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Background: HIV and syphilis are common sexually transmitted infections in sub-Saharan Africa. We aimed to investigate the prevalence and distribution of active syphilis while considering HIV status, demographic characteristics, and behavioural characteristics., Methods: The Population-based HIV Impact Assessment surveys used a cross-sectional, two-stage, stratified cluster sample design to collect data in Ethiopia, Tanzania, Uganda, Zambia, and Zimbabwe from 2015 to 2018. Eligible participants were aged 15 years and older and provided demographic information, behavioural information, and blood specimens for HIV and syphilis testing. Active syphilis was defined as the presence of both treponemal and non-treponemal antibodies, measured using an antigen-based rapid test. Multivariable logistic regression models with survey weights were applied. The estimated number of participants with active syphilis in each country was calculated by multiplying the survey-weighted syphilis prevalence by the corresponding participant population size from the latest national census data. The total burden across the five countries was obtained by summing these estimates., Findings: 102 831 participants enrolled in the five surveys (54 583 [57·6%] participants were female, 48 248 [42·4%] participants were male, 9036 [9·9%] participants were HIV positive). Population-based syphilis prevalence was 0·9% (95% CI 0·7-1·1) in Tanzania and Zimbabwe, 2·1% (1·9-2·4) in Uganda, and 3·0% (2·7-3·4) in Zambia. Overall, an estimated 1 027 615 (95% CI 877 243-1 158 246) participants had active syphilis across the five countries (266 383 HIV-positive and 761 232 HIV-negative individuals). Syphilis prevalence was higher among people living with HIV (range from 2·6% [95% CI 1·1-4·0] in Ethiopia to 9·6% [8·1-11·0] in Zambia) than among those without HIV (range from 0·8% [0·7-1·0] in Tanzania to 2·1% [1·8-2·4] in Zimbabwe). The odds of active syphilis were higher among people living with HIV than in those who were HIV negative (adjusted odds ratio [aOR] range from 2·5 [95% CI 1·8-3·4] in Uganda to 5·9 [3·8-9·2] in Zimbabwe), among divorced, separated, or widowed individuals (aOR range from 1·5 [1·1-2·0] in Uganda to 2·7 [1·7-4·3] in Zimbabwe), and among those reporting two or more sexual partners in the previous 12 months (aOR range from 1·1 [CI 0·8-1·5] in Uganda to 1·9 [1·1-3·3] in Zimbabwe)., Interpretation: This study shows the high burden of syphilis in five sub-Saharan African countries, with a correlation between HIV and active syphilis, underscoring the need for integrated sexual health services and targeted diagnosis, prevention, and treatment strategies to address this public health challenge., Funding: The President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Access to safe drinking water, sanitation, and hygiene, collectively called WASH, is a fundamental human right and a cornerstone of public health. However, inadequate WASH practices and environments significantly contribute to the global burden of diarrheal diseases, particularly, in children aged under 5 years. Inadequate WASH conditions are the primary drivers of various infectious diseases, including cholera, dysentery, hepatitis A, typhoid, and polio., Methods: We conducted secondary data analysis using the 2019 Zimbabwe Multiple Indicator Cluster Survey to investigate the specific WASH risk factors associated with recent diarrheal episodes in children aged under 5 years., Results: A total of 853 (14%) of 6092 children were reported to have experienced an episode of diarrhea in the last 2 weeks preceding the survey. Having insufficient water in the household was associated with 17.0% diarrhea episodes compared with 13.6% in those who did not face this problem. The availability of soap or detergents to wash hands was associated with a risk of diarrhea, with an odds ratio and 95% confidence interval of 1.19 (1.01-1.40), P = 0.033. The use of surface water, including rivers, dams, lakes, ponds, streams, canals, and irrigation channels, was associated with differences in diarrheal episodes, although this was of borderline significance, P = 0.082. Of the children who had a recent episode of diarrhea, 41.0% had their parents or caregivers seeking medical attention., Conclusions: There is need for an improvement in safe water supply to households and an improvement in health education on the importance of using soap after using the toilet to avoid contamination of food and water., Competing Interests: The authors have no competing interests to declare., (© 2024 The Author(s).)

