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Chikava T, Eghtessadi R, Chingombe I, Murewanhema G, Cheza A, Dzinamarira T, Herrera H, Musuka GN. Zimbabwean law and its impact on HIV programmes for key populations. Front Public Health 2023; 11:1272775. [PMID: 37920588 PMCID: PMC10619717 DOI: 10.3389/fpubh.2023.1272775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Tendai Chikava
- Independent Consultant, Independent Legal Consultancy Services, Harare, Zimbabwe
| | | | - Innocent Chingombe
- Independent Consultant, Independent Public Health Consultancy, Harare, Zimbabwe
| | - Grant Murewanhema
- College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Alexander Cheza
- Discipline of Public Health, University of KwaZulu Natal, Durban, South Africa
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Helena Herrera
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Godfrey N. Musuka
- Public Health Consultants, International Initiative for Impact Evaluation, Harare, Zimbabwe
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Mapingure MP, Zech JM, Hirsch-Moverman Y, Msukwa M, Howard AA, Makoni T, Gwanzura C, Apollo T, Sandy C, Musuka GN, Rabkin M. Integrating 3HP-based tuberculosis preventive treatment into Zimbabwe's Fast Track HIV treatment model: experiences from a pilot study. J Int AIDS Soc 2023; 26:e26105. [PMID: 37339341 DOI: 10.1002/jia2.26105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/02/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) causes one-third of HIV-related deaths worldwide, making TB preventive treatment (TPT) a critical element of HIV programmes. Approximately 16% of people living with HIV (PLHIV) on antiretrovirals in Zimbabwe are enrolled in the Fast Track (FT) differentiated service delivery model, which includes multi-month dispensing of antiretrovirals and quarterly health facility (HF) visits. We assessed the feasibility and acceptability of utilizing FT to deliver 3HP (3 months of once-weekly rifapentine and isoniazid) for TPT by aligning TPT and HIV visits, providing multi-month dispensing of 3HP, and using phone-based monitoring and adherence support. METHODS We recruited a purposive sample of 50 PLHIV enrolled in FT at a high-volume HF in urban Zimbabwe. At enrolment, participants provided written informed consent, completed a baseline survey, and received counselling, education and a 3-month supply of 3HP. A study nurse mentor called participants at weeks 2, 4 and 8 to monitor and support adherence and side effects. When participants returned for their routine 3-month FT visit, they completed another survey, and study staff conducted a structured medical record review. In-depth interviews were conducted with providers who participated in the pilot. RESULTS Participants were enrolled between April and June 2021 and followed through September 2021. Median age = 32 years (IQR 24,41), 50% female, median time in FT 1.8 years (IQR 0.8,2.7). Forty-eight participants (96%) completed 3HP in 13 weeks; one completed in 16 weeks, and one stopped due to jaundice. Most participants (94%) reported "always" or "almost always" taking 3HP correctly. All reported they were very satisfied with the counselling, education, support and quality of care they received from providers and FT service efficiency. Almost all (98%) said they would recommend it to other PLHIV. Challenges reported included pill burden (12%) and tolerability (24%), but none had difficulty with phone-based counselling or wished for additional HF-based visits. DISCUSSION Using FT to deliver 3HP was feasible and acceptable. Some reported tolerability challenges but 98% completed 3HP, and all appreciated the efficiency of aligning TPT and HIV HF visits, multi-month dispensing and phone-based counselling. CONCLUSIONS Scaling up this approach could expand TPT coverage in Zimbabwe.
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Affiliation(s)
| | | | - Yael Hirsch-Moverman
- ICAP at Columbia University, New York City, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | | | - Andrea A Howard
- ICAP at Columbia University, New York City, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Tatenda Makoni
- Zimbabwe Network for People Living with HIV (ZNNP+), Harare, Zimbabwe
| | | | - Tsitsi Apollo
- Ministry of Health and Child Care (MoHCC), Harare, Zimbabwe
| | - Charles Sandy
- Ministry of Health and Child Care (MoHCC), Harare, Zimbabwe
| | - Godfrey N Musuka
- International Initiative for Impact Evaluation (3ie), New Delhi, India
| | - Miriam Rabkin
- ICAP at Columbia University, New York City, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, USA
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Musuka GN, Dzinamarira T, Cuadros DF, Murewanhema G, Chingombe I, Takavarasha F, Herrera H, Mapingure M. Mothers' HIV status and their children's nutritional status: Insights from secondary analysis of the Zimbabwe Demographic and Health Survey data (2015-2016). Food Sci Nutr 2021; 9:5509-5516. [PMID: 34646520 PMCID: PMC8498060 DOI: 10.1002/fsn3.2509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/29/2021] [Accepted: 07/25/2021] [Indexed: 11/22/2022] Open
Abstract
Infants and young children are completely dependent on others, primarily their mothers, for nutrition. This means maternal health status is one of the most important maternal characteristics that are predictors of the nutritional status of children. This study aimed to describe the association between mothers' HIV status and their children's nutritional status using data from the Zimbabwe Demographic and Health Survey (2015-16). We used statistical analysis to determine the association between mothers' HIV status and their children's nutritional status. The findings revealed that 30%, 4%, and 11% of children whose mothers were HIV positive presented with moderate-to-severe stunting, wasting, and underweight, respectively. The risk of stunting was higher for children whose mothers were HIV positive compared with children whose mothers were HIV negative (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.00-1.52)). Maternal HIV-positive status is associated with an increased risk of the child being underweight (OR 1.69; 95% CI 1.24-2.30). The prevalence of being underweight, stunting, and wasting is still high among children of HIV-positive mothers several years into HIV Care and Treatment programs. This study's findings call for implementation of a robust national wide improved infant and young child feeding scheme to enhance the overall nutritional status of children in the country.
