Analysis of secondary data from Mycobacterium vaccae tuberculosis clinical trial

Background: Sputum culture conversion at two months is an important indicator for the effectiveness of treatment and the infectivity of a patient with pulmonary TB. This study aimed at investigating factors that are associated with tuberculosis culture conversion at two months as well as investigating whether sputum culture conversion at two months is a reliable predictor of relapse. Methods: The study makes use of data obtained from 347 newly diagnosed tuberculosis patients who participated in a randomized placebo controlled immunotherapy trial at King George V hospital in Durban. Above objectives were met by carrying out statistical analysis of the secondary data. Chi-square tests for categorical explanatory variables such as HIV status and smoking status and (b) t-tests for continuous variables such as age were used for investigating factors associated with 2-month culture conversion. Multivariate models were used to find the most important variables for predicting 2-month culture conversion. Kaplan Meier curves were used for investigating whether culture conversion at two months is a reliable predictor of relapse. Findings: Of the 347 tuberculosis patients, 34 % were HIV sero-positive. Age, body mass index (BMI), smoking status and gender were found to be important variables that affect sputum culture conversion at two months. At 5 % significance level there was no evidence that those who culture convert at two months were less likely to relapse than those who had not culture converted at two months (p=0.1165). However the trend shown is striking to report as it may be of clinical significance. Among those who had not culture converted at two months, more people (40) than expected (34) relapsed an among those who had culture converted at to months, less people (19) than expected (24) relapsed. Interpretation and recommendations: Some behavioral and biological factors affect two month tuberculosis culture conversion therefore successful tuberculosis management need to take into account the effect of these factors. This study did not show that the sterilizing potential of an anti-tuberculosis regimen can be obtained by evaluation of the culture conversion rates at two months and this may be due to small sample size

The landscape of COVID-19 vaccination in Zimbabwe : a narrative review and analysis of the strengths, weaknesses, opportunities and threats of the programme

The ongoing COVID-19 pandemic brought unprecedented challenges for the population. The advent of national COVID-19 vaccination programmes was therefore welcome as a key control strategy for the COVID-19 pandemic, as evidence has shown that vaccination is the best strategy to reduce the adverse individual and population level adverse outcomes associated with infectious diseases such as COVID-19. Zimbabwe rolled out its vaccination programme in February 2021 with an ambitious target to vaccinate at least 60% of its eligible population by December 2021. However, by that time, the country was still to reach that target. To move the vaccination programme towards achieving this target, it is crucial to understand the strengths, weaknesses, opportunities and threats to the programme. We, therefore, with this narrative review, discuss some of the strengths, weaknesses, opportunities and threats to the programme since its rollout in February 2021. Though the programme has several strengths and opportunities to leverage on, we argue that among other challenges, the emergence of new variants of concern poses one of the biggest threats to local, regional and international vaccination programmes and requires concerted multistakeholder efforts to deal with. Additionally, addressing vaccine hesitancy remains as important as availing the vaccines to the population, to obtain the most benefits out of the programme.https://www.mdpi.com/journal/vaccinesdm2022School of Health Systems and Public Health (SHSPH

HIV status, knowledge and prevention of cervical cancer amongst adolescent girls and women : a secondary data analysis

