Experiences of HIV positive women who utilised the PMTCT programme in one of the central hospitals in Bulawayo, Zimbabwe

Text in EnglishThis qualitative descriptive phenomenological study explored the experiences of HIV positive women utilising PMTCT services at a central hospital in Zimbabwe. Data was collected using in-depth interviews of fifteen participants. The interviews were audio recorded and transcribed verbatim. Using the Interpretive Phenomenological Analysis framework for data analysis, two super-ordinate themes emerged, namely resources for provision of PMTCT services and approaches and nature of PMTCT care. The study revealed challenges experienced by HIV positive women emanating from material, financial and human resource related constraints in the PMTCT setting. The resource challenges negatively affected access and utilisation of PMTCT services. A practice model, whose purpose is to enhance the quality and utilisation of PMTCT services, was developed and described. The model was evaluated using Chin and Krammer (2011) criteria plus a modified form of the Delphi technique. These findings have implications for effective PMTCT service provision. The key lessons learnt for programmatic improvement were that in order to provide quality and accessible PMTCT services the health care system will need to be well resourced. There is need to strengthen the health care system in line with HIV related programmatic changes.Health StudiesD. L.itt. et Phil. (Health Studies

The lived experiences of men who have sex with men when accessing HIV care services in Zimbabwe

Background: Key populations such as men who have sex with men are disproportionately affected by human immunodeficiency virus (HIV), yet they are underserved. This vulnerable group also faces stigma and discrimination when utilising the healthcare services. However, to achieve the HIV epidemic control, it is important for them to have access to HIV care services. Aim: The aim of this study was to explore and describe the experiences of men who have sex with men (MSM) as they accessed HIV care services in healthcare settings in Bulawayo, Zimbabwe. Setting: The study setting was healthcare facilities (state and private owned) in Bulawayo, Zimbabwe, that offer HIV care services. Methods: The study used a descriptive phenomenological design targeting self-identified MSM living with HIV. Data were gathered by using in-depth individual interviews that were audio recorded. Data saturation determined sample size. Data were transcribed verbatim and later analysed thematically. Results: The study revealed that counselling given to MSM was generalised and not individualised. Some clients faced stigma and discrimination after disclosure. Peer and family support were important in the journey to access HIV care services. Conclusion: An enabling environment was not provided for MSM clients to access HIV care services in the majority of health facilities. This calls for sensitisation and competency clinical training of service providers so that the diverse needs of MSM are met. Peer and family support for MSM needs to be strengthened

How do you expect us to survive? Lamentation of female sex workers in Zimbabwe during COVID-19 lockdown

The restrictive measures taken to curb and mitigate the spread of the corona virus of 2019 (COVID-19) had negative implications on the vulnerable populations. The most severely affected group among the vulnerable population were sex workers, whose work venues and customers were locked down. This descriptive phenomenological study explored effects of COVID-19 on female sex workers in Bulawayo, Zimbabwe. Snowballing sampling was used to recruit participants. Data were collected through in-depth face-to-face individual interviews with ten female sex workers. The sample size was determined by data saturation. Colaizzi's seven-step content analysis approach was followed to guide data analysis. Rigour was ensured by adhering to Guba and Lincoln's trustworthiness criteria. The study found that the lockdown measures impacted negatively on sex workers’ income, making it difficult for them to get money for food and rentals. In order to survive, sex workers adopted innovative entrepreneurship. Others engaged in risky sexual behaviours, further aggravating their situation emotionally and psychologically. It is recommended that the government and policy makers provide psychosocial and economic support to protect the rights of female sex workers in order to maintain the gains made in HIV response.College of Human Science

The lived experiences of men who have sex with men when accessing HIV care services

Background: Key populations such as men who have sex with men are disproportionately affected by human immunodeficiency virus (HIV), yet they are underserved. This vulnerable group also faces stigma and discrimination when utilising the healthcare services. However, to achieve the HIV epidemic control, it is important for them to have access to HIV care services. Aim: The aim of this study was to explore and describe the experiences of men who have sex with men (MSM) as they accessed HIV care services in healthcare settings in Bulawayo, Zimbabwe. Setting: The study setting was healthcare facilities (state and private owned) in Bulawayo, Zimbabwe, that offer HIV care services. Methods: The study used a descriptive phenomenological design targeting self-identified MSM living with HIV. Data were gathered by using in-depth individual interviews that were audio recorded. Data saturation determined sample size. Data were transcribed verbatim and later analysed thematically. Results: The study revealed that counselling given to MSM was generalised and not individualised. Some clients faced stigma and discrimination after disclosure. Peer and family support were important in the journey to access HIV care services. Conclusion: An enabling environment was not provided for MSM clients to access HIV care services in the majority of health facilities. This calls for sensitisation and competency clinical training of service providers so that the diverse needs of MSM are met. Peer and family support for MSM needs to be strengthened.College of Human Science

Challenges faced by healthcare workers at a central hospital in Zimbabwe after contracting COVID-19: An interpretive phenomenological analysis study