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Affiliation(s)
| | | | - Diego F Cuadros
- Department of Geography and Geographic Information ScienceUniversity of CincinnatiCincinnatiOHUSA
| | - Grant Murewanhema
- Unit of Obstetrics and GynaecologyFaculty of Medicine and Health SciencesUniversity of ZimbabweHarareZimbabwe
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Correa-Agudelo E, Kim HY, Musuka GN, Mukandavire Z, Akullian A, Cuadros DF. Associated health and social determinants of mobile populations across HIV epidemic gradients in Southern Africa. J Migr Health 2021; 3:100038. [PMID: 34405186 PMCID: PMC8352162 DOI: 10.1016/j.jmh.2021.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 11/05/2022] Open
Abstract
Background Growing travel connectivity and economic development have dramatically increased the magnitude of human mobility in Africa. In public health, vulnerable population groups such as mobile individuals are at an elevated risk of sexually transmitted diseases, including HIV. Methods The population-based Demographic Health Survey data of five Southern African countries with different HIV epidemic intensities (Angola, Malawi, South Africa, Zambia, and Zimbabwe) were used to investigate the association between HIV serostatus and population mobility adjusting for socio-demographic, sexual behavior and spatial covariates. Results Mobility was associated with HIV seropositive status only in Zimbabwe (adjusted odds ratio [AOR] = 1.37 [95% confidence interval [CI]: 1.01–1.67]). These associations were not significant in Angola, Malawi, South Africa, and Zambia. Females had higher odds of mobility than males in Zimbabwe (AOR = 1.37, CI: 1.10–1.69). The odds of mobility decreased with age in all five countries. Conclusions Our findings highlight the heterogeneity of the social and health determinants of mobile populations in several countries with different HIV epidemic intensities. Effective interventions using precise geographic focus combined with detailed attribute characterization of mobile populations can enhance their impact especially in areas with high density of mobile individuals and high HIV prevalence.
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Affiliation(s)
- Esteban Correa-Agudelo
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH, 45221, USA.,Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA
| | - Hae-Young Kim
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP) KwaZulu-Natal, South Africa.,Department of Population Health, New York University Grossman School of Medicine, USA
| | | | - Zindoga Mukandavire
- Centre for Data Science, Coventry University, UK.,School of Computing, Electronics and Mathematics, Coventry University, UK
| | - Adam Akullian
- Institute for Disease Modeling, Global Good Fund, Bellevue, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Diego F Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH, 45221, USA.,Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA
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Chingombe I, Mapingure MP, Balachandra S, Chipango TN, Gambanga F, Mushavi A, Apollo T, Suraratdecha C, Rogers JH, Ruangtragool L, Gonese E, Musuka GN, Mugurungi OM, Harris TG. Patient costs for prevention of mother-to-child HIV transmission and antiretroviral therapy services in public health facilities in Zimbabwe. PLoS One 2021; 16:e0256291. [PMID: 34407129 PMCID: PMC8372940 DOI: 10.1371/journal.pone.0256291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022] Open
Abstract
Zimbabwe has made large strides in addressing HIV. To ensure a continued robust response, a clear understanding of costs associated with its HIV program is critical. We conducted a cross-sectional evaluation in 2017 to estimate the annual average patient cost for accessing Prevention of Mother-To-Child Transmission (PMTCT) services (through antenatal care) and Antiretroviral Treatment (ART) services in Zimbabwe. Twenty sites representing different types of public health facilities in Zimbabwe were included. Data on patient costs were collected through in-person interviews with 414 ART and 424 PMTCT adult patients and through telephone interviews with 38 ART and 47 PMTCT adult patients who had missed their last appointment. The mean and median annual patient costs were examined overall and by service type for all participants and for those who paid any cost. Potential patient costs related to time lost were calculated by multiplying the total time to access services (travel time, waiting time, and clinic visit duration) by potential earnings (US$75 per month assuming 8 hours per day and 5 days per week). Mean annual patient costs for accessing services for the participants was US$20.00 [standard deviation (SD) = US$80.42, median = US$6.00, range = US$0.00-US$12,18.00] for PMTCT and US$18.73 (SD = US$58.54, median = US$8.00, range = US$0.00-US$ 908.00) for ART patients. The mean annual direct medical costs for PMTCT and ART were US$9.78 (SD = US$78.58, median = US$0.00, range = US$0.00-US$ 90) and US$7.49 (SD = US$60.00, median = US$0.00) while mean annual direct non-medical cost for US$10.23 (SD = US$17.35, median = US$4.00) and US$11.23 (SD = US$25.22, median = US$6.00, range = US$0.00-US$ 360.00). The PMTCT and ART costs per visit based on time lost were US$3.53 (US$1.13 to US$8.69) and US$3.43 (US$1.14 to US$8.53), respectively. The mean annual patient costs per person for PMTCT and ART in this evaluation will impact household income since PMTCT and ART services in Zimbabwe are supposed to be free.
