Survey of children accessing HIV services in a high prevalence setting: time for adolescents to count?

OBJECTIVE: To establish the proportion of adolescents among children infected with human immunodeficiency virus (HIV) in Zimbabwe who receive HIV care and support, and what clinic staff perceives to be the main problems faced by HIV-infected children and adolescents. METHODS: In July 2008, we sent a questionnaire to all 131 facilities providing HIV care in Zimbabwe. In it we requested an age breakdown of the children (aged 0-19 years) registered for care and asked what were the two major problems faced by younger children (0-5 years) and adolescents (10-19 years). FINDINGS: Nationally, 115 (88%) facilities responded. In 98 (75%) that provided complete data, 196 032 patients were registered and 24 958 (13%) of them were children. Of children under HIV care, 33% were aged 0-4 years; 25%, 5-9 years; 25%, 10-14 years; and 17%, 15-19 years. Staff highlighted differences in the problems most commonly faced by younger children and adolescents. For younger children, such problems were malnutrition and lack of appropriate drugs (cited by 46% and 40% of clinics, respectively); for adolescents they concerned psychosocial issues and poor drug adherence (cited by 56% and 36%, respectively). CONCLUSION: Interventions for the large cohort of adolescents who are receiving HIV care in Zimbabwe need to target the psychosocial concerns and poor drug adherence reported by staff as being the main concerns in this age group

Gender-related differences in outcomes and attrition on antiretroviral treatment among an HIV-infected patient cohort in Zimbabwe: 2007-2010.

OBJECTIVES: To determine (1) gender-related differences in antiretroviral therapy (ART) outcomes, and (2) gender-specific characteristics associated with attrition. METHODS: This was a retrospective patient record review of 3919 HIV-infected patients aged ≥15 years who initiated ART between 2007 and 2009 in 40 randomly selected ART facilities countrywide. RESULTS: Compared to females, males had more documented active tuberculosis (12% vs. 9%; p60kg), initiating ART at an urban health facility, and care at central/provincial or district/mission hospitals vs. primary healthcare facilities. CONCLUSIONS: Our findings show that males presented late for ART initiation compared to females. Similar to other studies, males had higher patient attrition and mortality compared to females and this may be attributed in part to late presentation for HIV treatment and care. These observations highlight the need to encourage early HIV testing and enrolment into HIV treatment and care, and eventually patient retention on ART, particularly amongst men

Improving access to pre-exposure prophylaxis for adolescent girls and young women: recommendations from healthcare providers in eastern Zimbabwe

Background: In sub-Saharan Africa, adolescent girls and young women (AGYW) are at high risk of acquiring HIV. A growing number of sub-Saharan African countries are beginning to avail pre-exposure prophylaxis, or PrEP, but with limited success. Unpacking strategies to overcome barriers to the uptake of PrEP is critical to prevent HIV amongst AGYW. This article explores health professionals’ views and recommendations on what is required to increase uptake of PrEP. Methods: The study draws on interview data from 12 providers of HIV prevention services in eastern Zimbabwe. The healthcare providers were purposefully recruited from a mix of rural and urban health facilities offering PrEP. The interviews were transcribed and imported into NVivo 12 for thematic coding and network analysis. Results: Our analysis revealed six broad strategies and 15 concrete recommendations which detail the range of elements healthcare providers consider central for facilitating engagement with PrEP. The healthcare providers called for: (1) PrEP marketing campaigns; (2) youth-friendly services or corners; (3) improved PrEP delivery mechanisms; (4) improvements in PrEP treatment; (5) greater engagement with key stakeholders, including with young people themselves; and (6) elimination of costs associated with PrEP use. These recommendations exemplify an awareness amongst healthcare providers that PrEP access is contingent on a range of factors both inside and outside of the clinical setting. Conclusions: Healthcare providers are at the frontline of the HIV epidemic response. Their community-embeddedness, coupled with their interactions and encounters with AGYW, make them well positioned to articulate context-specific measures for improving access to PrEP. Importantly, the breadth of their recommendations suggests recognition of PrEP use as a complex social practice that requires integration of a combination of interventions, spanning biomedical, structural, and behavioural domains

Unpacking early infant male circumcision decision-making using qualitative findings from Zimbabwe.

