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Mapingure M, Chingombe I, Dzinamarira T, Moyo B, Samba C, Murigo D, Mugurungi O, Mbunge E, Makota RB, Murewanhema G, Musuka G. Correction: Presence of tuberculosis symptoms among HIV-positive men who have sex with men (MSM) in Zimbabwe. AIDS Res Ther 2024; 21:26. [PMID: 38685106 PMCID: PMC11059734 DOI: 10.1186/s12981-024-00617-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
| | | | | | - Brian Moyo
- AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | - Owen Mugurungi
- AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Elliot Mbunge
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Kwaluseni, Eswatini
| | - Rutendo Birri Makota
- Department of Biological Sciences and Ecology, University of Zimbabwe, Harare, Zimbabwe
| | - Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Godfrey Musuka
- International Initiative for Impact Evaluation, Harare, Zimbabwe.
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Parmley LE, Miller SS, Chingombe I, Mapingure M, Mugurungi O, Rogers JH, Musuka G, Samba C, Hakim AJ, Harris TG. Social and structural drivers of HIV vulnerability among a respondent-driven sample of feminine and non-feminine presenting transgender women who have sex with men in Zimbabwe. J Int AIDS Soc 2024; 27:e26231. [PMID: 38627887 PMCID: PMC11021625 DOI: 10.1002/jia2.26231] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/23/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION We sought to characterize social and structural drivers of HIV vulnerability for transgender women (TGW) in Zimbabwe, where TGW are not legally recognized, and explore differences in vulnerability by feminine presentation. METHODS A secondary analysis was conducted with a sub-sample of participants recruited from a 2019 respondent-driven sampling survey that comprised men who have sex with men, TGW and genderqueer individuals assigned male sex at birth, from two cities in Zimbabwe. Survey questionnaires captured information related to socio-demographics, sexual and substance use behaviours, and social and structural barriers to HIV services. Secondary analyses were restricted to participants who identified as female, transfemale or transwomen (236/1538) and were unweighted. Descriptive statistics were used to calculate sample estimates and chi-square and Fisher's exact tests were used to assess differences in vulnerability by feminine presentation. RESULTS Among 236 TGW, almost half (45.3%) presented as feminine in the 6 months preceding the survey and 8.5% had ever used hormones to affirm their gender identities. Median age among TGW was 23 years (interquartile range: 20-26). Feminine presenting TGW in our sample had higher prevalence of arrest (15.9% vs. 3.9%), rejection by family/friends (38.3% vs. 14.0%), employment termination (11.2% vs. 3.9%), employment refusal (14.0% vs. 3.9%), denial of healthcare (16.8% vs. 2.3%), physical, sexual or verbal harassment or abuse (59.8% vs. 34.1%), alcohol dependence (32.7% vs. 12.4%), recent transactional sex with a male or TGW partner (30.8% vs. 13.3%) and recent non-injection drug use (38.3% vs. 20.2%) than non-feminine presenting TGW (all p-value <0.05). CONCLUSIONS Findings suggest that TGW, particularly feminine presenting TGW, experience social and structural inequities which may contribute to HIV vulnerability. Interventions aimed at addressing inequities, including trans competency training for providers and gender-affirming, psychosocial and legal support services for TGW, might mitigate risk.
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Affiliation(s)
| | | | | | | | - Owen Mugurungi
- Zimbabwe Ministry of Health and Child CareHarareZimbabwe
| | - John H. Rogers
- Division of Global HIV & TBU.S. Centers for Disease ControlHarareZimbabwe
| | | | | | - Avi J. Hakim
- Division of Global HIV & TBU.S. Centers for Disease ControlAtlantaGeorgiaUSA
| | - Tiffany G. Harris
- ICAP at Columbia UniversityNew YorkNew YorkUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
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Mapingure M, Chingombe I, Dzinamarira T, Moyo B, Samba C, Murigo D, Mugurungi O, Mbunge E, Makota RB, Murewanhema G, Musuka G. Presence of tuberculosis symptoms among HIV-positive men who have sex with men (MSM) in Zimbabwe. AIDS Res Ther 2024; 21:18. [PMID: 38549087 PMCID: PMC10979552 DOI: 10.1186/s12981-024-00605-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/14/2024] [Indexed: 04/01/2024] Open
Abstract
We conducted secondary data analysis using a biobehavioral survey dataset of 1538 MSM from Zimbabwe. Survey participants were screened for the four symptoms suggestive of tuberculosis infection using the WHO TB screening algorithm. Results: All participants experienced at least one symptom suggestive of tuberculosis. 40% of HIV-positive MSM reported having had a cough in the last month and 13% of them experienced unexpected weight loss. The prevalence of experiencing any of the four TB symptoms amongst HIV-positive MSM was 23%. Contribution There is an urgent need for active TB case finding and treatment amongst HIV-positive MSM in Zimbabwe. Clinicians will need to ensure that MSM who need TB testing receive it timeously.
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Affiliation(s)
| | | | | | - Brian Moyo
- AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | - Owen Mugurungi
- AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Elliot Mbunge
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Kwaluseni, Eswatini
| | - Rutendo Birri Makota
- Department of Biological Sciences and Ecology, University of Zimbabwe, Harare, Zimbabwe
| | - Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Godfrey Musuka
- International Initiative for Impact Evaluation, Harare, Zimbabwe.
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Breen RW, Parmley LE, Mapingure MP, Chingombe I, Mugurungi O, Musuka G, Hakim AJ, Rogers JH, Moyo B, Samba C, Miller SS, Lamb MR, Harris TG. Hepatitis B virus infection (HBV) and HIV-HBV coinfection among men who have sex with men, transgender women, and genderqueer individuals in Harare and Bulawayo Zimbabwe, 2019. Heliyon 2024; 10:e25790. [PMID: 38352793 PMCID: PMC10862682 DOI: 10.1016/j.heliyon.2024.e25790] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/21/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
Objectives To measure HIV and Hepatitis B virus (HBV) prevalence and associated risk behaviors among men who have sex with men (MSM) and transgender women/genderqueer individuals (TGW/GQ) in Zimbabwe. Methods We conducted a biobehavioral survey using respondent-driven sampling (RDS) among adult MSM and TGW/GQ in Harare and Bulawayo, Zimbabwe in 2019. Participants completed a questionnaire and underwent testing for HIV and HBV. Results Overall, 1,510 (Harare: 694, Bulawayo 816) participants were enrolled and consented to testing; 3.8 % (58) tested positive for HBV, 22.5 % (339) tested positive for HIV, and 2.2 % (33) tested positive for both HIV and HBV. HBV prevalence was higher among participants with HIV compared to HIV-negative participants (9.7 % vs. 2.1 %, p < 0.0001). Overall, HBV prevalence was not statistically different between MSM and TGW/GQ (3.7 % vs 4.5 %, p = 0.49) nor between Harare and Bulawayo (3.3 % vs 4.3 %, p = 0.33). Conclusions Our survey demonstrates the prevalence of HBV among MSM and TGW/GQ is lower than other estimates of HBV among MSM in Africa but remains high among our survey population living with HIV highlighting the need to expand HBV testing and treatment services, especially among people with HIV in Zimbabwe.
