103 results on '"Tsitsi Apollo"'
Search Results
2. Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018
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Trudy Tholakele Mhlanga, Bart K. M. Jacobs, Tom Decroo, Emma Govere, Hilda Bara, Prosper Chonzi, Ngwarai Sithole, Tsitsi Apollo, Wim Van Damme, Simbarashe Rusakaniko, Lutgarde Lynen, and Richard Makurumidze
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HIV viral load testing ,ART ,Viral load non-suppression ,Implementation ,Zimbabwe ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Abstract Background Since the scale-up of routine viral load (VL) testing started in 2016, there is limited evidence on VL suppression rates under programmatic settings and groups at risk of non-suppression. We conducted a study to estimate VL non-suppression (> 1000 copies/ml) and its risk factors using "routine" and "repeat after enhanced adherence counselling (EAC)" VL results. Methods We conducted an analytic cross-sectional study using secondary VL testing data collected between 2014 and 2018 from a centrally located laboratory. We analysed data from routine tests and repeat tests after an individual received EAC. Our outcome was viral load non-suppression. Bivariable and multivariable logistic regression was performed to identify factors associated with having VL non-suppression for routine and repeat VL. Results We analysed 103,609 VL test results (101,725 routine and 1884 repeat test results) collected from the country’s ten provinces. Of the 101,725 routine and 1884 repeat VL tests, 13.8% and 52.9% were non-suppressed, respectively. Only one in seven (1:7) of the non-suppressed routine VL tests had a repeat test after EAC. For routine VL tests; males (vs females, adjusted odds ratio (aOR) = 1.19, [95% CI 1.14–1.24]) and adolescents (10–19 years) (vs adults (25–49 years), aOR = 3.11, [95% CI 2.9–3.31]) were more at risk of VL non-suppression. The patients who received care at the secondary level (vs primary, aOR = 1.21, [95% CI 1.17–1.26]) and tertiary level (vs primary, aOR = 1.63, [95% CI 1.44–1.85]) had a higher risk of VL non-suppression compared to the primary level. Those that started ART in 2014–2015 (vs
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- 2022
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3. Integrating 3HP‐based tuberculosis preventive treatment into Zimbabwe's Fast Track HIV treatment model: experiences from a pilot study
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Munyaradzi P. Mapingure, Jennifer M. Zech, Yael Hirsch‐Moverman, Martin Msukwa, Andrea A. Howard, Tatenda Makoni, Clorata Gwanzura, Tsitsi Apollo, Charles Sandy, Godfrey N. Musuka, and Miriam Rabkin
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tuberculosis preventive treatment (TPT) ,differentiated service delivery ,people living with HIV (PLHIV) ,Zimbabwe ,Africa ,differentiated care ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Abstract Introduction Tuberculosis (TB) causes one‐third of HIV‐related deaths worldwide, making TB preventive treatment (TPT) a critical element of HIV programmes. Approximately 16% of people living with HIV (PLHIV) on antiretrovirals in Zimbabwe are enrolled in the Fast Track (FT) differentiated service delivery model, which includes multi‐month dispensing of antiretrovirals and quarterly health facility (HF) visits. We assessed the feasibility and acceptability of utilizing FT to deliver 3HP (3 months of once‐weekly rifapentine and isoniazid) for TPT by aligning TPT and HIV visits, providing multi‐month dispensing of 3HP, and using phone‐based monitoring and adherence support. Methods We recruited a purposive sample of 50 PLHIV enrolled in FT at a high‐volume HF in urban Zimbabwe. At enrolment, participants provided written informed consent, completed a baseline survey, and received counselling, education and a 3‐month supply of 3HP. A study nurse mentor called participants at weeks 2, 4 and 8 to monitor and support adherence and side effects. When participants returned for their routine 3‐month FT visit, they completed another survey, and study staff conducted a structured medical record review. In‐depth interviews were conducted with providers who participated in the pilot. Results Participants were enrolled between April and June 2021 and followed through September 2021. Median age = 32 years (IQR 24,41), 50% female, median time in FT 1.8 years (IQR 0.8,2.7). Forty‐eight participants (96%) completed 3HP in 13 weeks; one completed in 16 weeks, and one stopped due to jaundice. Most participants (94%) reported “always” or “almost always” taking 3HP correctly. All reported they were very satisfied with the counselling, education, support and quality of care they received from providers and FT service efficiency. Almost all (98%) said they would recommend it to other PLHIV. Challenges reported included pill burden (12%) and tolerability (24%), but none had difficulty with phone‐based counselling or wished for additional HF‐based visits. Discussion Using FT to deliver 3HP was feasible and acceptable. Some reported tolerability challenges but 98% completed 3HP, and all appreciated the efficiency of aligning TPT and HIV HF visits, multi‐month dispensing and phone‐based counselling. Conclusions Scaling up this approach could expand TPT coverage in Zimbabwe.