BACKGROUND Early infant male circumcision (EIMC) has been identified as a key HIV prevention intervention. Exploring the decision-making process for adoption of EIMC for HIV prevention among parents and other key stakeholders is critical for designing effective demand creation interventions to maximize uptake, roll out and impact in preventing HIV. This paper describes key players, decisions and actions involved in the EIMC decision-making process. METHODS Two complementary qualitative studies explored hypothetical and actual acceptability of EIMC in Zimbabwe. The first study (conducted 2010) explored hypothetical acceptability of EIMC among parents and wider family through focus group discussions (FGDs, n = 24). The follow-up study (conducted 2013) explored actual acceptability of EIMC among parents through twelve in-depth interviews (IDIs), four FGDs and short telephone interviews with additional parents (n = 95). Short statements from the telephone interviews were handwritten. FGDs and IDIs were audio-recorded, transcribed and translated into English. All data were thematically coded. RESULTS Study findings suggested that EIMC decision-making involved a discussion between the infant's parents. Male and female participants of all age groups acknowledged that the father had the final say. However, discussions around EIMC uptake suggested that the infant's mother could sometimes covertly influence the father's decision in the direction she favoured. Discussions also suggested that fathers who had undergone voluntary medical male circumcision were more likely to adopt EIMC for their sons, compared to their uncircumcised counterparts. Mothers-in-law/grandparents were reported to have considerable influence. Based on study findings, we describe key EIMC decision makers and attempt to illustrate alternative outcomes of their key actions and decisions around EIMC within the Zimbabwean context. CONCLUSIONS These complementary studies identified critical players, decisions and actions involved in the EIMC decision-making process. Findings on who influences decisions regarding EIMC in the Zimbabwean context highlighted the need for EIMC demand generation interventions to target fathers, mothers, grandmothers, other family members and the wider community

Predictors of Positivity Yield among Index Contacts in Harare and Matabeleland South Provinces, Zimbabwe, 2022

Background: Zimbabwe’s Index Testing programme has failed to achieve targets since its inception in 2017. We determined the index testing implementation modalities to identify and recommend effective contact elicitation, tracking and testing modalities to enhance positivity yield. Subjects dan Method: This study conducted a cross-sectional study on 50 multistage selected health facilities. Dependent variables were all clients, (≥15 years) diagnosed with HIV in 2021, whilst independent variables were contact tracking. The study instrument of variable measure was cascade analysis to identify tracing modalities against yield. Quantitative data were summarized as proportions, odds ratios, and adjusted odds ratios at a 5% significance level. Results: Of 6,308 index cases identified, females constituted 53.9% (n=3,401 and 67.6% (n=4,265) were retests. Index testing was offered to 66.4% (n=4,190), accepted by 93.1% (n=3,899) and the elicitation rate was 1:1.3 (n=5,080). A positivity yield of 27.5% (n=1,736) was achieved from 78.6% (n= 3,991) contacts. Mixed method tracking yielded 46.7% (n=349) positivity from a testing rate of 99.5% (n=748) in an urban setup, with 41.4% (n=1,243) preferring health worker referrals. As high as 202 contacts were not tested following elicitation through client referrals. In a rural setup, client referrals accounted for 53.1%, (n=1,103) yet 122 of these were not tested. The highest positivity yield was obtained from health worker referrals at 65.6% (n=196). Being male (aOR=3.09; 95%CI= 2.74 to 3.49), first tester (aOR=1.65; 95%CI= 1.43 to 1.91), anonymous tracking (aOR=8.46; 95%CI:3.37 to 22.75) and testing contacts within 7 days of elicitation (aOR=2.78; 95%CI=2.44 to 3.18) were identified as high predictors of positivity yield among index contacts. Conclusion: The identified high positivity yield among men, first-time testers and contacts tested within 7 days of elicitation may inform index testing focussing to improve program performance. Implementation fidelity and differentiated contact referrals were recommended to mitigate attritions at each stage of the index cascade to yield the best results on index contact tracing and testing. Keywords: targeted testing, HIV testing services, index contact tracing and testing, index testing cascade Correspondence: Hamufare Dumisani Mugauri. Faculty of Medicine and Health Sciences, Department of Primary Healthcare Sciences, New Health Sciences Building, Parirenyatwa Complex, Mazowe Road, Harare, Zimbabwe. Email: [email protected]. Mobile: +263772314894

Predictors of Positivity Yield among Index Contacts in Harare and Matabeleland South Provinces, Zimbabwe, 2022