TABLES AND FIGURES: TABLE 1: baseline characteristics of female ZDHS 2015 used in the analysis. TABLE 2: profiles of women whoever or never heard about cervical cancer. TABLE 3: profiles of women who were ever or never screened for cervical cancer. FIGURE 1: A) HIV in females; B) prevalence of knowledge about cervical cancer; and C) prevalence of cervical cancer testingINTRODUCTION : the objective of this manuscript was to describe the knowledge profiles and determinants of cervical cancer screening among HIV positive and negative adolescent girls and women in Zimbabwe. METHODS : we conducted secondary statistical data analysis to explore the determinants of cervical cancer screening among HIV positive and negative adolescent girls and women using Zimbabwe Demographic Health survey for 2015-16. RESULTS : a total of 9054 adolescent girls aged 15-19, and women aged 20-49 were included in the analysis and the majority (63%) of them resided in rural areas. More than two-thirds (65.9%) had attained secondary level of education. The majority (41.3%) of the adolescent girls and women belonged to the Apostolic sect. A number of key determinants have been identified for being ever screened for cervical cancer. The odds of being ever being screened increased by age, OR(CI) 4.38 (3.22-5.94), p<0.001 for women who are 40 years and older when compared to adolescent and young woman who are between 15-24 years. CONCLUSION : our study reports significant programmatic gaps in the provision of cervical cancer screening and treatment services in the country. The nascent Zimbabwe cervical cancer screening and treatment progamme will benefit from expansion of the number of facilities offering the services and the provision of more efficient health education to adolescent women and girls.http://www.panafrican-med-journal.comam2023School of Health Systems and Public Health (SHSPH

Reduced HIV transmission at subsequent pregnancy in a resource-poor setting

Several studies indicate that HIV-infected women continue to have children. We set out to determine the trend in HIV transmission at subsequent pregnancies. From 2002–2003, pregnant women were enrolled in a single dose nevirapine-based Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme. Six years later, women with subsequent children in this cohort were identified and their children's HIV status determined. From 330 identified HIV-infected mothers, 73 had second/subsequent children with HIV results. Of these, nine (12.3%, 95% confidence interval [CI]: 4.6–20.1%) children were HIV-infected. Of the 73 second children, 51 had older siblings who had been initially enrolled in the study with definitive HIV results with an infection rate of 17/51 (33.3%, 95% CI: 19.9–46.7). About 35% of the women had been on antiretroviral drugs. These results demonstrate lower subsequent HIV transmission rates in women on a national PMTCT programme in a resource-poor setting with the advent of antiretroviral therapy

Predicting HIV status among men who have sex with men in Bulawayo & Harare, Zimbabwe Using bio-behavioural data, recurrent neural networks, and machine learning techniques

DATA AVAILABILITY STATEMENT : The data used in this study is available upon reasonable request from the Ministry of Health and Child Care, Zimbabwe.HIV and AIDS continue to be major public health concerns globally. Despite significant progress in addressing their impact on the general population and achieving epidemic control, there is a need to improve HIV testing, particularly among men who have sex with men (MSM). This study applied deep and machine learning algorithms such as recurrent neural networks (RNNs), the bagging classifier, gradient boosting classifier, support vector machines, and Naïve Bayes classifier to predict HIV status among MSM using the dataset from the Zimbabwe Ministry of Health and Child Care. RNNs performed better than the bagging classifier, gradient boosting classifier, support vector machines, and Gaussian Naïve Bayes classifier in predicting HIV status. RNNs recorded a high prediction accuracy of 0.98 as compared to the Gaussian Naïve Bayes classifier (0.84), bagging classifier (0.91), support vector machine (0.91), and gradient boosting classifier (0.91). In addition, RNNs achieved a high precision of 0.98 for predicting both HIV-positive and -negative cases, a recall of 1.00 for HIV-negative cases and 0.94 for HIV-positive cases, and an F1-score of 0.99 for HIV-negative cases and 0.96 for positive cases. HIV status prediction models can significantly improve early HIV screening and assist healthcare professionals in effectively providing healthcare services to the MSM community. The results show that integrating HIV status prediction models into clinical software systems can complement indicator condition-guided HIV testing strategies and identify individuals that may require healthcare services, particularly for hard-to-reach vulnerable populations like MSM. Future studies are necessary to optimize machine learning models further to integrate them into primary care. The significance of this manuscript is that it presents results from a study population where very little information is available in Zimbabwe due to the criminalization of MSM activities in the country. For this reason, MSM tends to be a hidden sector of the population, frequently harassed and arrested. In almost all communities in Zimbabwe, MSM issues have remained taboo, and stigma exists in all sectors of society.The HIV and STI Biobehavioral Survey among Men Who Have Sex with Men, Transgender Women, and Genderqueer Individuals in Zimbabwe was funded by (PEPFAR) through CDC.https://www.mdpi.com/journal/tropicalmedam2023School of Health Systems and Public Health (SHSPH