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- 2023
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4. Identifying youth at high risk for sexually transmitted infections in community-based settings using a risk prediction tool: a validation study
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Katharina Kranzer, Victoria Simms, Ethel Dauya, Ioana D. Olaru, Chido Dziva Chikwari, Kevin Martin, Nicol Redzo, Tsitsi Bandason, Mandikudza Tembo, Suzanna C. Francis, Helen A. Weiss, Richard J. Hayes, Constancia Mavodza, Tsitsi Apollo, Gertrude Ncube, Anna Machiha, and Rashida Abbas Ferrand
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Sexually transmitted infections ,Adolescents ,Screening ,Risk prediction tool ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common bacterial sexually transmitted infections (STIs) worldwide. In the absence of affordable point-of-care STI tests, WHO recommends STI testing based on risk factors. This study aimed to develop a prediction tool with a sensitivity of > 90% and efficiency (defined as the percentage of individuals that are eligible for diagnostic testing) of
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- 2021
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5. 'Other risks don't stop': adapting a youth sexual and reproductive health intervention in Zimbabwe during COVID-19
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Constance R. S. Mackworth-Young, Constancia Mavodza, Rangarirayi Nyamwanza, Maureen Tshuma, Portia Nzombe, Chido Dziva Chikwari, Mandikudza Tembo, Ethel Dauya, Tsitsi Apollo, Rashida A. Ferrand, and Sarah Bernays
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youth ,young people ,sexual and reproductive health ,hiv ,covid-19 ,youth-friendly ,zimbabwe ,Diseases of the genitourinary system. Urology ,RC870-923 ,The family. Marriage. Woman ,HQ1-2044 - Abstract
COVID-19 threatens hard-won gains in sexual and reproductive health (SRH) through compromising the ability of services to meet needs. Youth are particularly threatened due to existing barriers to their access to services. CHIEDZA is a community-based integrated SRH intervention for youth being trialled in Zimbabwe. CHIEDZA closed in March 2020, in response to national lockdown, and reopened in May 2020, categorised as an essential service. We aimed to understand the impact of CHIEDZA’s closure and its reopening, with adaptations to reduce COVID-19 transmission, on provider and youth experiences. Qualitative methods included interviews with service providers (n = 22) and youth (n = 26), and observations of CHIEDZA sites (n = 10) and intervention team meetings (n = 7). Analysis was iterative and inductive. The sudden closure of CHIEDZA impeded youth access to SRH services. The reopening of CHIEDZA was welcomed, but the necessary adaptations impacted the intervention and engagement with it. Adaptations restricted time with healthcare providers, heightening the tension between numbers of youths accessing the service and quality of service provision. The removal of social activities, which had particularly appealed to young men, impacted youth engagement and access to services, particularly for males. This paper demonstrates how a community-based youth-centred SRH intervention has been affected by and adapted to COVID-19. We demonstrate how critical ongoing service provision is, but how adaptations negatively impact service provision and youth engagement. The impact of adaptations additionally emphasises how time with non-judgemental providers, social activities, and integrated services are core components of youth-friendly services, not added extras.
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- 2022
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6. Putting youth at the centre: co-design of a community-based intervention to improve HIV outcomes among youth in Zimbabwe [version 2; peer review: 2 approved]
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Constancia Mavodza, Stefanie Dringus, Maurice Wedner-Ross, Grace McHugh, Tsitsi Apollo, Ethel Dauya, Chido Dziva Chikwari, Mandikudza Tembo, Rashida A. Ferrand, Victoria Simms, Constance RS. Mackworth-Young, Aoife Doyle, Owen Mugurungi, and Sarah Bernays
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Adolescents ,Youth ,HIV care continuum ,HIV prevention ,sub-Saharan Africa ,eng ,Medicine ,Science - Abstract
Abstract Background Youth have disproportionately poor HIV outcomes. We aimed to co-design a community-based intervention with youth to improve HIV outcomes among 16-24 year-olds, to be trialled in Zimbabwe. Methods We conducted 90 in-depth interviews with youth, family members, community gatekeepers and healthcare providers to understand the barriers to uptake of existing HIV services. The interviews informed an outline intervention, which was refined through two participatory workshops with youth, and subsequent pilot-testing. Results Participants considered existing services inaccessible and unappealing: health facilities were perceived to be for ‘sick people’, centred around HIV and served by judgemental providers. Proposed features of an intervention to overcome these barriers included: i) delivery in a youth-only community space; ii) integration of HIV services with broader health services; iii) non-judgemental skilled healthcare providers; iv) entertainment to encourage attendance; and v) tailored timings and outreach. The intervention framework stands on three core pillars, based on optimising access (community-based youth-friendly settings); uptake and acceptability (service branding, confidentiality, and social activities); and content and quality (integrated HIV care cascade, high quality products, and trained providers). Conclusions Ongoing meaningful youth engagement is critical to designing HIV interventions if access, uptake, and coverage is to be achieved.
