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Murayama H, Nishi A, Endo A. Different time scales used for sexual partner surveys pose a challenge in modelling dynamics of sexually transmitted infections. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.25.23300526. [PMID: 38234724 PMCID: PMC10793542 DOI: 10.1101/2023.12.25.23300526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Mathematical models for sexually transmitted infections (STIs) are parameterised by empirical data on sexual behaviour (e.g. the number of partners over a given period) obtained from surveys. However, the time window for reporting sexual partnerships may vary between surveys and how data for different windows can be translated from one to another remains an open question. To highlight this issue, we compared the distributions of the number of sexual partners over one year and four weeks from the British National Surveys of Sexual Attitudes and Lifestyles. The results show that simple linear rescaling did not render the one-year and four-week partner distributions aligned. Parameterising STI models using survey-based sexual encounter rates without considering the implication of the reporting window used can lead to misleading results.
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Affiliation(s)
- Hiroaki Murayama
- School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Akihiro Nishi
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, US
| | - Akira Endo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- The Centre of Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Whitworth HS, Baisley KJ, Nnko S, Irani J, Aguirre-Beltran A, Changalucha J, Crucitti T, Francis S, Hashim R, Hansen CH, Hayes RJ, Buvé A, Watson-Jones D. Associations between age of menarche, early sexual debut and high-risk sexual behaviour among urban Tanzanian schoolgirls: A cross-sectional study. Trop Med Int Health 2023; 28:237-246. [PMID: 36717965 DOI: 10.1111/tmi.13858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES This cross-sectional survey aimed to explore associations between age of menarche, early sexual debut and high-risk sexual behaviour among urban Tanzanian schoolgirls. METHODS Secondary schoolgirls aged 17-18 years from Mwanza, Tanzania, participated in structured face-to-face questionnaire-based interviews, conducted by nurses and clinicians. Age of menarche was evaluated in categories of 11-12, 13-14, 15-16 or ≥17 years. Primary outcome measures were self-reported early sexual debut (first vaginal sex at <16 years) and high-risk sexual behaviour, including non-use of condoms, having sex for gifts/money, having older sexual partners and/or other risky behaviours. RESULTS Of 401 girls enrolled, 174 (43.4%) reported prior vaginal sex. Prevalence of early sexual debut was 14.2% but pressured/forced sex and risky sexual behaviours were common. Adjusted for potential confounding, younger age at menarche was associated with early sexual debut (adjusted odds ratio for linear trend: 1.88 per category, 95% confidence interval: 1.21-2.92, p = 0.005). This association remained after excluding girls with first sex at <8 years or experiencing pressure or force at first sex. Further, adjusted for potential confounding (including ever experiencing forced sex), early sexual debut was associated with high-risk sexual behaviour (adjusted odds ratio: 2.85, 95% confidence interval: 1.38-5.88, p = 0.004). CONCLUSIONS Among urban Tanzanian school girls, younger age of menarche was associated with early sexual debut, and early sexual debut was associated with high-risk sexual behaviour. Researchers and public health professionals developing and delivering interventions aimed at preventing adverse sexual health outcomes should consider the impact of these early biological and sexual exposures.