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Affiliation(s)
- Robin W.B. Breen
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | | | - Owen Mugurungi
- Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Avi J. Hakim
- Division of Global HIV & TB, Global Health Center, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John H. Rogers
- Division of Global HIV & TB, Global Health Center, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Brian Moyo
- Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | - Matthew R. Lamb
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- ICAP at Columbia University, New York, NY, USA
| | - Tiffany G. Harris
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- ICAP at Columbia University, New York, NY, USA
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Davis M, Musuka G, Mapingure MP, Hakim A, Parmley LE, Mugurungi O, Chingombe I, Miller SS, Rogers JH, Lamb MR, Samba C, Harris TG. Factors Associated with Having both Male and Female Recent Sexual Partnerships Among Men Who Have Sex with Men in Harare and Bulawayo, Zimbabwe. AIDS Behav 2024; 28:728-740. [PMID: 38236320 PMCID: PMC10876709 DOI: 10.1007/s10461-023-04262-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/19/2024]
Abstract
To better understand male and female sexual partnerships among men who have sex with men (MSM), we used data from a 2019 biobehavioral survey among MSM in Harare and Bulawayo, Zimbabwe to conduct bivariate analyses and multivariable logistic regression to determine whether sociodemographic characteristics and HIV-related factors were associated with having both male and female sexual partnerships within the last 6 months. Of included MSM (N = 1143), 31% reported both male and female partnerships in the last 6 months. Being married/cohabiting (adjusted odds ratio (aOR) = 8.58, 95% confidence interval (CI) = 4.92-14.95) or separated/divorced/widowed (aOR = 1.96, 95% CI = 1.24-3.08) vs. being single, and hazardous alcohol consumption (aOR = 1.58, 95% CI 1.19-2.09) were associated with higher odds of having both male and female recent partnerships. Being aged 35 + vs. 18-24 (aOR = 0.50, 95% CI = 0.31-0.81), condomless receptive anal intercourse at last sex with the main male partner (aOR = 0.43, 95% CI = 0.26-0.74), and positive HIV status (aOR = 0.46, 95% CI = 0.31-0.67) were associated with lower odds of recent male and female partnerships. MSM in Harare who reported harassment/abuse (aOR = 3.16, 95% CI = 1.72-5.79) had higher odds of both male and female partnerships than MSM in Bulawayo reporting harassment/abuse. The prevalence of both male and female recent partnerships (31%) was lower among MSM in this survey than in other biobehavioral surveys of MSM in sub-Saharan Africa. Findings suggest that MSM with recent male and female partnerships compared to MSM with only male recent partners have lower odds of positive HIV status and participate in behaviors that lower HIV risk; however, the direction of these relationships cannot be determined due to the cross-sectional nature of the data. The findings also suggest a possible connection between experiences of stigma of MSM behavior and not having both male and female partnerships that warrants further exploration. Accessible, stigma-free HIV testing and education programming that considers the potential overlap between the MSM and general populations via both male and female partnerships and the associated behaviors could be a key component of HIV elimination in Zimbabwe.
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Affiliation(s)
- Morgan Davis
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | | | | | - Avi Hakim
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Owen Mugurungi
- AIDS and TB Programme, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | - John H Rogers
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Matthew R Lamb
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- ICAP at Columbia University, New York, NY, USA
| | | | - Tiffany G Harris
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- ICAP at Columbia University, New York, NY, USA
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Makoni T, Madzima B, Dzinamarira T, Moyo E, Mpofu A, Chingombe I, Mapingure M, Musuka G. Putting communities at the forefront of community-led monitoring in Zimbabwe. Front Public Health 2024; 11:1320944. [PMID: 38259750 PMCID: PMC10801175 DOI: 10.3389/fpubh.2023.1320944] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Affiliation(s)
- Tatenda Makoni
- Zimbabwe National Network of People Living with HIV, Harare, Zimbabwe
| | | | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Enos Moyo
- School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa
| | | | | | | | - Godfrey Musuka
- International Initiative for Impact Evaluation, Harare, Zimbabwe
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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 M, Chingombe I, Dzinamarira T, Samba C, Moyo B, Mugurungi O, Musuka G. Diminished health and social outcomes among men who have sex with men who use drugs in Zimbabwe. South Afr J HIV Med 2023; 24:1513. [PMID: 37795428 PMCID: PMC10546898 DOI: 10.4102/sajhivmed.v24i1.1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/08/2023] [Indexed: 10/06/2023] Open
Abstract
No abstract available.
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Affiliation(s)
- Munyaradzi Mapingure
- Department of Strategic Information, ICAP at Columbia University, Harare, Zimbabwe
| | - Innocent Chingombe
- Department of Strategic Information, ICAP at Columbia University, Harare, Zimbabwe
| | - Tafadzwa Dzinamarira
- Department of Strategic Information, ICAP at Columbia University, Harare, Zimbabwe
| | | | - Brian Moyo
- AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Godfrey Musuka
- International Initiative for Impact Evaluation, Harare, Zimbabwe
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Mapingure M, Dzinamarira T, Mukandavire Z, Chingombe I, Cuadros DF, Eghtessadi R, Mutenherwa F, Herrera H, Madziva R, Mukwenha S, Murewanhema G, Musuka G. Understanding the role of intimate partner violence on HIV transmission in Zimbabwe: Secondary data analysis of data from the Zimbabwe demographic survey 2015-2016. Health Promot Perspect 2023; 13:113-119. [PMID: 37600546 PMCID: PMC10439455 DOI: 10.34172/hpp.2023.14] [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: 08/22/2022] [Accepted: 01/18/2023] [Indexed: 08/22/2023] Open
Abstract
Background Gender-based violence (GBV) has been shown to have significant and long-lasting impacts on women's physical and mental health. It is, therefore, important to study its occurrence in a population and its intersect with infectious diseases such as HIV to inform the wider health promotion agenda. This study aimed to determine the association between GBV and HIV status in women and adolescent girls in Zimbabwe. Methods A secondary data analysis of data from a cross-sectional Zimbabwe Demographic and Health Survey (ZDHS) was conducted. Statistical analysis was employed to establish the association between GBV and HIV status. Geospatial mapping was conducted using a kernel smoothing method was employed to generate a continuous kernel density surface to illustrate the local spatial variations of female HIV and GBV prevalence. Results Women and adolescent girls suffering emotional GBV, such as those subjected to humiliation by their husbands or partners, were 1.45 (1.14-1.84) [OR (95% CIs)] times more likely to be HIV positive than those who were never humiliated. The same was true for women and adolescent girls whose husbands or partners threatened to harm them or someone they love, 1.33 (1.04-1.68). There is a relationship between women's HIV status and intimate partner aggression, such as when their partners pushed, shook, or threw something at them or physically abused them. This was also the case for those who reported that partners kicked, dragged, or beat them, tried to choke or burn them on purpose, or threatened or attacked them with a knife, gun, or other weapons. Women who experienced forced sexual violence with threats were more likely 1.61 (1.08-2.41), to be HIV positive than those women who did not experience the same. Conclusion GBV is widely spread in Zimbabwe. There is a need for the government to implement creative strategies to reach out to survivors, especially those that are forced to have unprotected sex and are at increased risk of HIV acquisition. This manuscript raises issues that can be addressed by robust health promotion strategies to reduce the impact of the syndemic of GBV and HIV acquisition in Zimbabwe.