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- 2022
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7. Family Planning Experiences and Needs of Young Women Living With and Without HIV Accessing an Integrated HIV and SRH Intervention in Zimbabwe-An Exploratory Qualitative Study
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Constancia V. Mavodza, Joanna Busza, Constance R. S. Mackworth-Young, Rangarirai Nyamwanza, Portia Nzombe, Ethel Dauya, Chido Dziva Chikwari, Mandikudza Tembo, Victoria Simms, Owen Mugurungi, Tsitsi Apollo, Bernard Madzima, Rashida A. Ferrand, and Sarah Bernays
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HIV ,family planning ,integrated service delivery ,young people living with HIV ,Zimbabwe ,Gynecology and obstetrics ,RG1-991 ,Women. Feminism ,HQ1101-2030.7 - Abstract
BackgroundPeople living with HIV have higher unmet family planning needs compared to those without HIV. This is heightened for young people. However, the provision of family planning for young people within HIV programmes is uncommon. We investigated family planning uptake, acceptability of, and engagement with a service offering integrated HIV and sexual and reproductive health services for youth in a community-based setting in Zimbabwe.MethodsCHIEDZA, a community-based intervention offering integrated HIV and sexual and reproductive health services to young people aged 16–24 years, is being trialed in Zimbabwe. This exploratory qualitative study was nested within an ongoing study process evaluation. Data was collected between March-May 2021 with two sets of interviews conducted: I) twelve semi-structured interviews with young women living with HIV aged 17–25 years and II) fifteen interviews conducted with young women without HIV aged between 20 and 25 years who used a contraceptive method. A thematic analysis approach was used.ResultsBefore engaging with CHIEDZA, young women had experienced judgmental providers, on account of their age, and received misinformation about contraceptive use and inadequate information about ART-contraceptive interactions. These presented as barriers to uptake and engagement. Upon attending CHIEDZA, all the young women reported receiving non-judgmental care. For those living with HIV, they were able to access integrated HIV and family planning services that supported them having broader sexual and reproductive needs beyond their HIV diagnosis. The family planning preference of young women living with HIV included medium to long-acting contraceptives to minimize adherence challenges, and desired partner involvement in dual protection to prevent HIV transmission. CHIEDZA's ability to meet these preferences shaped uptake, acceptability, and engagement with integrated HIV and family services.ConclusionsRecommendations for an HIV and family planning integrated service for young people living with HIV include: offering a range of services (including method-mix contraceptives) to choose from; supporting their agency to engage with the services which are most acceptable to them; and providing trained, supportive, knowledgeable, and non-judgmental health providers who can provide accurate information and counsel. We recommend youth-friendly, differentiated, person-centered care that recognize the multiple and intersecting needs of young people living with HIV.
