Implementation and Operational Research: Cohort Analysis of Program Data to Estimate HIV Incidence and Uptake of HIV-Related Services Among Female Sex Workers in Zimbabwe, 2009-2014.

BACKGROUND: HIV epidemiology and intervention uptake among female sex workers (FSW) in sub-Saharan Africa remain poorly understood. Data from outreach programs are a neglected resource. METHODS: Analysis of data from FSW consultations with Zimbabwe's National Sex Work program, 2009-2014. At each visit, data were collected on sociodemographic characteristics, HIV testing history, HIV tests conducted by the program and antiretroviral (ARV) history. Characteristics at first visit and longitudinal data on program engagement, repeat HIV testing, and HIV seroconversion were analyzed using a cohort approach. RESULTS: Data were available for 13,360 women, 31,389 visits, 14,579 reported HIV tests, 2750 tests undertaken by the program, and 2387 reported ARV treatment initiations. At first visit, 72% of FSW had tested for HIV; 50% of these reported being HIV positive. Among HIV-positive women, 41% reported being on ARV. 56% of FSW attended the program only once. FSW who had not previously had an HIV-positive test had been tested within the last 6 months 27% of the time during follow-up. After testing HIV positive, women started on ARV at a rate of 23/100 person years of follow-up. Among those with 2 or more HIV tests, the HIV seroconversion rate was 9.8/100 person years of follow-up (95% confidence interval: 7.1 to 15.9). CONCLUSIONS: Individual-level outreach program data can be used to estimate HIV incidence and intervention uptake among FSW in Zimbabwe. Current data suggest very high HIV prevalence and incidence among this group and help identify areas for program improvement. Further methodological validation is required

Utilisation of Medical Services and Outcomes at Adult Rape Clinic at Parirenyatwa Group of Hospitals, Zimbabwe

Sexual violence is a major public health problem due to the associated risk of acquiring sexually transmitted infections, behavioural disorders and risk of committing suicide. The Adult Rape Clinic (ARC) was established at Parirenyatwa Hospital, Harare in 2009 with the objective of providing medical and support services for survivors of sexual violence in a safe and private environment. The data collected had never been analysed since the  establishment of the clinic. We described the clients‘ profile and the services offered at the clinic to identify gaps in service provision and areas of improvement. A retrospective record review of data was carried out from the ARC collected from February 2009 to December 2017. We analyzed 2343 affidavits that were available. Out of 2343 records analysed, (2190) 93.5% were female and 6.5 % (153) were male. The median age was 23years (Q1=21; Q3= 29) for males and 19 years (Q1= 17; Q2=25) for females. Among the clients, 2164 (92.4%) received a baseline HIV test, and 263 females and 6 males tested positive. From 2010 to 2017, six clients‘ seroconversion was recorded. Only 863(36.8%) clients presented within 3 days after the sexual assault. About 40% of male victims were assaulted by someone they knew and 27% were married. The study recommends further research on the determinants of late presentation after sexual assault. (Afr J Reprod Health 2019; 23[4]: 99-107).Keywords: Sexual violence, HIV test, maleLa violence sexuelle est un problème de santé publique majeur en raison du risque associé de contracter des infections sexuellement transmissibles, des troubles du comportement et du risque de suicide. La Clinique du viol pour adultes (CVA) a été créée à l'hôpital Parirenyatwa de Harare en 2009 dans le but de fournir des services médicaux et de soutien aux victimes de violences sexuelles dans un environnement sûr et privé. Les données  recueillies n'avaient jamais été analysées depuis la création de la clinique. Nous avons décrit le profil des clients et les services offerts à la clinique pour identifier les lacunes dans la prestation de services et les domaines à améliorer. Un examen rétrospectif des données a été effectué auprès de la CVA recueilli de février 2009 à décembre 2017. Nous avons analysé 2343 déclarations disponibles. Sur 2343 enregistrements analysés, (2190)93, 5% étaient des femmes et 6,5% (153) étaient des hommes. L'âge médian était de 23 ans (Q1 = 21; Q3 = 29) pour les hommes et 19 ans (Q1 = 17; Q2 = 25) pour les femmes. Parmi les clients, 2164 (92,4%) ont reçu un test de base du VIH, et 263 femmes et 6 hommes ont été positifs. De 2010 à 2017, la séroconversion de six clients a été enregistrée. Seulement 863 clients (36,8%) se sont présentés dans les 3 jours suivant l'agression sexuelle. Environ 40% des victimes masculines ont été agressées par une personne qu'elles connaissaient et 27% étaient mariées. L'étude recommande de poursuivre les recherches sur les déterminants de la présentation tardive après une agression sexuelle.Mots-clés: Violence sexuelle, test VIH, homm

HIV testing uptake and retention in care of HIV-infected pregnant and breastfeeding women initiated on 'Option B+' in rural Zimbabwe.

OBJECTIVES: Zimbabwe has started to scale up Option B+ for the prevention of mother-to-child transmission of HIV, but there is little published information about uptake or retention in care. This study determined the number and proportion of pregnant and lactating women in rural districts diagnosed with HIV infection and started on Option B+ along with six-month antiretroviral treatment (ART) outcomes. METHODS: This was a retrospective record review of women presenting to antenatal care or maternal and child health services at 34 health facilities in Chikomba and Gutu rural districts, Zimbabwe, between January and March 2014. RESULTS: A total of 2728 women presented to care of whom 2598 were eligible for HIV testing: 76% presented to antenatal care, 20% during labour and delivery and 4% while breastfeeding. Of 2097 (81%) HIV-tested women, 7% were HIV positive. Lower HIV testing uptake was found with increasing parity, late presentation to antenatal care, health centre attendance and in women tested during labour. Ninety-one per cent of the HIV-positive women were started on Option B+. Six-month ART retention in care, including transfers, was 83%. Loss to follow-up was the main cause of attrition. Increasing age and gravida status ≥2 were associated with higher six-month attrition. CONCLUSION: The uptake of HIV testing and Option B+ is high in women attending antenatal and post-natal clinics in rural Zimbabwe, suggesting that the strategy is feasible for national scale-up in the country