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Affiliation(s)
| | - Tafadzwa Dzinamarira
- ICAP at Columbia University, Harare, Zimbabwe
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Zindoga Mukandavire
- Emirates Aviation University, Centre for Data Science and Artificial Intelligence, Dubai, UAE
| | | | - Diego F. Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, USA
| | | | | | | | - Roda Madziva
- School of Sociology and Social Policy, University of Nottingham, Nottingham, United Kingdom
| | | | - Grant Murewanhema
- Unit of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Dzinamarira T, Mapingure M, Murewanhema G, Musuka G, Moyo B, Samba C, Sibindi M, Chikava T, Mugurungi O, Chingombe I. Conducting research among key populations in settings with discriminatory laws, policies, and practice: The case of men who have sex with men in Zimbabwe. Public Health in Practice 2022; 4:100337. [DOI: 10.1016/j.puhip.2022.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
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Parmley LE, Harris TG, Hakim AJ, Musuka G, Chingombe I, Mugurungi O, Moyo B, Mapingure M, Gozhora P, Samba C, Rogers JH. Recent HIV Infection Among Men Who Have Sex with Men, Transgender Women, and Genderqueer Individuals with Newly Diagnosed HIV Infection in Zimbabwe: Results from a Respondent-Driven Sampling Survey. AIDS Res Hum Retroviruses 2022; 38:834-839. [PMID: 35923140 PMCID: PMC9700339 DOI: 10.1089/aid.2021.0216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
In Africa, rapid testing for recent HIV infection (RTRI) is being scaled up; however, use of the recent infection testing algorithm (RITA), which uses viral load (VL) to confirm RTRI-recent infections, is not a widespread practice. We present results of recently acquired HIV infections among men who have sex with men (MSM), transgender women, and genderqueer (TGW/GQ) individuals with newly diagnosed HIV infection in Zimbabwe as per the national approach (RTRI) and applying a RITA. In 2019, 1,538 MSM and TGW/GQ in Harare and Bulawayo, Zimbabwe were recruited to participate in a biobehavioral survey using respondent-driven sampling. Consenting participants received HIV testing and all HIV-positive specimens were tested with the RTRI Asanté HIV-1 Rapid Recency Assay, and for VL and CD4 count. RTRI-recent participants with unsuppressed VL (≥1,000 copies/mL) were classified as RITA-recent. Descriptive statistics were used to summarize results among RTRI-recent and RITA-recent participants. Among those tested for HIV (1,511/1,538), 22.5% (340/1,511) tested positive and of those, 55.0% (187/340) self-reported an HIV-negative or unknown status. Among these, 8.6% (16/187) were classified as RTRI-recent and 91.4% (171/187) were classified as RTRI-long term. After accounting for VL, RITA-recency was 1.1% (2/187). Two of 16 (12.5%) RTRI-recent infections were RITA-recent. VL among RITA-recent cases were 9,052 copies/mL and 40,694 copies/mL and both had CD4 counts <500. Data highlight misclassification of recent infections among MSM and TGW/GQ with newly diagnosed HIV infection using RTRI. With the incorporation of VL, >85% of RTRI-recent cases were reclassified as RITA-long term. True characterization of recent infections may not be possible without VL testing, which remains challenging in resource-limited settings.
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Affiliation(s)
- Lauren Elizabeth Parmley
- ICAP at Columbia University, New York, New York, USA.,Address correspondence to: Lauren Elizabeth Parmley, ICAP at Columbia University, 60 Haven Avenue B110W, New York, NY 10027, USA
| | - Tiffany G. Harris
- ICAP at Columbia University, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Avi J. Hakim
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Brian Moyo
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | | | - John H. Rogers
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
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Murewanhema G, Musuka G, Mukwenha S, Chingombe I, Mapingure MP, Dzinamarira T. Hesitancy, ignorance or uncertainty? The need for effective communication strategies as Zimbabwe’s uptake of COVID-19 vaccine booster doses remains poor. Public Health in Practice 2022; 3:100244. [PMID: 35342889 PMCID: PMC8928722 DOI: 10.1016/j.puhip.2022.100244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/13/2022] [Indexed: 11/08/2022] Open
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Madziva R, Murewanhema G, Musuka G, Mapingure MP, Chingombe I, Herrera H, Chiyaka ET, Dzinamarira T. Fighting COVID-19 pandemic fatigue and complacency in Zimbabwe. Public Health in Practice 2022; 3:100236. [PMID: 35169760 PMCID: PMC8830151 DOI: 10.1016/j.puhip.2022.100236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 11/24/2022] Open
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Dzinamarira T, Nkambule SJ, Hlongwa M, Mhango M, Iradukunda PG, Chitungo I, Dzobo M, Mapingure MP, Chingombe I, Mashora M, Madziva R, Herrera H, Makanda P, Atwine J, Mbunge E, Musuka G, Murewanhema G, Ngara B. Risk factors for COVID-19 infection among healthcare workers. A first report from a living systematic review and meta-analysis. Saf Health Work 2022; 13:263-268. [PMID: 35433073 PMCID: PMC9004144 DOI: 10.1016/j.shaw.2022.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 12/23/2022] Open
Abstract
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 1.01–1.21) 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. PROSPERO registration number CRD42020193508 available for public comments via the link below https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193508).
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Affiliation(s)
- Tafadzwa Dzinamarira
- School of Health Systems & Public Health, University of Pretoria, Pretoria, 0002, South Africa
- ICAP at Columbia University, Harare, Zimbabwe
- Corresponding author. School of Health Systems & Public Health, University of Pretoria, Pretoria, 0002, South Africa..
| | - Sphamandla Josias Nkambule
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Mbuzeleni Hlongwa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Malizgani Mhango
- School of Public Health, University of Western Cape, 7535, Cape Town, South Africa
| | | | - Itai Chitungo
- College of Medicine and Health Sciences, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Mathias Dzobo
- School of Health Systems & Public Health, University of Pretoria, Pretoria, 0002, South Africa
| | | | | | | | - Roda Madziva
- School of Sociology and Social Policy, University of Nottingham, United Kingdom
| | - Helena Herrera
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, United Kingdom
| | - Pelagia Makanda
- Department of Medicine, Jinzhou Medical University, Jinzhou 121001, China
| | - James Atwine
- Department of Medicine, Jinzhou Medical University, Jinzhou 121001, China
| | - Elliot Mbunge
- Department of Information Technology, Faculty of Accounting and Informatics, Durban University of Technology, P O Box 1334, Durban 4000, South Africa
| | | | - Grant Murewanhema
- College of Medicine and Health Sciences, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Bernard Ngara
- College of Medicine and Health Sciences, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe
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Miller SS, Mantell JE, Parmley LE, Musuka G, Chingombe I, Mapingure M, Rogers JH, Wu Y, Hakim AJ, Mugurungi O, Samba C, Harris TG. Stigma, Social Cohesion, and HIV Risk Among Sexual and Gender Minorities in Two Cities in Zimbabwe. AIDS Behav 2022; 26:2994-3007. [PMID: 35304904 PMCID: PMC9372004 DOI: 10.1007/s10461-022-03622-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/24/2022]
Abstract
Though stigma is a recognized contributor to the disproportionate HIV burden among sexual and gender minorities (SGM) in sub-Saharan Africa, data describing this association among Zimbabwean SGM are limited. We examined relationships between SGM stigma and HIV and the potential for social cohesion to moderate the association among Zimbabwean men who have sex with men, transgender women, and genderqueer individuals. Consenting participants (n = 1511) recruited through respondent-driven sampling for a biobehavioral survey in Harare and Bulawayo completed structured interviews and received HIV testing. Reported SGM stigma was common (68.9% in Harare and 65.3% in Bulawayo) and associated with HIV infection in Harare (adjusted prevalence ratio [aPR] = 1.82, 95% confidence interval [CI] = 1.27–2.62) and Bulawayo (aPR = 1.51, 95% CI = 1.15–2.00) in relative risk regression. Social cohesion did not moderate these relationships. Findings demonstrate stigma’s association with HIV vulnerability among Zimbabwean SGM, highlighting the need for stigma-mitigation to reduce HIV transmission in this population.