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- 2022
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8. Addressing the challenges and relational aspects of index-linked HIV testing for children and adolescents: insights from the B-GAP study in Zimbabwe
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Chido Dziva Chikwari, Sarah Bernays, Stefanie Dringus, Victoria Simms, Helen A. Weiss, Edwin Sibanda, Katharina Kranzer, Gertrude Ncube, Rudo Chikodzore, Karen Webb, Trevor Chirimambowa, Kenny Sithole, Nonhlanhla Ndondo, Tsitsi Apollo, Miriam Mutseta, and Rashida A. Ferrand
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HIV testing ,Index-linked testing ,Barriers ,Children ,Adolescents ,Medicine (General) ,R5-920 - Abstract
Abstract Introduction Index-linked HIV testing, targeted at sexual contacts or children of individuals with HIV, may improve yield and efficiency. The B-GAP study evaluated index-linked testing approaches in health facility and community-based settings. This paper reports on a qualitative study to understand factors that affect uptake of index-linked HIV testing for children and adolescents. Methods We conducted four focus group discussions (FGDs) with caregivers who had their children tested through B-GAP and one FGD with providers who offered index-linked HIV testing to indexes. We aimed to understand enabling and inhibiting factors in the decision-making process. Translated and transcribed transcripts were read for familiarisation. Following initial coding, analytical memos were written to identify emerging key themes across the data. Results Our findings showed there was inadequate emphasis on paediatric HIV in routine care which had a negative impact on subsequent uptake of testing for children. Once the decision to test had been made, access to facilities was sometimes challenging and alleviated by community-based testing. A key finding was that HIV testing is not a discrete event but a process that was influenced by relationships with other family members and children themselves. These relationships raised complex issues that could prevent or delay the testing process. Conclusion There is a need to improve messaging on the importance of HIV testing for children and adolescents and to provide support to caregivers and their families in order to improve testing uptake. Addressing access barriers through the provision of community-based testing and implementing a family-centred approach can optimise index-linked testing.
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- 2020
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9. Peer-led counselling with problem discussion therapy for adolescents living with HIV in Zimbabwe: A cluster-randomised trial
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Victoria Simms, Helen A. Weiss, Silindweyinkosi Chinoda, Abigail Mutsinze, Sarah Bernays, Ruth Verhey, Carol Wogrin, Tsitsi Apollo, Owen Mugurungi, Dorcas Sithole, Dixon Chibanda, and Nicola Willis
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Medicine - Abstract
Background Adolescents living with HIV have poor virological suppression and high prevalence of common mental disorders (CMDs). In Zimbabwe, the Zvandiri adolescent peer support programme is effective at improving virological suppression. We assessed the effect of training Zvandiri peer counsellors known as Community Adolescent Treatment Supporters (CATS) in problem-solving therapy (PST) on virological suppression and mental health outcomes. Methods and findings Sixty clinics were randomised 1:1 to either normal Zvandiri peer counselling or a peer counsellor trained in PST. In January to March 2019, 842 adolescents aged 10 to 19 years and living with HIV who screened positive for CMDs were enrolled (375 (44.5%) male and 418 (49.6%) orphaned of at least one parent). The primary outcome was virological nonsuppression (viral load ≥1,000 copies/mL). Secondary outcomes were symptoms of CMDs measured with the Shona Symptom Questionnaire (SSQ ≥8) and depression measured with the Patient Health Questionnaire (PHQ-9 ≥10) and health utility score using the EQ-5D. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using logistic regression adjusting for clinic-level clustering. Case reviews and focus group discussions were used to determine feasibility of intervention delivery. At baseline, 35.1% of participants had virological nonsuppression and 70.3% had SSQ≥8. After 48 weeks, follow-up was 89.5% for viral load data and 90.9% for other outcomes. Virological nonsuppression decreased in both arms, but there was no evidence of an intervention effect (prevalence of nonsuppression 14.7% in the Zvandiri-PST arm versus 11.9% in the Zvandiri arm; AOR = 1.29; 95% CI 0.68, 2.48; p = 0.44). There was strong evidence of an apparent effect on common mental health outcomes (SSQ ≥8: 2.4% versus 10.3% [AOR = 0.19; 95% CI 0.08, 0.46; p < 0.001]; PHQ-9 ≥10: 2.9% versus 8.8% [AOR = 0.32; 95% CI 0.14, 0.78; p = 0.01]). Prevalence of EQ-5D index score Conclusions PST training for CATS did not add to the benefit of peer support in reducing virological nonsuppression but led to improved symptoms of CMD and depression compared to standard Zvandiri care among adolescents living with HIV in Zimbabwe. Active involvement of caregivers and strengthened referral structures could increase feasibility and effectiveness. Trial registration Pan African Clinical Trials Registry PACTR201810756862405. Victoria Simms and co-workers