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Affiliation(s)
- Hilary S Whitworth
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Kathy J Baisley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Soori Nnko
- National Institute for Medical Research, Mwanza, Tanzania
| | - Julia Irani
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aura Aguirre-Beltran
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - John Changalucha
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza, Tanzania
| | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Suzanna Francis
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ramadhan Hashim
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Christian Holm Hansen
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne Buvé
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Deborah Watson-Jones
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
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Magnolini R, Senkoro E, Kalinjuma AV, Kitau O, Kivuma B, Samson L, Eichenberger A, Mollel GJ, Krinke E, Okuma J, Ndege R, Glass T, Mapesi H, Vanobberghen F, Battegay M, Weisser M. Stigma-directed services (Stig2Health) to improve 'linkage to care' for people living with HIV in rural Tanzania: study protocol for a nested pre-post implementation study within the Kilombero and Ulanga Antiretroviral Cohort. AAS Open Res 2022; 5:14. [PMID: 36420449 PMCID: PMC9648364 DOI: 10.12688/aasopenres.13353.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 12/01/2022] Open
Abstract
Background: HIV-related stigma is a major barrier to the timely linkage and retention of patients in HIV care in sub-Saharan Africa, where most people living with HIV/AIDS reside. In this implementation study we aim to evaluate the effect of stigma-directed services on linkage to care and other health outcomes in newly diagnosed HIV-positive patients. Methods: In a nested project of the Kilombero and Ulanga Antiretroviral Cohort in rural Tanzania, we conduct a prospective observational pre-post study to assess the impact of a bundle of stigma-directed services for newly diagnosed HIV positive patients. Stigma-directed services, delivered by a lay person living with HIV, are i) post-test counseling, ii) post-test video-assisted teaching, iii) group support therapy and group health education, and iv) mobile health. Patients receiving stigma services (enrolled from 1 st February 2020 to 31 st August 2021) are compared to a historical control receiving the standard of care (enrolled from 1 st July 2017 to 1 st February 2019). The primary outcome is 'linkage to care'. Secondary endpoints are retention in care, viral suppression, death and clinical failure at 6-12 months (up to 31 st August 2022). Self-reported stigma and depression are assessed using the Berger Stigma scale and the PHQ-9 questionnaire, respectively. The sample size calculation was based on cohort data from 2018. Assuming a pre-intervention cohort of 511 newly diagnosed adults of whom 346 (68%) were in care and on antiretroviral treatment (ART) at 2 months, a 10% increase in linkage (from 70 to 80%), a two-sided type I error rate of 5%, and 90% power, 321 adults are required for the post-implementation group. Discussion: We expect that integration of stigma-directed services leads to an increase of proportions of patients in care and on ART. The findings will provide guidance on how to integrate stigma-directed services into routine care in rural sub-Saharan Africa.
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Affiliation(s)
- Raphael Magnolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Elizabeth Senkoro
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Aneth Vedastus Kalinjuma
- Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Bernard Kivuma
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Leila Samson
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Anna Eichenberger
- Ifakara Health Institute, Ifakara, Tanzania
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Getrud Joseph Mollel
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Eileen Krinke
- University Psychiatric Clinics Basel, Basel, Switzerland
- University of Zurich, Zurich, Switzerland
| | - James Okuma
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert Ndege
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Tracy Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Herry Mapesi
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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4
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Magnolini R, Senkoro E, Kalinjuma AV, Kitau O, Kivuma B, Samson L, Eichenberger A, Mollel GJ, Krinke E, Okuma J, Ndege R, Glass T, Mapesi H, Vanobberghen F, Battegay M, Weisser M. Stigma-directed services (Stig2Health) to improve 'linkage to care' for people living with HIV in rural Tanzania: study protocol for a nested pre-post implementation study within the Kilombero and Ulanga Antiretroviral Cohort. AAS Open Res 2022; 5:14. [PMID: 36420449 PMCID: PMC9648364 DOI: 10.12688/aasopenres.13353.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/20/2022] Open
Abstract
Background: HIV-related stigma is a major barrier to the timely linkage and retention of patients in HIV care in sub-Saharan Africa, where most people living with HIV/AIDS reside. In this implementation study we aim to evaluate the effect of stigma-directed services on linkage to care and other health outcomes in newly diagnosed HIV-positive patients. Methods: In a nested project of the Kilombero and Ulanga Antiretroviral Cohort in rural Tanzania, we conduct a prospective observational pre-post study to assess the impact of a bundle of stigma-directed services for newly diagnosed HIV positive patients. Stigma-directed services, delivered by a lay person living with HIV, are i) post-test counseling, ii) post-test video-assisted teaching, iii) group support therapy and group health education, and iv) mobile health. Patients receiving stigma services (enrolled from 1 st February 2020 to 31 st August 2021) are compared to a historical control receiving the standard of care (enrolled from 1 st July 2017 to 1 st February 2019). The primary outcome is 'linkage to care'. Secondary endpoints are retention in care, viral suppression, death and clinical failure at 6-12 months (up to 31 st August 2022). Self-reported stigma and depression are assessed using the Berger Stigma scale and the PHQ-9 questionnaire, respectively. The sample size calculation was based on cohort data from 2018. Assuming a pre-intervention cohort of 511 newly diagnosed adults of whom 346 (68%) were in care and on antiretroviral treatment (ART) at 2 months, a 10% increase in linkage (from 70 to 80%), a two-sided type I error rate of 5%, and 90% power, 321 adults are required for the post-implementation group. Discussion: We expect that integration of stigma-directed services leads to an increase of proportions of patients in care and on ART. The findings will provide guidance on how to integrate stigma-directed services into routine care in rural sub-Saharan Africa.