Background: Zimbabwe’s Index Testing programme has failed to achieve targets since its inception in 2017. We determined the index testing implementation modalities to identify and recommend effective contact elicitation, tracking and testing modalities to enhance positivity yield. Subjects dan Method: This study conducted a cross-sectional study on 50 multistage selected health facilities. Dependent variables were all clients, (≥15 years) diagnosed with HIV in 2021, whilst independent variables were contact tracking. The study instrument of variable measure was cascade analysis to identify tracing modalities against yield. Quantitative data were summarized as proportions, odds ratios, and adjusted odds ratios at a 5% significance level. Results: Of 6,308 index cases identified, females constituted 53.9% (n=3,401 and 67.6% (n=4,265) were retests. Index testing was offered to 66.4% (n=4,190), accepted by 93.1% (n=3,899) and the elicitation rate was 1:1.3 (n=5,080). A positivity yield of 27.5% (n=1,736) was achieved from 78.6% (n= 3,991) contacts. Mixed method tracking yielded 46.7% (n=349) positivity from a testing rate of 99.5% (n=748) in an urban setup, with 41.4% (n=1,243) preferring health worker referrals. As high as 202 contacts were not tested following elicitation through client referrals. In a rural setup, client referrals accounted for 53.1%, (n=1,103) yet 122 of these were not tested. The highest positivity yield was obtained from health worker referrals at 65.6% (n=196). Being male (aOR=3.09; 95%CI= 2.74 to 3.49), first tester (aOR=1.65; 95%CI= 1.43 to 1.91), anonymous tracking (aOR=8.46; 95%CI:3.37 to 22.75) and testing contacts within 7 days of elicitation (aOR=2.78; 95%CI=2.44 to 3.18) were identified as high predictors of positivity yield among index contacts. Conclusion: The identified high positivity yield among men, first-time testers and contacts tested within 7 days of elicitation may inform index testing focussing to improve program performance. Implementation fidelity and differentiated contact referrals were recommended to mitigate attritions at each stage of the index cascade to yield the best results on index contact tracing and testing. Keywords: targeted testing, HIV testing services, index contact tracing and testing, index testing cascade Correspondence: Hamufare Dumisani Mugauri. Faculty of Medicine and Health Sciences, Department of Primary Healthcare Sciences, New Health Sciences Building, Parirenyatwa Complex, Mazowe Road, Harare, Zimbabwe. Email: [email protected]. Mobile: +263772314894

Diminished health and social outcomes among men who have sex with men who use drugs in Zimbabwe

No abstract available

Did national HIV prevention programs contribute to HIV decline in eastern Zimbabwe? Evidence from a prospective community survey. Sexually Transmitted Diseases

Abstract Objective: To add to the evidence on the impact of national HIV prevention programmes in reducing HIV risk in sub-Saharan African countries. Methods: Statistical analysis of prospective data on exposure to HIV prevention programmes, relatives with AIDS and unemployment, and sexual behaviour change and HIV incidence, in a population cohort of 4,047 adults, collected over a period (1998)(1999)(2000)(2001)(2002)(2003) when HIV prevalence and risk-behaviour declined in eastern Zimbabwe. Results: Exposure to HIV prevention programmes and relatives with AIDS -but not unemployment -increased from 1998-2003. Men and women exposed to media campaigns and HIV/AIDS meetings had greater knowledge and self-efficacy, attributes that were concomitantly protective against HIV infection. Women attending community HIV/AIDS meetings before recruitment were more likely than other women to adopt lower-risk behaviour (96.4% versus 90.8%; aOR 3.09; 95% CI, 1.27-7.49) and had lower HIV incidence (0.9% versus 1.8%; aIRR 0.63; 95% CI, 0.32-1.24) during the inter-survey period. Prior exposure to relatives with AIDS was not associated with differences in behaviour change. More newly unemployed men than employed men adopted lowerrisk behaviour (84.2% versus 76.0%; aOR 2.13; 95% CI, 0.98-4.59). Conclusion: Community-based HIV/AIDS meetings reduced risk-behaviour amongst women who attended contributing to HIV decline in eastern Zimbabwe

HIV decline in Zimbabwe due to reductions in risky sex? Evidence from a comprehensive epidemiological review

Background Recent data from antenatal clinic (ANC) surveillance and general population surveys suggest substantial declines in human immunodeficiency virus (HIV) prevalence in Zimbabwe. We assessed the contributions of rising mortality, falling HIV incidence and sexual behaviour change to the decline in HIV prevalence. Methods Comprehensive review and secondary analysis of national and local sources on trends in HIV prevalence, HIV incidence, mortality and sexual behaviour covering the period 1985-2007. Results HIV prevalence fell in Zimbabwe over the past decade (national estimates: from 29.3% in 1997 to 15.6% in 2007). National census and survey estimates, vital registration data from Harare and Bulawayo, and prospective local population survey data from eastern Zimbabwe showed substantial rises in mortality during the 1990s levelling off after 2000. Direct estimates of HIV incidence in male factory workers and women attending pre- and post-natal clinics, trends in HIV prevalence in 15-24-year-olds, and back-calculation estimates based on the vital registration data from Harare indicated that HIV incidence may have peaked in the early 1990s and fallen during the 1990s. Household survey data showed reductions in numbers reporting casual partners from the late 1990s and high condom use in non-regular partnerships between 1998 and 2007. Conclusions These findings provide the first convincing evidence of an HIV decline accelerated by changes in sexual behaviour in a southern African country. However, in 2007, one in every seven adults in Zimbabwe was still infected with a life-threatening virus and mortality rates remained at crisis leve