report on a trial of problem discussion therapy for adolescents with HIV infection and common mental disorders in Zimbabwe. Author summary Why was this study done? Common mental disorders (CMDs) such as anxiety and depression are highly prevalent among adolescents living with HIV. It is important to identify strategies to treat CMDs in this population. The Friendship Bench is a proven effective mental health intervention based on problem-solving therapy (PST), which is delivered by trained lay counsellors. The Zvandiri programme is a proven effective intervention to improve HIV outcomes among adolescents, delivered by trained peer counsellors. It is not known whether PST could improve mental health, and HIV outcomes, among adolescents living with HIV, when delivered in addition to the Zvandiri programme. What did the researchers do and find? We conducted a trial among 842 adolescents living with HIV in Zimbabwe, who also had CMDs (depression and anxiety), and attended public health clinics for HIV care. We randomly allocated 30 clinics to provide Zvandiri peer counselling to adolescents living with HIV, and a further 30 clinics to provide Zvandiri counselling plus the Friendship Bench PST. After a year, there was no difference in the proportion with unsuppressed HIV viral load, and this was low in both groups. There was a substantial improvement in mental health (depression and anxiety) in both groups, with significantly better outcomes among those in the Friendship Bench group. The peer counsellors adapted their training and focused on problem discussion rather than problem-solving, because many adolescents identified problems that they did not have the resources to solve. What do these findings mean? To our knowledge, this is the first study to show that an intervention can improve mental health among adolescents living with HIV who have mental health disorders. The lack of an impact on HIV viral load, compared to the Zvandiri programme, might be because of the effectiveness of the Zvandiri counselling and the presence of resistance to HIV drugs in a small number of participants. Mental healthcare should be integrated in HIV care for adolescents. It should be age specific, with shorter sessions than for adults, creating a space for discussing and sharing problems, and involving caregivers as appropriate.
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- 2022
10. Integrating HIV services and other health services: A systematic review and meta-analysis
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Caroline A. Bulstra, Jan A. C. Hontelez, Moritz Otto, Anna Stepanova, Erik Lamontagne, Anna Yakusik, Wafaa M. El-Sadr, Tsitsi Apollo, Miriam Rabkin, UNAIDS Expert Group on Integration, Rifat Atun, and Till Bärnighausen
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Medicine - Abstract
Background Integration of HIV services with other health services has been proposed as an important strategy to boost the sustainability of the global HIV response. We conducted a systematic and comprehensive synthesis of the existing scientific evidence on the impact of service integration on the HIV care cascade, health outcomes, and cost-effectiveness. Methods and findings We reviewed the global quantitative empirical evidence on integration published between 1 January 2010 and 10 September 2021. We included experimental and observational studies that featured both an integration intervention and a comparator in our review. Of the 7,118 unique peer-reviewed English-language studies that our search algorithm identified, 114 met all of our selection criteria for data extraction. Most of the studies (90) were conducted in sub-Saharan Africa, primarily in East Africa (55) and Southern Africa (24). The most common forms of integration were (i) HIV testing and counselling added to non-HIV services and (ii) non-HIV services added to antiretroviral therapy (ART). The most commonly integrated non-HIV services were maternal and child healthcare, tuberculosis testing and treatment, primary healthcare, family planning, and sexual and reproductive health services. Values for HIV care cascade outcomes tended to be better in integrated services: uptake of HIV testing and counselling (pooled risk ratio [RR] across 37 studies: 1.67 [95% CI 1.41–1.99], p < 0.001), ART initiation coverage (pooled RR across 19 studies: 1.42 [95% CI 1.16–1.75], p = 0.002), time until ART initiation (pooled RR across 5 studies: 0.45 [95% CI 0.20–1.00], p = 0.050), retention in HIV care (pooled RR across 19 studies: 1.68 [95% CI 1.05–2.69], p = 0.031), and viral suppression (pooled RR across 9 studies: 1.19 [95% CI 1.03–1.37], p = 0.025). Also, treatment success for non-HIV-related diseases and conditions and the uptake of non-HIV services were commonly higher in integrated services. We did not find any significant differences for the following outcomes in our meta-analyses: HIV testing yield, ART adherence, HIV-free survival among infants, and HIV and non-HIV mortality. We could not conduct meta-analyses for several outcomes (HIV infections averted, costs, and cost-effectiveness), because our systematic review did not identify sufficient poolable studies. Study limitations included possible publication bias of studies with significant or favourable findings and comparatively weak evidence from some world regions and on integration of services for key populations in the HIV response. Conclusions Integration of HIV services and other health