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Crowdsourcing strategies are useful in the development of public health interventions. Crowdsourcing engages end users in a co-creation process through challenge contests, designathons or online collaborations. Drawing on our experience of crowdsourcing in four African countries, we provide guidance on designing crowdsourcing strategies across seven steps: deciding on the type of crowdsourcing strategy, convening a steering committee, developing the content of the call for ideas, promotion, evaluation, recognizing finalists and sharing back ideas or implementing the solutions. [ABSTRACT FROM AUTHOR]

Introduction In early 2020, the coronavirus disease 2019 (COVID-19) pandemic began sweeping across the globe and threatened to profoundly affect sub-Saharan Africa. (1) Many high- and middle-income countries imposed stern [...], Objective To investigate community and health-care workers' perspectives on the coronavirus disease 2019 (COVID-19) pandemic and on early pandemic responses during the first 2 weeks of national lockdown in Zimbabwe. Methods Rapid qualitative research was carried out between March and April 2020 via phone interviews with one representative from each of four community-based organizations and 16 health-care workers involved in a trial of community-based services for young people. In addition, information on COVID-19 was collected from social media platforms, news outlets and government announcements. Data were analysed thematically. Findings Four themes emerged: (i) individuals were overloaded with information but lacked trusted sources, which resulted in widespread fear and unanswered questions; (ii) communities had limited ability to comply with prevention measures, such as social distancing, because access to long-term food supplies and water at home was limited and because income had to be earned daily; (iii) health-care workers perceived themselves to be vulnerable and undervalued because of a shortage of personal protective equipment and inadequate pay; and (iv) other health conditions were sidelined because resources were redirected, with potentially wide-reaching implications. Conclusion It is important that prevention measures against COVID-19 are appropriate for the local context. In Zimbabwe, communities require support with basic needs and access to reliable information to enable them to follow prevention measures. In addition, health-care workers urgently need personal protective equipment and adequate salaries. Essential health-care services and medications for conditions other than COVID-19 must also continue to be provided to help reduce excess mortality and morbidity. [phrase omitted] Objectif Connaitre le point de vue des communautes et soignants vis-a-vis de la pandemie de maladie a coronavirus 2019 (COVID-19) ainsi que des reactions initiales durant les deux premieres semaines de confinement au Zimbabwe. Methodes Une recherche qualitative rapide a ete menee entre mars et avril 2020 sous forme d'entretiens telephoniques avec un representant de chacun des quatre organismes communautaires et 16 soignants qui participaient a un test sur les services communautaires destines aux jeunes. En outre, des informations sur la COVID-19 ont ete recoltees via les reseaux sociaux, les medias et les declarations du gouvernement. Les donnees ont ete analysees par themes. Resultats Quatre themes ont ete identifies: (i) les individus etaient submerges d'informations mais manquaient de sources fiables, ce qui a engendre de la peur et laisse de nombreuses questions en suspens; (ii) les communautes disposaient de capacites limitees pour appliquer les mesures de prevention telles que la distanciation physique, en raison d'un acces restreint a l'approvisionnement alimentaire et a l'eau a domicile et de la necessite de generer des revenus au quotidien; (iii) les soignants se consideraient comme vulnerables et peu reconnus, compte tenu de la penurie d'equipements de protection personnelle et de l'insuffisance de leur remuneration; et enfin, (iv) d'autres pathologies ont ete negligees car les ressources etaient reaffectees, avec des repercussions parfois considerables. Conclusion Les mesures de prevention pour lutter contre la COVID-19 doivent imperativement etre adaptees au contexte local. Au Zimbabwe, les communautes requierent du soutien pour repondre aux besoins fondamentaux et acceder a des informations fiables qui leur permettent d'appliquer ces mesures de prevention. D'autre part, les soignants doivent de toute urgence disposer d'un equipement de protection personnelle et beneficier d'une remuneration adequate. Les medicaments et soins de sante essentiels pour des pathologies autres que la COVID-19 doivent egalement continuer a etre administres pour contribuer a diminuer les taux de mortalite et de morbidite excessifs. [phrase omitted] Objetivo Examinar las opiniones de la comunidad y de los profesionales sanitarios sobre la pandemia de la enfermedad por coronavirus de 2019 (COVID-19) y sobre las respuestas tempranas a la pandemia durante las dos primeras semanas de confinamiento nacional en Zimbabue. Metodos Entre marzo y abril de 2020 se realizo un estudio cualitativo rapido mediante entrevistas telefonicas con un representante de cada una de las cuatro organizaciones comunitarias y con 16 profesionales sanitarios que participaban en un estudio sobre los servicios comunitarios para jovenes. Ademas, se recopilo informacion sobre la COVID-19 a traves de plataformas de las redes sociales, los medios de comunicacion y los anuncios del gobierno. Los datos se analizaron tematicamente. Resultados Surgieron cuatro temas: i) las personas estaban sobrecargadas de informacion y no disponian de fuentes fiables, lo que generaba un temor generalizado y dudas sin respuestas; ii) las comunidades tenian una capacidad limitada para cumplir las medidas de prevencion, como el distanciamiento fisico, debido a que el acceso a los suministros de alimentos y de agua a largo plazo en el hogar era limitado, ademas de que debian percibir ingresos diariamente; iii) los profesionales sanitarios se consideraban vulnerables y subestimados debido a la escasez de los equipos de proteccion personal y a una remuneracion inadecuada; y iv) se excluian otras enfermedades debido a la reorientacion de los recursos, lo que planteaba riesgos importantes. Conclusion Es importante que las medidas de prevencion contra la COVID-19 sean apropiadas para el contexto local. En Zimbabue, las comunidades necesitan apoyo para satisfacer sus necesidades basicas y tener acceso a informacion fiable que les permita aplicar las medidas de prevencion. Ademas, los profesionales sanitarios necesitan con urgencia equipos de proteccion personal y remuneraciones adecuadas. Tambien se deben seguir prestando los servicios basicos de atencion sanitaria y los medicamentos para las enfermedades distintas de la COVID-19 para contribuir a la reduccion del exceso de mortalidad y morbilidad.