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Affiliation(s)
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | | | - John H Rogers
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Yingfeng Wu
- ICAP at Columbia University, New York, NY, USA
| | - Avi J Hakim
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Owen Mugurungi
- AIDS and TB Programme, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Tiffany G Harris
- ICAP at Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Harris TG, Wu Y, Parmley LE, Musuka G, Mapingure MP, Chingombe I, Mugurungi O, Hakim A, Gozhora P, Miller SS, Lamb MR, Samba C, Rogers JH. HIV care cascade and associated factors among men who have sex with men, transgender women, and genderqueer individuals in Zimbabwe: findings from a biobehavioural survey using respondent-driven sampling. Lancet HIV 2022; 9:e182-e201. [PMID: 35150606 PMCID: PMC10654134 DOI: 10.1016/s2352-3018(21)00297-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/28/2021] [Accepted: 11/10/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Globally, men who have sex with men (MSM), transgender women, and genderqueer individuals are at greater risk for HIV than the general population although little data are available from these groups in Zimbabwe, a country with a national adult HIV prevalence of 12·9%. We aimed to examine progress towards the UNAIDS 90-90-90 treatment targets and factors associated with meeting the targets among a sample of MSM, transgender women, and genderqueer individuals in Zimbabwe. METHODS In this cross-sectional survey in 2019, we used respondent-driven sampling to identify MSM, transgender women, and genderqueer individuals aged at least 18 years to participate in a biobehavioural survey in Harare and Bulawayo, Zimbabwe. Participants were eligible to participate if they were assigned male at birth; had engaged in anal or oral sex with a man in the past 12 months; resided in Harare or Bulawayo for at least 1 month; spoke English, Shona, or Ndebele; provided written informed consent; and were in possession of a valid recruitment coupon if applicable. Enrolled participants completed a questionnaire and underwent HIV testing, and off-site viral load testing was done on all HIV-positive samples. Unweighted bivariate analyses and multivariable logistic regression models were used to evaluate the association of sociodemographic, behavioural, and other factors with HIV-positive status awareness among MSM, transgender women, and genderqueer individuals, and with viral load suppression among MSM. Analyses were done firstly using self-reported information and then by classifying those with a viral load of less than 200 copies per mL as being aware of their status and on treatment (viral load recategorisation). FINDINGS Among MSM, 248 (21%; 95% CI 19-24) of 1176 tested positive for HIV. Of those who tested positive, based on self-report, 119 (48%; 95% CI 42-54) reported knowing their HIV status, of whom 112 (94%; 88-98) reported using antiretroviral therapy (ART), of whom 89 (79%; 71-87) had viral load suppression. Based on viral load recategorisation, 180 (73%; 67-78) of 248 MSM testing HIV positive reported knowing their HIV status, of whom 174 (97%; 93-99) reported using ART, of whom 151 (87%; 81-91) had viral load suppression. 92 (28%; 23-33) of 335 transgender women and genderqueer individuals tested positive for HIV. Based on self-reports from these individuals 34 (37%; 27-48) of 92 participants reported knowing their HIV status, of whom 31 (91%; 76-98) reported using ART, of whom 27 (87%; 70-96%) had viral load suppression. Based on viral load recategorisation of data from transgender women and genderqueer participants, 53 (58%; 47-58) of 92 reported awareness of their HIV status, of whom 50 (94%; 84-99) reported using ART, of whom 46 (92%; 81-98) had viral load suppression. HIV-positive MSM aged 18-24 years had lower odds of being aware of their status than those aged at least 35 years (adjusted odds ratio [aOR] 0·34; 95% CI 0·13-0·92), as did HIV-positive MSM aged 25-34 years (aOR 0·26; 0·12-0·56). HIV-positive MSM aged 18-24 years also had a lower odds of having viral load suppression than those aged 35 years and older (aOR 0·35; 0·16-0·78), as did those aged 25-34 years (aOR 0·36; 0·19-0·67). No factors were significantly associated with awareness among transgender women and genderqueer individuals in multivariable models. INTERPRETATION Our survey showed that HIV prevalence was high and the largest difference between our results and the 90-90-90 treatment targets was in HIV status awareness, indicating the need for improvements in engaging MSM (especially young MSM), transgender women, and genderqueer individuals in HIV testing services. FUNDING US President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention.
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Affiliation(s)
- Tiffany G Harris
- ICAP at Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Yingfeng Wu
- ICAP at Columbia University, New York, NY, USA
| | | | | | | | | | - Owen Mugurungi
- AIDS and TB Programme, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - Avi Hakim
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Matthew R Lamb
- ICAP at Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - John H Rogers
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Harare, Zimbabwe
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Parmley LE, Harris TG, Chingombe I, Mapingure M, Mugurungi O, Rogers JH, Gozhora P, Wu Y, Samba C, Musuka G, Hakim AJ. Engagement in the pre-exposure prophylaxis (PrEP) cascade among a respondent-driven sample of sexually active men who have sex with men and transgender women during early PrEP implementation in Zimbabwe. J Int AIDS Soc 2022; 25:e25873. [PMID: 35148029 PMCID: PMC8834645 DOI: 10.1002/jia2.25873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/22/2021] [Accepted: 12/16/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Zimbabwe is scaling up pre-exposure prophylaxis (PrEP) for key populations, including men who have sex with men (MSM) and transgender women (TGW). To assess implementation and inform HIV programming, we evaluated gaps in PrEP awareness, uptake and use, and correlates of awareness and uptake among a sample of MSM, TGW and genderqueer individuals (GQ) in Harare and Bulawayo, Zimbabwe. METHODS Respondent-driven sampling was used to recruit 1194 MSM and 344 TGW/GQ aged ≥18 to participate in a cross-sectional survey assessing HIV-related outcomes in 2019. Consenting participants completed a questionnaire on socio-demographic information, sexual risk practices and engagement in HIV services and underwent HIV testing. Descriptive statistics were used to assess the PrEP cascade. Multiple logistic regression models were used to identify factors associated with PrEP awareness and uptake among HIV-negative participants. Data were unweighted as the sample did not reach convergence on key estimates. RESULTS Among the 1167 HIV-negative participants, most (79.2%) were MSM compared to TGW/GQ (20.8%). Median age was 24 years. Overall, 45.8% were aware of PrEP and of those, 31.3% had ever taken PrEP. Most (71.1%) reporting never taking PrEP were willing to start PrEP; the main reasons for never starting PrEP included not knowing where to access it (24.8%) and fearing side effects (20.4%). Among those who had ever taken PrEP, 74.9% had taken PrEP in the last 6 months; of these, 42.4% had taken PrEP the day of or day preceding the survey. Side effects represented the most common (59.5%) reason for discontinuing PrEP. MSM (adjusted odds ratio [aOR]: 2.5, 95% confidence interval [CI]: 1.8-3.6) and TGW/GQ in Harare (aOR: 3.1, 95% CI: 2.1-4.7), and TGW/GQ in Bulawayo (aOR: 2.4, 95% CI: 1.1-5.3) had higher awareness of PrEP than MSM in Bulawayo. Overall, TGW/GQ were more likely to have ever taken PrEP compared to MSM (aOR: 1.6, 95% CI: 1.01-2.4). CONCLUSIONS Findings emphasize the need for tailored interventions to promote PrEP among key populations. As HIV programs in Zimbabwe continue to expand PrEP services, these data, including barriers to starting and continuing PrEP, can inform strategies to address gaps along the PrEP cascade.