services tends to improve health and health systems outcomes. Despite some scientific limitations, the global evidence shows that service integration can be a valuable strategy to boost the sustainability of the HIV response and contribute to the goal of ‘ending AIDS by 2030’, while simultaneously supporting progress towards universal health coverage. Caroline Bulstra and co-workers assess evidence on the benefits of service integration in the HIV care cascade. Author summary Why was this study done? The rapid scale-up of HIV testing and antiretroviral therapy (ART) in many countries and communities over the past 2 decades has been largely achieved with stand-alone HIV programmes. Increasing life expectancy and the side effects of ART are leading to more co-morbidities among people living with HIV, suggesting that ART programmes that also offer other treatments could improve both healthcare effectiveness and the patient experience. Other reasons for integration of services include the hope that joint delivery of services will increase coverage and reduce costs. The global evidence on integration of HIV services and other health services, to our knowledge, has never been synthesised, and it is thus unclear what the empirical effects of integration are. What did the researchers do and find? We conducted a systematic review and meta-analysis to synthesise the results of integrating HIV services and other health services for HIV care cascade outcomes (testing, linkage to care, treatment initiation, treatment adherence, retention, and viral suppression), HIV health outcomes (new infections and mortality), non-HIV health outcomes, and costs and cost-effectiveness. In most of the 114 studies that our systematic review identified most outcomes were better in integrated compared to separate services. What do these findings mean? Integration of HIV services and other health services tends to improve health and health systems outcomes. The success of integration strategies is highly context-specific, and more evidence is needed on integration in specific geographical areas and for key populations in the HIV response. Despite such limitations, our systematic review and meta-analysis support the case for integration as a valuable and viable strategy to boost the sustainability of the HIV response and contribute to the goal of ‘ending AIDS by 2030’, while simultaneously supporting progress towards universal health coverage.
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- 2021
11. When healthcare providers are supportive, ‘I'd rather not test alone’: Exploring uptake and acceptability of HIV self‐testing for youth in Zimbabwe – A mixed method study
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Constancia V. Mavodza, Constance R. S. Mackworth‐Young, Tsitsi Bandason, Ethel Dauya, Chido Dziva Chikwari, Mandikudza Tembo, Tsitsi Apollo, Getrude Ncube, Katharina Kranzer, Rashida Abbas Ferrand, and Sarah Bernays
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decision‐making ,HIV self‐testing ,preferences ,sequential explanatory mixed method design ,youth ,Zimbabwe ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Abstract Introduction In sub‐Saharan Africa, less than half of young people know their HIV status. HIV self‐testing (HIVST) is a testing strategy with the potential to offer privacy and autonomy. We aimed to understand the uptake and acceptability of different HIV testing options for youth in Harare, Zimbabwe. Methods This study was nested within a cluster randomized trial of a youth‐friendly community‐based integrated HIV and sexual and reproductive health intervention for youth aged 16–24 years. Three HIV testing options were offered: (1) provider‐delivered testing; (2) HIVST on site in a private booth without a provider present; and (3) provision of a test kit to test off site. Descriptive statistics and proportions were used to investigate the uptake of HIV testing in a client sample. A focus group discussion (FGD) with intervention providers alongside in‐depth interviews, paired interviews and FGDs with a selected sample of youth clients explored uptake and acceptability of the different HIV testing strategies. Thematic analysis was used to analyse the qualitative data. Results Between April and June 2019, 951 eligible clients were tested for HIV: 898 (94.4%) chose option 1, 30 (3.25%) chose option 2 and 23 (2.4%) chose option 3. Option 1 clients cited their trust in the service and a desire for immediate counselling, support and guidance from trusted providers as the reasons for their choice. Young people were not confident in their expertise to conduct HIVST. Concerns about limited privacy, confidentiality and lack of support in the event of an HIV‐positive result were barriers for off‐site HIVST. Conclusions In the context of supportive, trusted and youth‐friendly providers, youth clients overwhelmingly preferred provider‐delivered HIV testing over client‐initiated HIVST or HIVST off site. This highlights the importance of listening to youth to improve engagement in testing. While young people want autonomy in choosing when, where and how to test, they do not want to necessarily test on their own. They desire quality in‐person counselling, guidance and support, alongside privacy and confidentiality. To increase the appeal of HIVST for youth, greater provision of access to private spaces is required, and accessible pre‐ and post‐test counselling and support may improve uptake.