Background: Children encounter multiple barriers in accessing facilities. HIV self-testing using oral mucosal transudate (OMT) tests has been shown to be effective in reaching hard-to-reach populations. We evaluated the feasibility and accuracy of caregivers conducting HIV testing using OMTs in children in Zimbabwe. Methods: We offered OMTs to caregivers (.18 years) living with HIV to test children (2-18 years) living in their households. All caregivers were provided with manufacturer instructions. In Phase 1 (January-December 2018, 9 clinics), caregivers additionally received a demonstration by a provider using a test kit and video. In Phase 2 (January-May 2019, 3 clinics), caregivers did not receive a demonstration. We collected demographic data and assessed caregiver's ability to perform the test and interpret results. Caregiver performance was assessed by direct observation and scored using a predefined checklist. Factors associated with obtaining a full score were analyzed using logistic regression. Results: Overall 400 caregivers (83.0% female, median age 38 years) who were observed tested 786 children (54.6% female, median age 8 years). For most tests, caregivers correctly collected oral fluid [87.1% without provider demonstrations (n = 629) and 96.8% with demonstrations (n = 157), P = 0.002]. The majority correctly used a timer (90.3% without demonstrations and 96.8% with demonstrations, P = 0.02). In multivariate logistic regression caregivers who obtained a full score for performance were more likely to have received a demonstration (odds ratio 4.14, 95% confidence interval: 2.01 to 8.50). Conclusions: Caregiver-provided testing using OMTs is a feasible and accurate HIV testing strategy for children. We recommend operational research to support implementation at scale. [ABSTRACT FROM AUTHOR]

Background: Syndromic management of sexually transmitted infections (STIs) is the standard of care in resource-constrained settings. Co-prevalent STIs, if asymptomatic, may remain unidentified when individuals present with a particular syndrome. We investigated the prevalence of co-prevalent STIs in individuals with genital ulcer disease (GUD) syndrome in Zimbabwe (GUD data to be presented elsewhere). Methods: We consecutively enrolled individuals aged ≥16 years presenting with GUD at two primary health care clinics in Harare. Socio-demographic data, sexual behavior and clinical history were collected. Genital ulcer swabs were collected to test for GUD aetiology. Urine was collected to test for Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) using the GeneXpert platform. Those with symptoms were managed syndromically; asymptomatic participants with a positive test result were contacted within 7 days for treatment. Selfcollected vaginal swabs were used to test for Trichomonas vaginalis (TV) using a point-of-care (POC) lateral flow assay in females and treated immediately. All participants were offered an HIV test (unless known HIV-positive). Results: From July-December 2022, 160 participants were recruited (53.1% female, median age 27 years). A total of 48/160 (30%) were HIV-positive with 12/48 (25.0%) newly diagnosed. Overall, 50/160 (31.3%, 95% CI: 24.2 -- 39.0) participants had CT and/or GC: the prevalence of CT and GC were 23.8% (95% CI: 17.4 -- 31.1) and 16.9% (95% CI: 11.4 -- 23.6) respectively. Among those with NG/CT, 82.0% completed treatment, of whom only 34.1% had symptoms and therefore treated syndromically. TV prevalence was 25.9% (95% CI: 16.9 -- 36.5), of whom 72.7% (16/22) were symptomatic. All were treated on the same day. Younger age (OR 1.08 for every year lower age, 95% CI:1.03-1.13) and not using a condom at last sexual intercourse (OR = 2.50, 95% CI:1.01-6.17) were associated with increased odds of a co-prevalent STI (excluding HIV); positive HIV status was not associated with having a co-prevalent STI. Conclusion: There was high prevalence of HIV and other co-prevalent STIs among GUD treatment seekers. While HIV testing is routinely offered, testing for other STIs should be considered among individuals presenting with STI syndromes such as GUD. POC tests facilitate completion of treatment. [ABSTRACT FROM AUTHOR]