Objectives: In recent years, mpox, a zoonotic disease caused by the mpox virus, has transcended its primary association with Central and West Africa, emerging as a global public health concern. The virus poses a substantial threat, particularly, to vulnerable demographics such as young children and individuals with compromised immune systems. This critical literature review aimed to comprehensively evaluate the burden, risk factors, and current management strategies associated with mpox in Africa., Methods: This critical literature review was guided by Jesson & Laccy's guidelines on conducting critical literature reviews. We searched PubMed and Google Scholar databases and websites of the World Health Organization and health ministries in different African countries. We included articles written in English and published between 2010 and 2023. The synthesis of findings involved several steps, including summarizing themes, integrating themes, and linking themes to research questions., Results: A total of 25 articles were included in this review. The review revealed that mpox cases are concentrated in Central African countries. The risk factors for mpox identified include being in contact with bushmeat or rodents, not having been vaccinated against smallpox, being HIV-positive, and having close physical contact with someone with the disease. The clinical presentation of mpox revealed in this review includes a skin rash, fever, lymphadenopathy, headache, pruritus, sore throat, and body aches. Four themes arose on strategies to prevent and control mpox in Africa., Conclusions: The prevention and control of mpox in Africa require an improvement in community education, vaccination, disease surveillance, and infection control measures., Competing Interests: The authors have no competing interests to declare., (© 2024 The Author(s).)

Background: Using data from the Zimbabwe Population-based HIV Impact Assessment survey 2015-2016, we examined the TB care cascade and factors associated with not receiving TB diagnostic testing among adult PLHIV with TB symptoms., Methods: Statistical Analysis was limited to PLHIV aged 15 years and older in HIV care. Weighted logistic regression with not receiving TB testing as outcome was adjusted for covariates with crude odd ratios (ORs) with p < 0.25. All analyses accounted for multistage survey design., Results: Among 3507 adult PLHIV in HIV care, 2288 (59.7 %, 95 % CI:58.1-61.3) were female and 2425 (63.6 %, 95 % CI:61.1-66.1) lived in rural areas. 1197(48.7 %, 95 % CI:46.5-51.0) reported being screened for TB symptoms at their last HIV care visit. In the previous 12 months, 639 (26.0 %, 95 % CI:23.9-28.1) reported having symptoms and of those, 239 (37.8 %, 95 % CI:33.3-42.2) received TB testing. Of PLHIV tested for TB, 36 (49.5 %, 95 % CI:35.0-63.1) were diagnosed with TB; 32 (90.3 %, 95 % CI:78.9-100) of those diagnosed with TB received treatment. Never having used IPT was associated with not receiving TB testing., Conclusion: The results suggest suboptimal utilization of TB screening and diagnostic testing among PLHIV. New approaches are needed to reach opportunities missed in the HIV/TB integrated services., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

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., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

Background: The impact of the COVID-19 vaccination campaign in the US has been hampered by a substantial geographical heterogeneity of the vaccination coverage. Several studies have proposed vaccination hesitancy as a key driver of the vaccination uptake disparities. However, the impact of other important structural determinants such as local disparities in healthcare capacity is virtually unknown., Methods: In this cross-sectional study, we conducted causal inference and geospatial analyses to assess the impact of healthcare capacity on the vaccination coverage disparity in the US. We evaluated the causal relationship between the healthcare system capacity of 2417 US counties and their COVID-19 vaccination rate. We also conducted geospatial analyses using spatial scan statistics to identify areas with low vaccination rates., Findings: We found a causal effect of the constraints in the healthcare capacity of a county and its low-vaccination uptake. Counties with higher constraints in their healthcare capacity were more probable to have COVID-19 vaccination rates ≤50, with 35% higher constraints in low-vaccinated areas (vaccination rates ≤ 50) compared to high-vaccinated areas (vaccination rates > 50). We also found that COVID-19 vaccination in the US exhibits a distinct spatial structure with defined "vaccination coldspots"., Interpretation: We found that the healthcare capacity of a county is an important determinant of low vaccine uptake. Our study highlights that even in high-income nations, internal disparities in healthcare capacity play an important role in the health outcomes of the nation. Therefore, strengthening the funding and infrastructure of the healthcare system, particularly in rural underserved areas, should be intensified to help vulnerable communities., Funding: None., Competing Interests: The authors have no conflicts of interest to declare., (© 2022 The Authors.)

Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Although there has been a global reduction in wild poliovirus (WPV) type 1 cases, Africa has experienced a re-emergence of the disease. This article discusses the re-emergence of WPV in Africa, the transmission and pathogenesis of WPV, and the role of environmental surveillance and other strategies used to interrupt all WPV transmission in the region permanently., (© 2022 The Author(s).)

Background: An abnormal vaginal discharge is a frequent manifestation of reproductive tract infections, including sexually transmitted infections (STIs) and vulvovaginal candidiasis. It is also a manifestation of bacterial vaginosis, which has a prevalence of up to 50% among women of reproductive age. Reproductive tract infections are associated with a range of reproductive health challenges and increase the risk of HIV acquisition., Methods: This study was performed to critically review and discuss the current diagnostic and treatment approaches to abnormal vaginal discharge among women of reproductive age in sub-Saharan Africa, and to call for a paradigm shift from the syndromic approach to specific pathogen identification and directed antimicrobial therapy., Discussion: Young women have the highest incidence of HIV infection in sub-Saharan Africa. Countries in sub-Saharan Africa where the prevalence of both STIs and bacterial vaginosis is very high have been employing a syndromic approach for the treatment of abnormal vaginal discharge since around 1984. However, the syndromic approach has several limitations, with the potential to miss infections, over-diagnose and over-treat STIs, and propagate antimicrobial resistance, which is one of the greatest global health challenges of the 21 st century., Conclusions: The low to middle-income countries of sub-Saharan Africa must innovate and leverage improved diagnostics to capacitate primary health care and other levels for point-of-care diagnostic testing, in order to provide an immediate diagnosis and treatment for women with an abnormal vaginal discharge., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reportcoed in this paper., (© 2022 The Author(s).)

Adolescent girls and young women (AGYW) from sub-Saharan Africa (SSA), aged 15-24, remain at substantial risk of acquiring HIV. AGYW accounted for 63% of all new HIV infections in 2021. Reducing incident infections in AGYW and among the other key populations is key to eliminating HIV infections. Expedited prioritization and actions to reduce incident infections among AGYW from sub-Saharan Africa are therefore required to attain the UNAIDS 95-95-95 targets by 2030. In this article, we discuss the factors contributing to higher HIV infections among AGYW and strategies that can be used to reduce HIV infection among them. Several biological, socio-economic, religious, and cultural factors continue to put the AGYW at a disproportionately high risk of acquiring HIV. Many AGYW in SSA are economically marginalized and therefore are unable to negotiate condom use and monogamy. Patriarchal culture predominant in SSA also exacerbates AGYW's inferiority in sexual matters. To address these factors, a multi-pronged approach is required. Some of the strategies we recommend are passing stricter sentences for sexual offenders and abusers, economically empowering AGYW, increasing the provision of sexual and reproductive health and rights (SRHR) education and services to AGYW, increasing access to pre-exposure and post-exposure prophylaxis, treatment of HIV as prevention, and engaging and educating communities on SRHR matters., (© 2022 The Author(s).)

The 2025 UNAIDS targets prioritize reaching all subpopulations living with HIV and those at risk for HIV as the only pathway to achieving control of the HIV epidemic. This has brought to the fore the importance of addressing the needs of key marginalized groups and placing such communities at the center of HIV response strategies. However, the COVID-19 pandemic has resulted in a setback in terms of confronting HIV. With this in mind, it is important not only to protect services within HIV responses among key populations, but also to expand such services to meet the UNAIDS 2025 targets. Without this, gains in controlling COVID-19 may be achieved at the expense of losses in controlling the spread of HIV, which had been achieved after sustained and resource-intensive actions., Competing Interests: The authors declare no competing interests., (© 2022 The Author(s).)

Zimbabwe continues to confront the COVID-19 pandemic; there is an urgent need for the rapid scale-up of genomic surveillance efforts. In this piece, we express concern on the limited capacity for SARS-CoV-2 genomic surveillance in Zimbabwe due to limited skillsets and laboratory infrastructural deficiencies. We call for an urgent need for funding from the government of Zimbabwe to set up a robust genomic surveillance program to detect SARS-CoV-2 variants of concern in Zimbabwe and guide public health responses accordingly., Competing Interests: None to declare, (© 2021 The Author(s).)