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Affiliation(s)
- Innocent Chingombe
- ICAP at Columbia University, New York, NY, United States of America
- * E-mail:
| | | | | | | | - Fiona Gambanga
- ICAP at Columbia University, New York, NY, United States of America
| | | | | | - Chutima Suraratdecha
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia United States of America
| | - John H. Rogers
- U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Leala Ruangtragool
- PHI/CDC Global HIV Surveillance Fellow, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Elizabeth Gonese
- U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
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Kim H, Musuka GN, Mukandavire Z, Branscum A, Cuadros DF. When distance matters: Mapping HIV health care underserved communities in sub-Saharan Africa. PLOS Glob Public Health 2021; 1:e0000013. [PMID: 36962273 PMCID: PMC10021734 DOI: 10.1371/journal.pgph.0000013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
Despite efforts to increase the proportion of individuals diagnosed with HIV who receive anti-retroviral therapy, 28% of people living with HIV (PLHIV) aged 15 years and older in eastern and southern Africa and 42% in western and central Africa were not receiving anti-retroviral therapy in 2019. Therefore, improving access to health care services is key to reduce HIV incidence and prevalence. The main aim of this study was to generate high-resolution maps of underserved areas where people cannot access the closest health care facilities within appropriate travel time in sub-Saharan Africa (SSA). Main sources of data for this study were the estimated number of PLHIV for adults aged 15-49 years in 47 countries in SSA and the global map of travel time to the nearest health care facility by motorized and non-motorized transportation. These data were used to estimate and map the number of PLHIV in underserved areas at a travel distance of 10, 30, and 60 minutes from the nearest healthcare facility. We identified and mapped more than 7 million PLHIV in the areas with a lack of access to health care within 10-minute travel time and 1.5 million PLHIV in the areas with a lack of access to health care within 60-minute travel time. The identified locations of underserved areas are an indicator of the challenge faced by PLHIV in accessing health services in SSA, a situation that is likely worsened by the COVID-19 pandemic. These findings can contribute to developing cost-effective geospatial policies for interventions aimed at underserved areas at a finer resolution for communities that have usually been identified in aggregated spatial areas. Further development and implementation of tailored intervention and treatment programs, especially in areas identified as underserved for PLHIV, should be explored. Geospatial analyses could complement the decision-making process with stakeholders to enhance healthcare access for PLHIV in SSA.
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Affiliation(s)
- Hana Kim
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, Ohio, United States of America
- Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, Ohio, United States of America
| | | | - Zindoga Mukandavire
- Centre for Data Science and Artificial Intelligence, Emirates Aviation University, Dubai, UAE
| | - Adam Branscum
- Department of Biostatistics, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, United States of America
| | - Diego F Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, Ohio, United States of America
- Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, Ohio, United States of America
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Musuka GN, Meiswinkel R, Baylis M, Kelly PJ, Mellor PS. Prevalence of Culicoides imicola and other species (Diptera: Ceratopogonidae) at eight sites in Zimbabwe. J S Afr Vet Assoc 2001; 72:62-3. [PMID: 11513259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
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Abstract
Briefly reports on the distribution of heartwater disease in the sandveld regions of Botswana west of Mahalapye and Shoshong villages.
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