, during which did not register deaths. From 2016 to 2018, 289 registered suicide cases were analyzed. A total of 219 (75.8%) were men aged 20-39. The most common suicide method was hanging, with 249 cases (86.2%). Conclusion: Though the SRSMM is a complex system, it has good data quality, is representative, and is useful for improving vital statistics and identifying risk groups. The findings of this evaluation demonstrate the need to add key variables on the system that can allow meaningful analysis on risk factors and interventions; and to expand the system nationally in order to have an overview of the severity of suicide

Low engagement in HIV services and progress through the treatment cascade among key populations living with HIV in Mozambique : alarming gaps in knowledge of status

Background: Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises in Mozambique estimate that key populations (KP), defined as men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID), along with their partners account for about one third of all new infections. There is limited data describing the engagement of KP living with HIV in testing, care and treatment services. Methods: We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique conducted 2011–2014 in order to assess service uptake and progress though the HIV treatment cascade among MSM, FSW, and PWID. Unweighted pooled estimates were calculated for each key population group. Results: Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. Conclusion: Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade in line with global targets and should include viral load testing to guarantee a more complete picture of the treatment cascade

Implementation of a mass gathering surveillance system during a Mozambican cultural ceremony in 2020

Introduction: Cultural festivals are events that bring together a large number of people in close contact for extended periods of time, which can contribute to disease outbreaks and other public health threats. Every year in Maputo province, on February 2, the capital of Mozambique celebrates the traditional ceremony Gwaza-Muthini (GM), where nearly 5000 people participate. An enhanced real-time surveillance system was implemented to monitor the occurrence of health events during the GM event. Methods: A cross-sectional descriptive study was conducted between February 1-3, 2020. A direct observation of the event site, waste disposal, public toilets, hygiene, sanitation, and safety conditions of the food vendors was carried out prior to the event. To monitor health events, clinical patient data were collected from the event’s medical post and the local health facility’s registration logbooks, using a real-time electronic mobile system. For the diagnosis evaluation, they were divided into traumatic and non-traumatic origin. Results: Forty patients were seen at the two health facilities; of whom, 73% (29) were male, 58% (23) presented with traumatic injuries, 43% (17) with non-traumatic diagnosis. Of injuries, 48% (11/23) were victims of physical aggression, 35% (8/23) of traffic accidents. Of the 17 patients with non-traumatic diagnosis, 47% (8/17) were hypertensive. No foodborne disease was observed during the event. Conclusion: Although this study was focused on monitoring health events that could lead to outbreak diseases, such as foodborne diseases the 2020 annual GM traditional ceremony occurred without significant health risk, and patients had no condition needing hospitalization

Young key populations left behind: The necessity for a targeted response in Mozambique

Introduction: The first exposure to high-risk sexual and drug use behaviors often occurs during the period of youth (15–24 years old). These behaviors increase the risk of HIV infection, especially among young key populations (KP)–men how have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID). We describe the characteristics of young KP participants in the first Biobehavioral Surveillance (BBS) surveys conducted in Mozambique and examine their risk behaviors compared to adult KP. Methods: Respondent-driven sampling (RDS) methodology was used to recruit KP in three major urban areas in Mozambique. RDS-weighted pooled estimates were calculated to estimate the proportion of young KP residing in each survey city. Unweighted pooled estimates of risk behaviors were calculated for each key population group and chi-square analysis assessed differences in proportions between youth (aged less than 24 years old) and older adult KP for each population group. Results: The majority of MSM and FSW participants were young 80.7% (95% CI: 71.5–89.9%) and 71.9% (95% CI: 71.9–79.5%), respectively, although not among PWID (18.2%, 95% CI: 13.2–23.2%). Young KP were single or never married, had a secondary education level or higher, and low employment rates. They reported lower perception of HIV risk (MSM: 72.3% vs 56.7%, p\u3c0.001, FSW: 45.3% vs 24.4%, p\u3c0.001), lower HIV testing uptake (MSM: 67.5% vs 72.3%, p\u3c0.001; FSW: 63.2% vs 80.6%; p\u3c0.001, PWID: 53.3% vs 31.2%; p = 0.001), greater underage sexual debut (MSM: 9.6% vs 4.8%, p\u3c0.001; FSW: 35.2% vs 22.9%, p\u3c0.001), and greater underage initiation of injection drug use (PWID: 31.9% vs 7.0%, p\u3c0.001). Young KP also had lower HIV prevalence compared to older KP: MSM: 3.3% vs 27.0%, p\u3c0.001; FSW: 17.2% vs 53.7%, p\u3c0.001; and PWID: 6.0% vs 55.0%, p\u3c0.001. There was no significant difference in condom use across the populations. Conclusion: There is an immediate need for a targeted HIV response for young KP in Mozambique so that they are not left behind. Youth must be engaged in the design and implementation of interventions to ensure that low risk behaviors are sustained as they get older to prevent HIV infection