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- 2021
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12. Strengthening provider-initiated testing and counselling in Zimbabwe by deploying supplemental providers: a time series analysis
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Aaron F. Bochner, Beth A. Tippett Barr, Batsirai Makunike, Gloria Gonese, Blessing Wazara, Richard Mashapa, Elizabeth Meacham, Ponesai Nyika, Gertrude Ncube, Shirish Balachandra, Ruth Levine, Frances Petracca, Tsitsi Apollo, Ann Downer, and Stefan Z. Wiktor
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HIV testing services ,Provider initiated testing and counselling ,Human resources ,Zimbabwe ,Implementation science ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Expansion of provider-initiated testing and counselling (PITC) is one strategy to increase accessibility of HIV testing services. Insufficient human resources was identified as a primary barrier to increasing PITC coverage in Zimbabwe. We evaluated if deployment of supplemental PITC providers at public facilities in Zimbabwe was associated with increased numbers of individuals tested and diagnosed with HIV. Methods From July 2016 to May 2017, International Training and Education Center for Health (I-TECH) deployed 138 PITC providers to supplement existing ministry healthcare workers offering PITC at 249 facilities. These supplemental providers were assigned to facilities on a weekly basis. Each week, I-TECH providers reported the number of HIV tests and positive diagnoses they performed. Using routine reporting systems, we obtained from each facility the number of clients tested and diagnosed with HIV per month. Including data both before and during the intervention period, and utilizing the weekly variability in placement locations of the supplemental PITC providers, we employed generalized estimating equations to assess if the placement of supplemental PITC providers at a facility was associated with a change in facility outputs. Results Supplemental PITC providers performed an average of 62 (SD = 52) HIV tests per week and diagnosed 4.4 (SD = 4.9) individuals with HIV per week. However, using facility reports from the same period, we found that each person-week of PITC provider deployment at a facility was associated with an additional 16.7 (95% CI, 12.2–21.1) individuals tested and an additional 0.9 (95% CI, 0.5–1.2) individuals diagnosed with HIV. We also found that staff placement at clinics was associated with a larger increase in HIV testing than staff placement at polyclinics or hospitals (24.0 vs. 9.8; p
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- 2019
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13. Provision of HIV viral load testing services in Zimbabwe: Secondary data analyses using data from health facilities using the electronic Patient Monitoring System.
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Tsitsi Apollo, Kudakwashe C Takarinda, Andrew Phillips, Chiratidzo Ndhlovu, and Frances M Cowan
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Medicine ,Science - Abstract
IntroductionRoutine viral load (VL) testing among persons living with Human Immunodeficiency Virus (PLHIV) enables earlier detection of sub-optimal antiretroviral therapy (ART) adherence and for appropriate management of treatment failure. Since adoption of this policy by Zimbabwe in 2016, the extent of implementation is unclear. Therefore we set out to determine among PLHIV ever enrolled on ART from 2004-2017 and in ART care for ≥12 months at health facilities providing ART in Zimbabwe: numbers (proportions) with VL testing uptake, VL suppression and subsequently switched to 2nd-line ART following confirmed virologic failure.Materials and methodsWe used retrospective data from the electronic Patient Monitoring System (ePMS) in which PLHIV on ART are registered at 525 public and 4 private health facilities.ResultsAmong the 392,832 PLHIV in ART care for ≥12 months, 99,721 (25.4%) had an initial VL test done and results available of whom 81,932 (82%) were virally suppressed. Among those with a VL>1000 copies/mL; 6,689 (37.2%) had a follow-up VL test and 4,086 (61%) had unsuppressed VLs of whom only 1,749 (42.8%) were switched to 2nd-line ART. Lower age particularly adolescents (10-19 years) were more likely (ARR 1.34; 95%CI: 1.25-1.44) to have virologic failure.ConclusionThe study findings provide insights to implementation gaps including limitations in VL testing; low identification of high- risk PLHIV in care and lack of prompt utilization of test results. The use of electronic patient-level data has demonstrated its usefulness in assessing the performance of the national VL testing program. By end of 2017 implementation of VL testing was sub-optimal, and virological failure was relatively common, particularly among adolescents. Of concern is evidence of failure to act on VL test results that were received. A quality improvement initiative has been planned in response to these findings and its effect on patient management will be monitored.
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- 2021
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14. Patient costs for prevention of mother-to-child HIV transmission and antiretroviral therapy services in public health facilities in Zimbabwe.