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Affiliation(s)
- Raphael Magnolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Elizabeth Senkoro
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Aneth Vedastus Kalinjuma
- Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Bernard Kivuma
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Leila Samson
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Anna Eichenberger
- Ifakara Health Institute, Ifakara, Tanzania
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Getrud Joseph Mollel
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Eileen Krinke
- University Psychiatric Clinics Basel, Basel, Switzerland
- University of Zurich, Zurich, Switzerland
| | - James Okuma
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert Ndege
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Tracy Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Herry Mapesi
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Parmley LE, Rosen JG, Nuh O, Venegas M, Sunday A, İ Nergiz A, Thiim A. Nothing about us without us: considerations for ensuring rights-affirming index case testing for young people. J Int AIDS Soc 2020; 23:e25595. [PMID: 32779384 PMCID: PMC7417867 DOI: 10.1002/jia2.25595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Joseph G Rosen
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Oğuzhan Nuh
- Social PolicyGender Identity, and Sexual Orientation Studies AssociationIstanbulTurkey
| | - Manuel Venegas
- defeatHIV Community Advisory BoardFred Hutch Cancer Research CenterSeattleWAUSA
| | - Aaron Sunday
- African Network of Adolescents and Young Persons Development (ANAYD)KadunaKaduna StateNigeria
- Association of Positive Youth Living with HIV in Nigeria (APYIN)AbujaNigeria
| | - Ali İ Nergiz
- Cerrahpasa Medical SchoolIstanbul University‐CerrahpasaIstanbulTurkey
| | - Aron Thiim
- Program RISEJustice Resource InstituteFraminghamMAUSA
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Morhason-Bello IO, Kabakama S, Baisley K, Francis SC, Watson-Jones D. Reported oral and anal sex among adolescents and adults reporting heterosexual sex in sub-Saharan Africa: a systematic review. Reprod Health 2019; 16:48. [PMID: 31060573 PMCID: PMC6501425 DOI: 10.1186/s12978-019-0722-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oral and anal sexual behaviours are increasingly reported among adolescents and adults reporting heterosexual sex in peer-reviewed journals in high income countries, but less is known about these behaviours in low and middle-income countries, especially in sub-Saharan Africa. The aim of this systematic review is to describe the prevalence of, and motivations for, oral and anal sex among adolescents and adults reporting heterosexual sex in sub-Saharan Africa. METHODS A systematic review of published articles that reported oral and or anal sex in sub-Saharan Africa was conducted from seven databases up to and including 30th August 2018. RESULTS Of 13,592 articles, 103 met the inclusion criteria. The prevalence of reporting ever practising oral sex among adolescents, university students and a combined population of adolescents/adults ranged from 1.7-26.6%, 5.0-46.4% and 3.0-47.2% respectively. Similarly, prevalences of reported ever practising anal sex ranged from 6.4-12.4% among adolescents, 0.3-46.5% among university students and 4.3-37.8% amongst combined population of adolescents and adults. Higher prevalences of oral and anal sex were reported among populations at high-risk for sexually transmitted infections and HIV and university students and, in most studies, both behaviours were more commonly reported by males than females. Heterosexual oral and anal sexual acts were associated with some high-risk behaviours such as inconsistent condom use and multiple sexual partners. CONCLUSION Reported oral and anal sex between men and women are prevalent behaviours in sub-Saharan Africa. Health professionals and policy makers should be aware of these behaviours and their potential associated health risks.