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Affiliation(s)
| | - Tiffany G Harris
- ICAP at Columbia University, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | | | - Owen Mugurungi
- Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - John H Rogers
- Division of Global HIV & TB, U.S. Centers for Disease Control, Harare, Zimbabwe
| | | | - Yingfeng Wu
- ICAP at Columbia University, New York, New York, USA
| | | | | | - Avi J Hakim
- Division of Global HIV & TB, U.S. Centers for Disease Control, Atlanta, Georgia, USA
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Parmley LE, Chingombe I, Wu Y, Mapingure M, Mugurungi O, Samba C, Rogers JH, Hakim AJ, Gozhora P, Miller SS, Musuka G, Harris TG. High Burden of Active Syphilis and Human Immunodeficiency Virus/Syphilis Coinfection Among Men Who Have Sex With Men, Transwomen, and Genderqueer Individuals in Zimbabwe. Sex Transm Dis 2022; 49:111-116. [PMID: 34508022 PMCID: PMC8746901 DOI: 10.1097/olq.0000000000001553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/21/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Syphilis increases human immunodeficiency virus (HIV) acquisition risk and impacts the immunologic and virologic response among people living with HIV (PLHIV). We assessed the prevalence of active or current syphilis and HIV/syphilis and their correlates among men who have sex with men (MSM), transwomen, and genderqueer (TGW/GQ) individuals in Zimbabwe. METHODS Among a respondent-driven sample of MSM and TGW/GQ who were tested for HIV and syphilis in Harare and Bulawayo, Zimbabwe in 2019 (n = 1511), multiple logistic regression was used to assess correlates of active syphilis. Unadjusted logistic regression was used among PLHIV (n = 340) due to small sample size. All analyses were unweighted as data did not reach convergence for HIV. RESULTS Prevalence of active syphilis overall and among PLHIV was 5.5% and 10.1%, respectively, in Harare, and 5.6% and 11.0%, respectively, in Bulawayo. Participants were more likely to have active syphilis if they were PLHIV (adjusted odds ratio [aOR], 2.2; 95% confidence interval [CI], 1.4-3.6), aged 25-34 years (aOR, 2.2 years; 95% CI, 1.3-3.8 years; reference, 18-24 years), or self-report sexually transmitted infection symptoms (aOR, 1.8; 95% CI, 1.1-3.0). Compared with Bulawayo TGW/GQ, MSM in Harare (aOR, 0.2; 95% CI, 0.1-0.5) and Bulawayo (aOR, 0.2; 95% CI, 0.1-0.4), and TGW/GQ in Harare (aOR, 0.2; 95% CI, 0.1-0.6) were less likely to have active syphilis. Among PLHIV, coinfection was 13.0% among TGW/GQ and 9.7% among MSM. Odds of coinfection were higher for those aged 25 to 34 years (OR, 3.7 years; 95% CI, 1.2-11.1 years) and lower among Harare MSM (OR, 0.2; 95% CI, 0.1-0.7), Bulawayo MSM (OR, 0.1; 95% CI, 0.0-0.4), and Harare TGW/GQ (OR, 0.1; 95% CI, 0.0-0.4) compared with Bulawayo TGW/GQ. CONCLUSIONS Findings highlight a high burden of syphilis among MSM and TGW/GQ and underscore the importance of HIV/syphilis detection and improved service delivery for these groups.
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Affiliation(s)
- Lauren E. Parmley
- From the Strategic Information Unit, ICAP at Columbia University, New York, NY
| | | | - Yingfeng Wu
- From the Strategic Information Unit, ICAP at Columbia University, New York, NY
| | | | - Owen Mugurungi
- AIDS and TB Programme, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - John H. Rogers
- Division of Global HIV & TB, U.S. Centres for Disease Control and Prevention, Harare, Zimbabwe
| | - Avi J. Hakim
- Division of Global HIV & TB, U.S. Centres for Disease Control and Prevention, Atlanta, GA
| | | | - Sophia S. Miller
- From the Strategic Information Unit, ICAP at Columbia University, New York, NY
| | | | - Tiffany G. Harris
- From the Strategic Information Unit, ICAP at Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Musuka G, Mukandavire Z, Murewanhema G, Cuadros D, Mutenherwa F, Chingombe I, Eghtessadi R, Herrera H, Dzinamarira T, Mapingure MP. HIV status, knowledge and prevention of cervical cancer amongst adolescent girls and women: a secondary data analysis. Pan Afr Med J 2022; 41:262. [PMID: 35734312 PMCID: PMC9187985 DOI: 10.11604/pamj.2022.41.262.32615] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/19/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction 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.
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Affiliation(s)
| | - Zindoga Mukandavire
- Emirates Aviation University, Centre for Data Science and Artificial Intelligence, Dubai, UAE
| | - Grant Murewanhema
- Unit of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Diego Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, USA
| | | | | | | | | | - Tafadzwa Dzinamarira
- Columbia University, Harare, Zimbabwe
- School of Health Systems and Public Health, University of Pretoria, Pretoria, 0002, South Africa
- Corresponding author: Tafadzwa Dzinamarira, School of Health Systems and Public Health, University of Pretoria, Pretoria, 0002, South Africa.
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Parmley LE, Miller SS, Harris TG, Mugurungi O, Rogers JH, Hakim A, Musuka G, Chingombe I, Mapingure M. Characterizing acceptable and appropriate implementation strategies of a biobehavioral survey among men who have sex with men and others assigned male who have sex with men in Zimbabwe. PLOS Glob Public Health 2022; 2:e0001097. [PMID: 36962664 PMCID: PMC10021218 DOI: 10.1371/journal.pgph.0001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/19/2022] [Indexed: 03/26/2023]
Abstract
Key populations including men who have sex with men (MSM), female sex workers, people who inject drugs, transgender persons, and prisoners account for nearly 50% of new HIV infections globally. To inform the HIV response and monitor trends in HIV prevalence and incidence among key populations, countries have increased efforts to implement biobehavioral surveys (BBS) with these groups as part of routine surveillance. Yet the marginalized nature of populations participating in a BBS requires contextually acceptable and appropriate strategies for effective implementation. We conducted a formative assessment to inform the first BBS conducted with MSM and others assigned male who have sex with men (OAMSM) in Zimbabwe, where same-sex sexual behaviors are illegal and highly stigmatized and describe applications of our findings. Qualitative data were collected through four focus groups with 32 MSM/OAMSM and 25 in-depth interviews (15 MSM/OAMSM, 10 service providers/gatekeepers) from December 2018 to January 2019. Rapid assessment techniques were employed including rapid identification of themes from audio recordings and review of detailed field notes and memos to identify key themes. Findings from this assessment included contextually relevant considerations including behaviors and terminology to avoid when working with MSM/OAMSM in Zimbabwe, appropriate compensation amounts for survey participation, proposed data collection sites, and differences in sexual openness, marital status, and networks among younger and older MSM/OAMSM. Participants also reported strong network ties suggesting respondent-driven sampling-a peer chain referral approach-to be an appropriate recruitment method in this context. Taken together, these findings highlighted key considerations and strategies for implementation to ensure the subsequent BBS in Zimbabwe was both acceptable and appropriate. These results and applications of these results are important for informing surveillance efforts and broader HIV-related engagement efforts among MSM/OAMSM in Zimbabwe as well as in other contextually similar countries in Southern Africa.