COVID-19 prevalence among healthcare workers. A systematic review and meta-analysis

Understanding the burden of SARS-CoV-2 infections among healthcare workers is a critical component to inform occupational health policy and strategy. We conducted a systematic review and meta-analysis to map and analayse the available global evidence on the prevalence of SARS-CoV-2 infections among healthcare workers. The random-effects adjusted pooled prevalence of COVID-19 among those studies that conducted the test using the antibody (Ab) method was 7% [95% CI: 3 to 17%]. The random-effects adjusted pooled prevalence of COVID-19 among those studies that conducted the test using the PCR method was 11% [95% CI: 7 to 16%]. We found the burden of COVID-19 among healthcare workers to be quite significant and therefore a cause for global health concern. Furthermore, COVID-19 infections among healthcare workers affect service delivery through workers’ sick leave, the isolation of confirmed cases and quarantine of contacts, all of which place significant strain on an already shrunken health workforce.SUPPLEMENTARY MATERIALS : SUPPLEMENTARY FILE S1: PRISMA Flow Diagram, SUPPLEMENTARY FILE S2: List of full text articles reviewed, SUPPLEMENTARY FILE S3: Distribution of COVID-19 burden among health care workers in included studies, SUPPLEMENTARY FILE S4: Characteristics of included studies, SUPPLEMENTARY FILE S5: Egger’s plots for assessing the presence of publication bias for the meta-analysis, SUPPLEMENTARY FILE S6: Presentation of findings for assessing and accounting for small-study effects.https://www.mdpi.com/journal/ijerphSchool of Health Systems and Public Health (SHSPH

Risk factors for COVID-19 infection among healthcare workers. A first report from a living systematic review and meta-analysis

Health care workers (HCWs) are more than ten times more likely to be infected with coronavirus infectious disease 2019 (COVID-19) than the general population, thus demonstrating the burden of COVID- 19 among HCWs. Factors that expose HCWs to a differentially high-risk of COVID-19 acquisition are important to elucidate, enable appropriate public health interventions to mitigate against high risk and reduce adverse outcomes from the infection. We conducted a systematic review and meta-analysis to summarize and critically analyze the existing evidence on SARS-CoV-2 risk factors among HCWs. With no geographical limitation, we included studies, in any country, that reported (i) the PCR laboratory diagnosis of COVID-19 as an independent variable (ii) one or more COVID-19 risk factors among HCWs with risk estimates (relative risk, odds ratio, or hazard ratio) (iii) original, quantitative study design, and published in English or Mandarian. Our initial search resulted in 470 articles overall, however, only 10 studies met the inclusion criteria for this review. Out of the 10 studies included in the review, inadequate/ lack of protective personal equipment, performing tracheal intubation, and gender were the most common risk factors of COVID-19. Based on the random effects adjusted pooled relative risk, HCWs who reported the use of protective personal equipment were 29% (95% CI: 16% to 41%) less likely to test positive for COVID-19. The study also revealed that HCWs who performed tracheal intubations were 34% (95% CI: 14% to 57%) more likely to test positive for COVID-19. Interestingly, this study showed that female HCWs are at 11% higher risk (RR 1.11 95% CI 1.01e1.21) of COVID-19 than their male counterparts. This article presents initial findings from a living systematic review and meta-analysis, therefore, did not yield many studies; however, it revealed a significant insight into better understanding COVID-19 risk factors among HCWs; insights important for devising preventive strategies that protect them from this infection.http://www.e-shaw.netam2023School of Health Systems and Public Health (SHSPH

Risk factors for COVID-19 infection among healthcare workers. A first report from a living systematic review and meta-analysis