Background: Partner notification is considered integral to the management of sexually transmitted infections (STI). Patient-referral is a common partner notification strategy, particularly in resource-limited settings. It relies on index cases notifying and encouraging their partners to access treatment; however, it has shown limited efficacy. Little is understood about adolescent and young peoples' experiences of partner notification, particularly, the risks and challenges encountered during patientreferral. A deeper understanding of the barriers and challenges of partner notification is critical to addressing the increasing rates of STIs among this population group. Methods: This mixed methods study examined adolescent and young peoples' experiences of engaging in the patient-referral partner notification process. All adolescent and young people (16-24 years) attending a community-based sexual and reproductive health service in Zimbabwe who were diagnosed with an STI were counselled and offered partner notification slips. Their partners could access free treatment at the service. Quantitative intervention data on partner notification slip uptake and partner treatment was collected and analysed. Youth researchers conducted in-depth interviews with 41 purposively selected adolescent and young people diagnosed with an STI to explore their experiences of partner notification. Qualitative data was analysed using thematic analysis. Results: Among 1807 adolescent and young people (85% female) offered partner notification slips, 103 partners (5.7%) returned for treatment. Most participants described feeling ill-equipped to counsel and persuade their partners to seek treatment. Dilemmas described suggested partner notification posed considerable social risks to adolescent and young people, threatening their emotional and physical safety. Except for a minority in long-term, publicly acknowledged relationships, participants did not expect partner notification would achieve successful outcomes. Conclusion: Partner notification exposes adolescent and young people to social, emotional, and physical harms. Low rates of partner return suggest partner notification is failing to reduce reinfection. Urgent interrogation of whether partner notification is a suitable or constructive strategy to continue to pursue with adolescent and young people is needed. Attention and investment should instead be directed toward developing parallel interventions that respond to adolescent and young peoples' realities to prevent reinfection and interrupt onward transmission of STIs. [ABSTRACT FROM AUTHOR]

Background: Gaps persist in HIV testing for children who were not tested in prevention of mother-to-child HIV transmission programs. Oral mucosal transudate (OMT) rapid HIV tests have been shown to be highly sensitive in adults, but their performance has not been established in children. Methods: Antiretroviral therapy-naive children aged 18 months to 18 years in Kenya and Zimbabwe were tested for HIV using rapid OraQuick ADVANCE Rapid HIV-1/2 Antibody test on oral fluids (OMT) and blood-based rapid diagnostic testing (BBT). BBT followed Kenyan and Zimbabwean national algorithms. Sensitivity and specificity were calculated using the national algorithms as the reference standard. Results: A total of 1776 children were enrolled; median age was 7.3 years (interquartile range: 4.7-11.6). Among 71 children positive by BBT, all 71 were positive by OMT (sensitivity: 100% [97.5% confidence interval (CI): 94.9% to 100%]). Among the 1705 children negative by BBT, 1703 were negative by OMT (specificity: 99.9% [95% CI: 99.6% to 100.0%]). Due to discrepant BBT and OMT results, 2 children who initially tested BBT-negative and OMT-positive were subsequently confirmed positive within 1 week by further tests. Excluding these 2 children, the sensitivity and specificity of OMT compared with those of BBT were each 100% (97.5% CI: 94.9% to 100% and 99.8% to 100%, respectively). Conclusions: Compared to national algorithms, OMT did not miss any HIV-positive children. These data suggest that OMTs are valid in this age range. Future research should explore the acceptability and uptake of OMT by caregivers and health workers to increase pediatric HIV testing coverage. [ABSTRACT FROM AUTHOR]