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Affiliation(s)
- Lauren E Parmley
- ICAP at Columbia University, New York, New York, United States of America
| | - Sophia S Miller
- ICAP at Columbia University, New York, New York, United States of America
| | - Tiffany G Harris
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Owen Mugurungi
- Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - John H Rogers
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Avi Hakim
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Dzinamarira T, Murewanhema G, Mhango M, Iradukunda PG, Chitungo I, Mashora M, Makanda P, Atwine J, Chimene M, Mbunge E, Mapingure MP, Chingombe I, Musuka G, Nkambule SJ, Ngara B. COVID-19 Prevalence among Healthcare Workers. A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2021; 19:ijerph19010146. [PMID: 35010412 PMCID: PMC8750782 DOI: 10.3390/ijerph19010146] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Tafadzwa Dzinamarira
- School of Health Systems & Public Health, University of Pretoria, Pretoria 0002, South Africa
- ICAP at Columbia University, Harare, Zimbabwe; (M.P.M.); (I.C.); (G.M.)
- Correspondence:
| | - Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe;
| | - Malizgani Mhango
- School of Public Health, University of Western Cape, Cape Town 7535, South Africa;
| | - Patrick Gad Iradukunda
- London School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, UK;
| | - Itai Chitungo
- Faculty of Medicine, College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe; (I.C.); (B.N.)
| | | | - Pelagia Makanda
- Department of Medicine, Jinzhou Medical University, Jinzhou 121001, China; (P.M.); (J.A.)
| | - James Atwine
- Department of Medicine, Jinzhou Medical University, Jinzhou 121001, China; (P.M.); (J.A.)
| | - Munashe Chimene
- Department of Health Sciences, Africa University, Mutare, Zimbabwe;
| | - Elliot Mbunge
- Department of Information Technology, Faculty of Accounting and Informatics, Durban University of Technology, Durban 4000, South Africa;
| | | | | | - Godfrey Musuka
- ICAP at Columbia University, Harare, Zimbabwe; (M.P.M.); (I.C.); (G.M.)
| | - Sphamandla Josias Nkambule
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa;
| | - Bernard Ngara
- Faculty of Medicine, College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe; (I.C.); (B.N.)
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22
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Murewanhema G, Mukwenha S, Dzinamarira T, Mukandavire Z, Cuadros D, Madziva R, Chingombe I, Mapingure M, Herrera H, Musuka G. Optimising COVID-19 Vaccination Policy to Mitigate SARS-CoV-2 Transmission within Schools in Zimbabwe. Vaccines (Basel) 2021; 9:1481. [PMID: 34960227 PMCID: PMC8709186 DOI: 10.3390/vaccines9121481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/15/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022] Open
Abstract
The COVID-19 pandemic has disrupted the learning of millions of children across the world. Since March 2020 when the first cases of COVID-19 were reported in Zimbabwe, the country, like many others, has gone through periods of closing and re-opening of schools as part of the national COVID-19 control and mitigation measures. Schools promote the social, mental, physical, and moral development of children. With this viewpoint, the authors argue that schools should not be closed to provide a measured and efficient response to the threats posed by the COVID-19 epidemic. Rather, infection prevention and control strategies, including vaccination of learners and teachers, and surveillance in schools should be heightened. The use of multiple prevention strategies discussed in this viewpoint has shown that when outbreaks in school settings are adequately managed, the transmission usually is low. The information presented here suggests that schools should remain open due to the preponderance of evidence indicating the overriding positive impacts of this policy on the health, development, and wellbeing of children.
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Affiliation(s)
- Grant Murewanhema
- Unit of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe;
| | - Solomon Mukwenha
- ICAP at Columbia University, Harare, Zimbabwe; (S.M.); (I.C.); (M.M.); (G.M.)
| | - Tafadzwa Dzinamarira
- ICAP at Columbia University, Harare, Zimbabwe; (S.M.); (I.C.); (M.M.); (G.M.)
- School of Health Systems & Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Zindoga Mukandavire
- Center for Data Science and Artificial Intelligence, Emirates Aviation University, Dubai P.O. Box 53044, United Arab Emirates;
| | - Diego Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Roda Madziva
- School of Sociology and Social Policy, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Innocent Chingombe
- ICAP at Columbia University, Harare, Zimbabwe; (S.M.); (I.C.); (M.M.); (G.M.)
| | | | - Helena Herrera
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2UP, UK;
| | - Godfrey Musuka
- ICAP at Columbia University, Harare, Zimbabwe; (S.M.); (I.C.); (M.M.); (G.M.)
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23
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Mukwenha S, Dzinamarira T, Chingombe I, Mapingure MP, Musuka G. Health emergency and disaster risk management: A case of Zimbabwe’s preparedness and response to cyclones and tropical storms: We are not there yet! Public Health in Practice 2021; 2:100131. [PMID: 36101640 PMCID: PMC9461620 DOI: 10.1016/j.puhip.2021.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Abstract
Cyclones and tropical storms are important threats to public health faced by countries worldwide as they are associated with infectious disease outbreaks, unsafe food and water to mention a few. To help meet these challenges, the World Health Organization encourages countries to strengthen their capacities for health emergency and disaster risk management incorporating measures for prevention, mitigation, preparedness, response and recovery. In this letter, we unpack the case of Zimbabwe’s preparedness and response to cyclones and tropical storms. Zimbabwe has been hit by several cyclones and tropical storms in the past two decades of varying magnitude and public health impacts. While the state of readiness and nature of response has improved over the years, we discuss the preparedness for and response to the 2019 Cyclone Idai to highlight the gaps that remain.