Background Healthcare workers play a critical role in the delivery of healthcare services. Because of the high risk of exposure to healthcare workers, the emergence of coronavirus disease 2019 (COVID-19) has had a significant impact as they struggled to contain the pandemic. The purpose of this study was to explore and describe the challenges they faced after contracting COVID-19. Methods An interpretative phenomenological analysis (IPA) design was employed to gain insight into the lived experiences of healthcare workers who contracted COVID-19 in the course of their duties. This study involved participants who were healthcare workers based at a central hospital in Bulawayo, Zimbabwe. Data were collected through in-depth interviews that were audio recorded. A sample size of ten was reached based on data saturation. Results The study showed that healthcare workers lacked psychosocial support, experienced economic challenges as they incurred diagnostic and treatment costs. The study also found that the healthcare workers experienced stigma and discrimination both at work and in the community. Findings also indicate that healthcare workers did not receive institutional support. The study demonstrated lack of preparedness at the institution evidenced by inadequate testing for COVID-19 and shortage of personal protective equipment.College of Human Science

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

Innovative strategies to enhance HIV service delivery among female sex workers during the COVID-19 pandemic in Zimbabwe

Globally, access to HIV services by key populations has always been a challenge even prior the emergence of Coronavirus disease in 2019 (COVID-19). With reference to Zimbabwe, sex workers experienced challenges in accessing HIV services as was exacerbated by the pandemic and related lockdown restrictions. In the given context, it was critical to develop innovative approaches to increase female sex workers’ access to HIV treatment. Such approaches help prevent treatment interruption and contribute to HIV epidemic control. The study aimed to explore and describe the innovative approaches that were adopted to enhance HIV service delivery among female sex workers during the COVID-19 pandemic in Zimbabwe. A qualitative, descriptive phenomenological design was used to attain the study’s objective. Ten purposefully sampled participants were individually interviewed following a semi-structured interview guide. Data were analysed using Colaizzi’s seven steps. The research findings yielded the following themes: participants received differentiated HIV service delivery through community-based outreach, virtual psychosocial interventions, and support systems through peers, family, and institutions. The innovative approaches to promote HIV service delivery during COVID-19 enhanced female sex workers’ access to differentiated person-centred care and promoted treatment continuity. Community workers were also vital in supporting their peers’ treatment adherence. The lessons drawn from this study are critical and can be utilised in different settings

How do you expect us to survive? Lamentation of female sex workers in Zimbabwe during COVID-19 lockdown

The restrictive measures taken to curb and mitigate the spread of the corona virus of 2019 (COVID-19) had negative implications on the vulnerable populations. The most severely affected group among the vulnerable population were sex workers, whose work venues and customers were locked down. This descriptive phenomenological study explored effects of COVID-19 on female sex workers in Bulawayo, Zimbabwe. Snowballing sampling was used to recruit participants. Data were collected through in-depth face-to-face individual interviews with ten female sex workers. The sample size was determined by data saturation. Colaizzi's seven-step content analysis approach was followed to guide data analysis. Rigour was ensured by adhering to Guba and Lincoln's trustworthiness criteria. The study found that the lockdown measures impacted negatively on sex workers’ income, making it difficult for them to get money for food and rentals. In order to survive, sex workers adopted innovative entrepreneurship. Others engaged in risky sexual behaviours, further aggravating their situation emotionally and psychologically. It is recommended that the government and policy makers provide psychosocial and economic support to protect the rights of female sex workers in order to maintain the gains made in HIV response.College of Human Science

A model for enhancing prevention of mother to child HIV transmission in a low resource setting

The prevention of mother-to-child transmission (PMTCT) programmes plays a significant role in the reduction of human immunodeficiency virus (HIV) infections in the under-five age group and maternal mortalities. A phenomenological study on the experiences of HIV-positive women who utilised the PMTCT services identified challenges affecting the use of those services. An enabling environment is required for the effectiveness of the PMTCT programme.College of Human Science

How do you expect us to survive? Lamentation of female sex workers in Zimbabwe during COVID-19 lockdown

The restrictive measures taken to curb and mitigate the spread of the corona virus (COVID-19) had negative implications on the vulnerable populations. Of the latter, the most severely affected were sex workers, whose work venues and customers were locked down. This descriptive phenomenological study explored effects of COVID-19 on female sex workers in Bulawayo, Zimbabwe. Snowballing sampling was used to recruit participants. Data were collected through in-depth face-to-face individual interviews with ten female sex workers. The sample size was determined by data saturation. Colaizzi's seven-step content analysis approach was followed to guide data analysis. Rigour was ensured by adhering to Guba and Lincoln's trustworthiness criteria. The study found that the measures impacted negatively on sex workers’ income, making it difficult for them to get money for food and rentals. In response, some sex workers adopted innovative entrepreneurship. Others engaged in risky sexual behaviours, further aggravating their situation emotionally and psychologically. It is recommended that the government and policy makers provide psychosocial and economic support to protect the rights of female sex workers in order to maintain the gains made in HIV response