Health care workers (HCWs) are more than ten times more likely to be infected with COVID-19 compared to the general population, thus demonstrating the burden of COVID-19 among HCWs. Factors that expose HCWs to a differentially high-risk of COVID-19 acquisition are important to elucidate, to enable appropriate public health interventions to mitigate against high risk and reduce adverse outcomes from the infection. We conducted a systematic review and meta analysis to summarise and critically analyse the existing evidence on SARS-CoV-2 risk factors among HCWs. With no geographical limitation, we included studies, in any country, that reported (i) PCR laboratory diagnosis of COVID—19 as an independent variable (ii) one or more COVID-19 risk factors among health care workers with risk estimates (relative risk, odds ratio or harzard ratio) (iii) original, quantitative study design and published in English or Mandarian. Our initial search resulted in 470 articles overall, however, only 10 studies met the inclusion criteria for this review. Out of the 10 studies included in the review, inadequate/lack of protective personal equipment (PPE), performing tracheal intubation (PTI) and gender were the most common risk factors of COVID-19. Based on the random effects adjusted pooled relative risk, HCWs who reported use PPE were 29% (95% CI: 16% to 41%) less likely to test positive for COVID-19. The study also revealed that HCWs who performed tracheal intubations were 34% (95% CI: 14% to 57%) more likely to test positive for COVID-19. Interestingly, this study showed that female HCWs are at 11% higher risk (RR 1.11 95% CI 1.01-1.21) of COVID-19 than their male counterparts. This paper presents initial findings from a living systematic review and meta-analysis, therefore, did not yield many studies, however, it revealed a significant insight to better understand COVID-19 risk factors among HCWs; insights important for devising preventive strategies that protect them from this infection

Zimbabwe (2015): Quantitative Study Evaluating Knowledge and Behaviours on Family Planning, Violence against Women and Girls and Cervical Cancer Screening Behaviours among men and women aged 15 - 49 years.

The goal of this study was to add to the body of knowledge on Family Planning, Violence Against Women and Girls and Cervical Cancer Screening. This quantitative study provided evidence for monitoring, segmentation and evaluating the implementation of PSI Zimbabwe's programs and impact of their interventions. This information will be used to develop interventions and communications for the interventions. Study objectives for this study aims to answer three fundamental questions related to segmentation i). What are the levels and trends in knowledge of family planning,VAWG and cervical cancer screening?.ii). Monitoring What are the trends and current levels in family planning, VAWG and cervical behaviors and correlates identified through qualitative studies?, iii). Evaluation is exposure to PSI Zimbabwe communication activities leading to changes in knowledge and behaviors of family planning, VAWG, cervical cancer screening?. This study was conducted among men and women aged between 15-49 years in Zimbabwe. The study was a stratified multi-stage cluster sampling approach. Respondents for this study were selected from 100 enumeration areas (35 in urban and 65 in rural). Data was collected using structured questionnaires and smartphones. Analysis was done using stata version 13. Analyses consisted of descriptive statistics for key program indicators and Analysis of Variance (ANOVA) to examine trends over time. Bivariate analysis was done using place of residence as exposure variables and program indicators as outcome variables.

Hesitancy, ignorance or uncertainty? The need for effective communication strategies as Zimbabwe’s uptake of COVID-19 vaccine booster doses remains poor

Zimbabwe started an ambitious COVID-19 vaccination programme in February 2021, aiming to vaccinate at least 60% of its eligible population by December 2021. The efforts to protect the population from the devastating effects of COVID-19 were remarkable, especially given that the country was not a part of the COVID-19 Vaccines Global Access (COVAX) initiative, and the government had to seek alternative sources of vaccines. The trajectory of COVID-19 vaccination in the country followed a very slow initial uptake from February to early June 2021. A sharp rise in demand and uptake followed between June and August 2021, coinciding with a harsh Delta variant-driven epidemic. However, as the situation stabilised and the cases plummeted, the uptake of the vaccines fell again, and by the beginning of December 2021, reports from the Ministry of Health and Child Care (MoHCC) of Zimbabwe show that the daily uptake had significantly gone down.https://www.sciencedirect.com/journal/public-health-in-practiceam2023School of Health Systems and Public Health (SHSPH