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24
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Musuka G, Dzinamarira T, Murewanhema G, Cuadros D, Chingombe I, Herrera H, Takavarasha F, Mapingure M. Associations of diarrhea episodes and seeking medical treatment among children under five years: Insights from the Zimbabwe Demographic Health Survey (2015-2016). Food Sci Nutr 2021; 9:6335-6342. [PMID: 34760263 PMCID: PMC8565232 DOI: 10.1002/fsn3.2596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/18/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 12/24/2022] Open
Abstract
Diarrhea is a significant pediatric public health concern globally and places a significant burden on healthcare systems. In resource-limited settings, the problems of diarrhea could be worse than reported. Continuously monitoring and understanding the changing epidemiology of diarrhea, including risk factors, remain an important aspect necessary to design effective public health interventions to reduce the incidence, outcomes and strain on healthcare resources caused by diarrheal illness. We, therefore, undertook this study to understand the factors associated with diarrhea as well as describe determinants for seeking medical treatment in children under-five in Zimbabwe using the Zimbabwe Demographic and Health Survey 2015-2016 Data. Children with recent diarrhea were on average younger (mean age 22 months), compared to those who did not have an episode of diarrhea (mean age 30 months) p = .001. Incidence of recent diarrhea was lower among female children compared to their male counterparts (16% vs. 19%), p = .013. Incidence of diarrhea decreased with increasing maternal education level and so was the same for increasing wealth quintile. Those with unimproved sources of drinking water had a higher incidence of diarrhea. The wealth quintile remained the only factor associated with seeking medical attention for a recent diarrhea episode among children less than 6 years, with those in the highest wealth quintile being 2.49 times likely to do so, p = .031. The results are useful in informing pediatric public health policies and strategies for them to be successful in significantly reducing the incidence, morbidity, mortality and significant healthcare costs and burden to society associated with caring for children with diarrheal illnesses.
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Affiliation(s)
| | - Tafadzwa Dzinamarira
- ICAP at Columbia UniversityHarareZimbabwe
- School of Health Systems & Public HealthUniversity of PretoriaPretoriaSouth Africa
| | - Grant Murewanhema
- Unit of Obstetrics and GynaecologyFaculty of Medicine and Health SciencesUniversity of ZimbabweHarareZimbabwe
| | - Diego Cuadros
- Department of Geography and Geographic Information ScienceUniversity of CincinnatiUSA
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25
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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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26
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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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27
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Mapingure M, Mukandavire Z, Chingombe I, Cuadros D, Mutenherwa F, Mugurungi O, Musuka G. Understanding HIV and associated risk factors among religious groups in Zimbabwe. BMC Public Health 2021; 21:375. [PMID: 33596877 PMCID: PMC7891154 DOI: 10.1186/s12889-021-10405-8] [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: 06/09/2020] [Accepted: 02/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The influence of religion and belief systems is widely recognized as an important factor in understanding of health risk perception and myths in the general fight against the HIV pandemic. This study compares the understanding of HIV risk factors and utilization of some HIV services among religious groups in Zimbabwe. METHODS We conducted secondary data statistical analysis to investigate the understanding of HIV and associated risk factors among religious groups in Zimbabwe using 2015-2016 Zimbabwe Demographic and Health Survey (ZDHS) data. We began by investigating associations between understanding of HIV and associated risk factors among religious groups. A multivariate stepwise backward elimination method was carried out to explore factors determining understanding of HIV risk after controlling for confounding factors using the most recent ZDHS data (2015-2016). RESULTS The results from the three surveys showed that, in general apostolic sector had low understanding of HIV and associated risk factors compared to other religious groups. Analysis of the 2015-2016 ZDHS data showed that women belonging to the apostolic sector were less likely to know where to get an HIV test odds ratio (OR) and 95% confidence interval, 0.665 (0.503-0.880) and to know that male circumcision reduces HIV transmission OR 0.863 (0.781-0.955). Women from this group had no knowledge that circumcised men can be infected if they do not use condoms OR 0.633 (0.579-0.693), nor that it is possible for a healthy-looking person to have HIV, OR 0.814 (0.719-0.921). They would not buy vegetables from a vendor with HIV OR 0.817 (0.729-0.915) and were less likely to support that HIV positive children should be allowed to attend school with HIV negative children OR 0.804 (0.680-0.950). Similar results were obtained for men in the apostolic sector. These men also did not agree that women were justified to use condoms if the husband has an Sexually Transmitted Infection (STI) OR 0.851 (0.748-0.967). CONCLUSIONS Our results suggest that apostolic sector lack adequate knowledge of HIV and associated risk factors than other religious groups. Targeting HIV prevention programmes by religious groups could be an efficient approach for controlling HIV in Zimbabwe.
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Affiliation(s)
| | - Zindoga Mukandavire
- Centre for Data Science, Coventry University, Coventry, UK.,School of Computing, Electronics and Mathematics, Coventry University, Coventry, UK
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Strauss M, George G, Mantell JE, Mapingure M, Masvawure TB, Lamb MR, Zech JM, Musuka G, Chingombe I, Msukwa M, Boccanera R, Gwanzura C, Apollo T, Rabkin M. Optimizing Differentiated HIV Treatment Models in Urban Zimbabwe: Assessing Patient Preferences Using a Discrete Choice Experiment. AIDS Behav 2021; 25:397-413. [PMID: 32812124 PMCID: PMC7846512 DOI: 10.1007/s10461-020-02994-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Differentiated service delivery holds great promise for streamlining the delivery of health services for HIV. This study used a discrete choice experiment to assess preferences for differentiated HIV treatment delivery model characteristics among 500 virally suppressed adults on antiretroviral therapy in Harare, Zimbabwe. Treatment model characteristics included location, consultation type, healthcare worker cadre, operation times, visit frequency and duration, and cost. A mixed effects logit model was used for parameter estimates to identify potential preference heterogeneity among participants, and interaction effects were estimated for sex and age as potential sources of divergence in preferences. Results indicated that participants preferred health facility-based services, less frequent visits, individual consultations, shorter waiting times, lower cost and, delivered by respectful and understanding healthcare workers. Some preference heterogeneity was found, particularly for location of service delivery and group vs. individual models; however, this was not fully explained by sex and age characteristics of participants. In urban areas, facility-based models, such as the Fast Track model requiring less frequent clinic visits, are likely to better align with patient preferences than some of the other community-based or group models that have been implemented. As Zimbabwe scales up differentiated treatment models for stable patients, a clear understanding of patient preferences can help in designing services that will ensure optimal utilization and improve the efficiency of service delivery.
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Affiliation(s)
- Michael Strauss
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa.
| | - Gavin George
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
| | - Joanne E Mantell
- Department of Psychiatry, Division of Gender, Sexuality and Health, The New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | | | - Tsitsi B Masvawure
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, MA, USA
| | - Matthew R Lamb
- ICAP at Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | | | | | - Rodrigo Boccanera
- Health Resources and Services Administration (HRSA), Rockville, MD, USA
| | - Clorata Gwanzura
- HIV/AIDS and STIs Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Tsitsi Apollo
- HIV/AIDS and STIs Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Miriam Rabkin
- ICAP at Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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29
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Rabkin M, Strauss M, Mantell JE, Mapingure M, Masvawure TB, Lamb MR, Zech JM, Musuka G, Chingombe I, Msukwa M, Boccanera R, Gwanzura C, George G, Apollo T. Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study. PLoS One 2020; 15:e0228148. [PMID: 31990930 PMCID: PMC6986745 DOI: 10.1371/journal.pone.0228148] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/14/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Zimbabwe is scaling up HIV differentiated service delivery (DSD) to improve treatment outcomes and health system efficiencies. Shifting stable patients into less-intensive DSD models is a high priority in order to accommodate the large numbers of newly-diagnosed people living with HIV (PLHIV) needing treatment and to provide healthcare workers with the time and space needed to treat people with advanced HIV disease. DSD is also seen as a way to improve service quality and enhance retention in care. National guidelines support five differentiated antiretroviral treatment models (DART) for stable HIV-positive adults, but little is known about patient preferences, a critical element needed to guide DART scale-up and ensure person-centered care. We designed a mixed-methods study to explore treatment preferences of PLHIV in urban Zimbabwe. METHODS The study was conducted in Harare, and included 35 health care worker (HCW) key informant interviews (KII); 8 focus group discussions (FGD) with 54 PLHIV; a discrete choice experiment (DCE) in which 500 adult DART-eligible PLHIV selected their preferences for health facility (HF) vs. community location, individual vs. group meetings, provider cadre and attitude, clinic operation times, visit frequency, visit duration and cost to patient; and a survey with the 500 DCE participants exploring DART knowledge and preferences. RESULTS Patient preferences were consistent in the FGDs, DCE and survey. Participants strongly preferred respectful HCWs, HF-based services, individual DART models, and less costly services. Patients also preferred less frequent visits and shorter wait times. They were indifferent to variations in HCW cadre and distances from home to HF. These preferences were mostly homogenous, with only minor differences between male vs. female and older vs. younger patients. HCWs in the KII correctly characterized facility-based individual models as the one most favored by patients; HCWs also preferred this model, which they felt decongested HFs and reduced their workload. CONCLUSIONS DART-eligible PLHIV in Harare found it relatively easy to access HFs, and preferred attributes associated with facility-based individual models. Prioritizing these for scale-up in urban areas may be the most efficient way to sustain positive patient outcomes and increase health system performance.