Introduction The number of new paediatric infections per year has declined in sub-Saharan Africa due to preventionof-mother-to-child HIV transmission programmes; many children and adolescents living with HIV remain undiagnosed. In this protocol paper, we describe the methodology for evaluating an index-linked HIV testing approach for children aged 2-18 years in health facility and community settings in Zimbabwe. Methods and analysis Individuals attending for HIV care at selected primary healthcare clinics (PHCs) will be asked if they have any children aged 2-18 years in their households who have not been tested for HIV. Three options for HIV testing for these children will be offered: testing at the PHC; home-based testing performed by community workers; or an oral mucosal HIV test given to the caregiver to test the children at home. All eligible children will be followed-up to ascertain whether HIV testing occurred. For those who did not test, reasons will be determined, and for those who tested, the HIV test result will be recorded. The primary outcome will be uptake of HIV testing. The secondary outcomes will be preferred HIV testing method, HIV yield, prevalence and proportion of those testing positive linking to care and having an undetectable viral load at 12 months. HIV test results will be stratified by sex and age group, and factors associated with uptake of HIV testing and choice of HIV testing method will be investigated. Ethics and dissemination Ethical approval for this study was granted by the Medical Research Council of Zimbabwe, the London School of Hygiene and Tropical Medicine and the Institutional Review Board of the Biomedical Research and Training Institute. Study results will be presented at national policy meetings and national and international research conferences. Results will also be published in international peer-reviewed scientific journals and disseminated to study communities at the end of study. [ABSTRACT FROM AUTHOR]

Background: Mobile phones may help young people (YP) access health information and support health service engagement. However, in low-income settings there is limited knowledge on YP's phone and internet access to inform the feasibility of implementing digital health interventions. Objective: We investigated access to information and communication technologies among adolescents and young adults in Zimbabwe. Methods: A cross-sectional population-based survey was conducted from October to December 2018 among YP aged 13-24 years in 5 communities in urban and peri-urban Harare and Mashonaland East, Zimbabwe. Consenting YP completed a self-completed tablet-based questionnaire on mobile phone ownership and use, and use of the internet. The primary outcome was the proportion who reported owning a mobile phone. Secondary outcomes included phone and internet access and use behavior, and ownership and use of other technological devices. Multivariable logistic regression was used to investigate factors associated with mobile phone ownership and with internet access, with adjustment for the one-stage cluster sampling design. A priori exploratory variables were age, sex, marital status, and urban/peri-urban residence. Results: A total of 634/719 (88.2%) eligible YP, mean age 18.0 years (SD 3.3) and 62.6% (397/634) females, participated. Of the YP interviewed, 62.6% (396/633; 95% CI 58.5-66.5) reported owning a phone and a further 4.3% (27/633) reported having access to a shared phone. Phone ownership increased with age: 27.0% (43/159) of 13-15-year olds, 61.0% (72/118) of 16-17-year olds, 71.5% (103/144) of 18-19-year olds, and 84.7% (171/202) of 20-24-year olds (odds ratio [OR] 1.4, 95% CI 1.3-1.5) per year increase. Ownership was similar among females and males: 61.0% (236/387; 95% CI 55.6-66.1) versus 64.8% (153/236; 95% CI 57.8-71.2), age-adjusted OR 0.7 (95% CI 0.5-1.1); higher in those with secondary level education compared to primary or no education: 67.1% (346/516; 95% CI 62.6-71.2) versus 26% (21/82; 95% CI 16.4-37.7), age-adjusted OR 2.3 (95% CI 1.1-4.8); and similar across other sociodemographic factors. YP reported that 85.3% (361/423) of phones, either owned or shared, were smartphones. Among phone owners, the most commonly used phone app was WhatsApp (71.2%, 282/396), and 16.4% (65/396) reported having ever used their phone to track their health. A total of 407/631 (64.5%; 95% CI 60.3-68.5) currently had access to the internet (used in last 3 months on any device) with access increasing with age (OR 1.2, 95% CI 1.2-1.3 per year increase). In age-adjusted analysis, internet access was higher among males, the unmarried, those with a higher level of education, phone owners, and those who had lived in the community for more than 1 year. The aspect of the internet that YP most disliked was unwanted sexual (29.2%, 136/465) and violent (13.1%, 61/465) content. Conclusions: Mobile phone–based interventions may be feasible in this population; however, such interventions could increase inequity, especially if they require access to the internet. Internet-based interventions should consider potential risks for participants and incorporate skill-building sessions on safe internet and phone use. JMIR Mhealth Uhealth 2021;9(1):e21244 doi:10.2196/21244 [ABSTRACT FROM AUTHOR]