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Affiliation(s)
- Imran O. Morhason-Bello
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
- Obstetrics and Gynaecology Department, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Severin Kabakama
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
| | - Kathy Baisley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Suzanna C. Francis
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Deborah Watson-Jones
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
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Doyle AM, Floyd S, Baisley K, Orindi B, Kwaro D, Mthiyane TN, Muuo S, Shahmanesh M, Ziraba A, Birdthistle I. Who are the male sexual partners of adolescent girls and young women? Comparative analysis of population data in three settings prior to DREAMS roll-out. PLoS One 2018; 13:e0198783. [PMID: 30265667 PMCID: PMC6161870 DOI: 10.1371/journal.pone.0198783] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 05/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The DREAMS (Determined Resilient Empowered AIDS-free, Mentored and Safe) Partnership aims to reduce HIV incidence among adolescent girls and young women (AGYW,15-24y) with a core package of evidence-based interventions. Some interventions, including voluntary HIV counselling and testing and circumcision, will be targeted at the male sexual partners of AGYW. A priority of DREAMS is to characterise the male partners for effective targeting. METHODS Using population-based data (2010-2015) in three DREAMS impact evaluation settings in Kenya and South Africa, we describe the demographic characteristics and sexual behaviour of male partners reported by AGYW, and the characteristics of males who report sexual activity with AGYW. RESULTS In all settings, over 90% of recent male partners reported by AGYW were aged <35 years. Median ages of spousal and non-spousal partners were 29 and 23 years respectively in uMkhanyakude (rural South Africa) and 21 and 20 years respectively in Nairobi (urban Kenya). Most males reporting an AGYW partner had never been married (89%) and many were in school (39%). Most male partners reported only 1 AGYW partner in the past year; in Gem (rural Kenya) and Nairobi 25%-29% reported 2+(AGYW or older female) partners. Concurrent partners were reported by 16% of male partners in Gem and 3-4% in uMkhanyakude. Two thirds of male partners in Gem reported testing for HIV in the past 6 months and under half in uMkhanyakude reported testing for HIV in the past year. Almost all (96%) partners in Nairobi were circumcised, compared to 45% in Gem and 43% in uMkhanyakude. CONCLUSIONS With almost all AGYW's sexual partners aged 15-34 years, this is an appropriate target group for DREAMS interventions. Encouraging young men to reduce their number of partners and concurrency, and uptake prevention and treatment services such as HIV testing, circumcision and ART is crucial in the effort to reduce HIV among both AGYW and young men.
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Affiliation(s)
- Aoife M. Doyle
- MRC Tropical Epidemiology Group, Department of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Sian Floyd
- MRC Tropical Epidemiology Group, Department of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kathy Baisley
- MRC Tropical Epidemiology Group, Department of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- African Health Research Institute, KwaZulu- Natal, South Africa
| | - Benedict Orindi
- African Population and Health Research Center, Nairobi, Kenya
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Daniel Kwaro
- Kenya Medical Research Institute, Gem, Siaya county, Kenya
| | | | - Sheru Muuo
- African Population and Health Research Center, Nairobi, Kenya
| | - Maryam Shahmanesh
- African Health Research Institute, KwaZulu- Natal, South Africa
- University College London, London, United Kingdom
| | - Abdhalah Ziraba
- African Population and Health Research Center, Nairobi, Kenya
| | - Isolde Birdthistle
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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