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Affiliation(s)
- Miriam Rabkin
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
- * E-mail:
| | - Michael Strauss
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
| | - Joanne E. Mantell
- Department of Psychiatry, Division of Gender, Sexuality and Health, Columbia University, New York, New York, United States of America
- The New York State Psychiatric Institute, New York, New York, United States of America
| | | | - Tsitsi B. Masvawure
- Department of Sociology and Anthropology, College of the Holy Cross, Worcester, Massachusetts, United States of America
| | - Matthew R. Lamb
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Jennifer M. Zech
- ICAP at Columbia University, New York, New York, United States of America
| | | | | | | | - Rodrigo Boccanera
- Health Resources and Services Administration (HRSA), Bethesda, Maryland, United States of America
| | - Clorata Gwanzura
- Ministry of Health and Child Care, HIV/AIDS and STIs Unit, Harare, Zimbabwe
| | - Gavin George
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
| | - Tsitsi Apollo
- Ministry of Health and Child Care, HIV/AIDS and STIs Unit, Harare, Zimbabwe
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30
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Musuka G, Mutenherwa F, Mukandavire Z, Chingombe I, Mapingure M. Association between alcohol use and HIV status: findings from Zambia and Zimbabwe. BMC Res Notes 2018; 11:508. [PMID: 30053880 PMCID: PMC6062959 DOI: 10.1186/s13104-018-3646-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
Objective To conduct statistical analysis to assess the association between alcohol use and HIV status using Demographic Health Survey data from Zambia (2013–2014) and Zimbabwe (2015–2016). Results The study showed an association between alcohol use and HIV status using nationally representative population-based surveys. The surveys were conducted among men (15–54 years) and women (15–49 years) in 2013–2014 and 2015–2016 in Zambia and Zimbabwe respectively. HIV prevalence in the two countries was higher among males and females who drank alcohol compared to those who did not. This study reinforces the existing knowledge base on the association between alcohol use and HIV sero-status and calls for further research to explore the causal pathways between alcohol consumption and HIV status.
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Affiliation(s)
| | | | - Zindoga Mukandavire
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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31
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Musuka G, Teveredzi V, Busang L, Chingombe I, Makadzange P, Mokgweetsinyana S, Ncube R, Maradzika J, Chinamasa CF, Moeti T. Community attitudes on tuberculosis in Botswana: an opportunity for improving the National Tuberculosis Programme outcomes, 2011. BMC Res Notes 2018; 11:499. [PMID: 30037334 PMCID: PMC6057039 DOI: 10.1186/s13104-018-3585-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/07/2018] [Indexed: 12/05/2022] Open
Abstract
Objectives The Botswana tuberculosis HIV Knowledge Attitude and Practice study sought to assess knowledge, attitudes and practices of communities on TB and identify sources of their information on this disease and HIV. Specific objectives of the study were to: (a) collect baseline information on the knowledge, attitudes, and practices about tuberculosis treatment seeking and adherence behaviors in Botswana. (b) Identify barriers which discourage people who may have smear positive tuberculosis from testing and getting treatment (e.g. social stigma) and constraints which prevent them from initiating and completing treatment. Results Approximately 92% of respondents (n = 2029), reported that having TB was not something embarrassing, while about 97% (n = 2030) were not ashamed of having a family member with TB. Approximately 95% (n = 2030) expressed willingness to accommodate their relatives with TB at their homes or, work with TB patients (n = 2026). About 21% of the respondents however, believed in myths that TB infection is a result of either having sex with women who had miscarried (n = 2028), or food poisoning (n = 2031) while about 17% believed that TB infection is a result of sleeping with a widow or widower (n = 2031).
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Affiliation(s)
- Godfrey Musuka
- African Comprehensive HIV/AIDS Partnerships, Gaborone, Botswana. .,ICAP at Columbia University, Harare, Zimbabwe.
| | - Vonai Teveredzi
- African Comprehensive HIV/AIDS Partnerships, Gaborone, Botswana.,Ark Foundation, Harare, Zimbabwe
| | - Lesego Busang
- African Comprehensive HIV/AIDS Partnerships, Gaborone, Botswana
| | - Innocent Chingombe
- African Comprehensive HIV/AIDS Partnerships, Gaborone, Botswana.,ICAP at Columbia University, Harare, Zimbabwe
| | | | | | | | - Julita Maradzika
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | - Themba Moeti
- African Comprehensive HIV/AIDS Partnerships, Gaborone, Botswana.,Health Systems Trust, Durban, South Africa
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George G, Reardon C, Gunthorp J, Moeti T, Chingombe I, Busang L, Musuka G. The Madikwe Forum: a comprehensive partnership for supporting governance of Botswana's HIV and AIDS response. Afr J AIDS Res 2012; 11:27-35. [PMID: 25870895 DOI: 10.2989/16085906.2012.671252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There is a need for actors within the philanthropic sector to pursue collaborative partnerships with developing nations which could result in sustainable country-led responses to HIV and AIDS. There is also a need to evaluate the structures governing these partnerships in order to determine their effectiveness in strengthening national responses to HIV and AIDS. This article presents findings from a qualitative study of a governance structure of the African Comprehensive HIV/AIDS Partnerships (ACHAP), namely the Madikwe Forum. The investigation sought to critically reflect on the role and effectiveness of the Madikwe Forum in Botswana's response to HIV and AIDS and to consider the value of such a forum for other developing nations and partnership arrangements. The findings indicate that the Madikwe Forum has enabled considerable progress in the implementation of ACHAP-supported initiatives in Botswana. The constructive working relationship and close alignment between ACHAP and the Botswana government's objectives and priority areas were viewed as critical to this success. However, problems exist regarding the operation of the forum as well as a lack of focus on monitoring and evaluation, which requires the forum's urgent attention.
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Affiliation(s)
- Gavin George
- a Health Economics and HIV and AIDS Division (HEARD) , University of KwaZulu-Natal , Private Bag , X54001 , Durban , South Africa
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