Competing Interests: We declare no competing interests.

The COVID-19 pandemic has seen developed countries relax immigration procedures for health workers seeking new work opportunities elsewhere. Our letter outlines the risks to the HIV & TB program of health workers' outward migration from Zimbabwe, a country with one of the worst morbidity and mortality rates in the world from these two diseases. We discuss the recent legal changes in immigration to the United Kingdom (UK), which facilitate easier relocation of appropriately trained and experienced health professionals to that country. Additionally, we discuss key issues health workers in Zimbabwe face on a daily basis and why the UK is a naturally fertile ground for their migration., (© 2021 The Author(s).)

The easing of COVID-19 restrictions in southern Africa, including Zimbabwe, has seen most countries reopening schools for face-to-face learning. In this letter we discuss the paradox of reopening schools in the COVID-19 era and proffer recommendations for safe learning environments., Competing Interests: None to declare., (© 2020 The Author(s).)

Covid-19 cases and death are on the rise in Zimbabwe and other Southern African countries. This increase poses a major risk of outbreaks in institutions such as prisons and detention centers. Zimbabwe has a total of 46 main prisons that are overcrowded and without adequate running water, hand sanitizers, and face masks for both prisoners and warden officers. Although the country has released some prisoners, it is still not enough to decongest the prisons and mitigate the Covid-19 risk. There is a need to further decongest the prisons, ensure facilities have adequate tap water, and consider the use of video and audio technology to minimize visitors to inmates., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

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., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

The arrival of COVID-19 has disrupted health service provision globally. In this note, the authors discuss the impact of the COVID-19 pandemic on the provision of tuberculosis (TB) services in Zimbabwe. TB is endemic in the country and disruption of services may potentially have serious consequences for patients with existing and undiagnosed TB. In this letter, the authors discuss the need for innovative strategies that ensure TB prevention and treatment services in a manner which reduces COVID-19 risk to patients and healthcare workers., (© 2020 The Author(s).)

Background: Short-term mortality rates among patients with HIV receiving antiretroviral therapy (ART) in sub-Saharan Africa are higher than those recorded in high-income countries, but systematic long-term comparisons have not been made because of the scarcity of available data. We analysed the effect of the implementation of Botswana's national ART programme, known as Masa, from 2002 to 2010., Methods: The Masa programme started on Jan 21, 2002. Patients who were eligible for ART according to national guidelines had their data collected prospectively through a clinical information system developed by the Botswana Ministry of Health. A dataset of all available electronic records for adults (≥18 years) who had enrolled by April 30, 2010, was extracted and sent to the study team. All data were anonymised before analysis. The primary outcome was mortality. To assess the effect of loss to follow-up, we did a series of sensitivity analyses assuming varying proportions of the population lost to follow-up to be dead., Findings: We analysed the records of 126,263 patients, of whom 102,713 had documented initiation of ART. Median follow-up time was 35 months (IQR 14-56), with a median of eight follow-up visits (4-14). 15,270 patients were deemed lost to follow-up by the end of the study. 63% (78,866) of the study population were women; median age at baseline was 34 years for women (IQR 29-41) and 38 years for men (33-45). 10,230 (8%) deaths were documented during the 9 years of the study. Mortality was highest during the first 3 months after treatment initiation at 12·8 deaths per 100 person-years (95% CI 12·4-13·2), but decreased to 1·16 deaths per 100 person-years (1·12-1·2) in the second year of treatment, and to 0·15 deaths per 100 person-years (0·09-0·25) over the next 7 years of follow-up. In each calendar year after the start of the Masa programme in 2002, average CD4 cell counts at enrolment increased (from 101 cells/μL [IQR 44-156] in 2002, to 191 cells/μL [115-239] in 2010). In each year, the proportion of the total enrolled population who died in that year decreased, from 63% (88 of 140) in 2002, to 0·8% (13 of 1599) in 2010. A sensitivity analysis assuming that 60% of the population lost to follow-up had died gave 3000 additional deaths, increasing overall mortality from 8% to 11-13%., Interpretation: The Botswana national HIV/AIDS treatment programme reduced mortality among adults with HIV to levels much the same as in other low-income or middle-income countries., Funding: The African Comprehensive HIV/AIDS Partnerships., (Copyright © 2014 Farahani et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.)