Recognizing the hidden : strengthening the HIV surveillance system among key and priority populations in Mozambique

High quality, representative data from HIV surveillance systems that have country ownership and commitment are critical for guiding national HIV responses, especially among key and priority populations given their disproportionate role in the transmission of the virus. Between 2011 to 2013, the Mozambique Ministry of Health has conducted five Biobehavioral Surveillance Surveys among key populations (female sex workers, men who has sex with men and people who inject drugs) and priority populations (long distance truck drives and miners) as part of the national HIV surveillance system. We describe the experience of strengthening the HIV surveillance system among those populations through the implementation of these surveys in Mozambique. We document the lessons learned through the impact on coordination and collaboration; workforce development and institutional capacity building; data use and dissemination; advocacy and policy impact; financial sustainability and community impact. Key lessons learned include the importance of multisectoral collaboration, vital role of data to support key populations visibility and advocacy efforts, and institutional capacity building of government agencies and key populations organizations. Given that traditional surveillance methodologies from routine data often do not capture these hidden populations, it will be important to ensure that Biobehavioral Surveillance Surveys are an integral part of ongoing HIV surveillance activities in Mozambique

Prevalence and risk factors associated with HIV/hepatitis B and HIV/hepatitis C co-infections among people who inject drugs in Mozambique

Background: There is scare information about HIV co-infections with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) among People Who Inject Drugs (PWID) in Mozambique. This information is critical to ensure the treatment necessary to decrease the progression of liver disease and the transmission of both HIV and hepatitis. We assess the prevalence of HIV, HBV and HCV co-infections as well as associated risk factors among PWID. Methods: The first Bio-Behavioral Surveillance Survey was conducted in 2013-2014 among persons who self-reported to have ever injected drugs. Using respondent-driven sampling, PWID aged 18 years and older were recruited in two cross-sectional samples in Maputo and Nampula/Nacala, two large urban centers of Mozambique. Rapid screening of HIV, HBV (HBsAg) and HCV was performed on site. Data from participants in both cities were pooled to conduct RDS-weighted bivariate analyses with HIV/HBV and HIV/HCV co-infections as separate outcomes. Unweighted bivariate and multivariate logistic regression analyses were conducted to assess correlates of co-infection. Results: Among 492 eligible PWID, 93.3% were male and median age was 32 years [IQR: 27-36]. HIV, HBV and HCV prevalence were respectively 44.9% (95% CI:37.6-52.3), 32.8% (95% CI:26.3-39.5) and 38.3 (95% CI:30.6-45.9). Co-infections of HIV/HBV, HIV/HCV and HIV/HBV/HCV were identified in 13.1% (95% CI:7.2-18.9), 29.5% (95% CI:22.2-36.8) and 9.2% (95% CI:3.7-14.7) of PWID, respectively. Older age, history of needle/syringe sharing and history of injection with used needle/syringe was associated with HIV/HBV co-infection. Living in Maputo city, have older age, history of needle/syringe sharing and history of injection with used needle/syringe was associated with HIV/HCV co-infection. Conclusion: There is a high burden of HBV and HCV among HIV-infected PWID in Mozambique. Our results highlight the need for targeted harm reduction interventions that include needle exchange programs and integrated services for the diagnosis and treatment of HIV, HBV and HCV to address these epidemics among PWID. Efforts should be made to strengthen ART coverage in the population as an important treatment strategy for both viruses