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Innocent Chingombe, Munyaradzi P Mapingure, Shirish Balachandra, Tendayi N Chipango, Fiona Gambanga, Angela Mushavi, Tsitsi Apollo, Chutima Suraratdecha, John H Rogers, Leala Ruangtragool, Elizabeth Gonese, Godfrey N Musuka, Owen M Mugurungi, and Tiffany G Harris
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Medicine ,Science - 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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- 2021
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15. Evaluation of the Zimbabwe HIV case surveillance pilot project, 2019
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Peter Nsubuga, Simbarashe Mabaya, Tsitsi Apollo, Ngwarai Sithole, Brian Komtenza, Takura Matare, Anesu Chimwaza, Kudakwashe Takarinda, Brian Moyo, Leon Mbano, Regis Choto, Thandekile Moyo, David Lowrance, Daniel Low-Beer, Owen Mugurungi, and Alex Gasasira
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hiv ,case surveillance ,informatics ,electronic health records ,continuum of care ,patient monitoring ,Medicine - Abstract
INTRODUCTION: Zimbabwe has a high burden of HIV (i.e., estimated 1.3 million HIV-infected and 13.8% HIV incidence in 2017). In 2017 the country developed and implemented a pilot of HIV case surveillance (CS) based on the 2017 World Health Organisation (WHO) person-centred HIV patient monitoring (PM) and case surveillance guidelines. At the end of the pilot phase an evaluation was conducted to inform further steps. METHODS: The pilot was conducted in two districts (i.e., Umzingwane in Matabeleland South Province and Mutare in Manicaland Province) from August 2017 to December 2018. A mixed-methods cross-sectional study of stakeholders and health facility staff was used to assess the design and operations, performance, usefulness, sustainability, and scalability of the CS system. A total of 13 stakeholders responded to an online questionnaire, while 33 health facility respondents were interviewed in 11 health facilities in the two districts. RESULTS: The HIV CS system was adequately designed for Zimbabwe’s context, integrated within existing health information systems at the facility level. However, the training was minimal, and an opportunity to train the data entry clerks in data analysis was missed. The system performed well in terms of surveillance and informatics attributes. However, viral load test results return was a significant problem. CONCLUSION: The HIV CS system was found useful at the health facility level and should be rolled out in a phased manner, beginning in Manicaland and Matabeleland South provinces. An electronic link needs to be made between the health facilities and the laboratory to reduce viral load test results delays.
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- 2020
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16. Acceptability of Community-Based Tuberculosis Preventive Treatment for People Living with HIV in Zimbabwe
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Martin K. Msukwa, Munyaradzi P. Mapingure, Jennifer M. Zech, Tsitsi B. Masvawure, Joanne E. Mantell, Godfrey Musuka, Tsitsi Apollo, Rodrigo Boccanera, Innocent Chingombe, Clorata Gwanzura, Andrea A. Howard, and Miriam Rabkin
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HIV ,TB prevention ,TPT ,differentiated service delivery ,Zimbabwe ,integration ,Medicine - Abstract
As Zimbabwe expands tuberculosis preventive treatment (TPT) for people living with HIV (PLHIV), the Ministry of Health and Child Care is considering making TPT more accessible to PLHIV via less-intensive differentiated service delivery models such as Community ART Refill Groups (CARGs). We designed a study to assess the feasibility and acceptability of integrating TPT into CARGs among key stakeholders, including CARG members, in Zimbabwe. We conducted 45 key informant interviews (KII) with policy makers, implementers, and CARG leaders; 16 focus group discussions (FGD) with 136 PLHIV in CARGs; and structured observations of 8 CARG meetings. KII and FGD were conducted in English and Shona. CARG observations were conducted using a structured checklist and time-motion data capture. Ninety six percent of participants supported TPT integration into CARGs and preferred multi-month TPT dispensing aligned with ART dispensing schedules. Participants noted that the existing CARG support systems could be used for TB symptom screening and TPT adherence monitoring/support. Other perceived advantages included convenience for PLHIV and decreased health facility provider workloads. Participants expressed concerns about possible medication stockouts and limited knowledge about TPT among CARG leaders but were confident that CARGs could effectively provide community-based TPT education, adherence monitoring/support, and TB symptom screening provided that CARG leaders received appropriate training and supervision. These results are consistent with findings from pilot projects in other African countries that are scaling up both differentiated service delivery for HIV and TPT and suggest that designing contextually appropriate approaches to integrating TPT into less-intensive HIV treatment models is an effective way to reach people who are established on ART but who may have missed out on access to TPT.
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- 2022
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17. Anti-retroviral therapy after 'Treat All' in Harare, Zimbabwe: What are the changes in uptake, time to initiation and retention? [version 2; peer review: 2 approved]
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Takura Matare, Hemant Deepak Shewade, Ronald T. Ncube, Kudzai Masunda, Innocent Mukeredzi, Kudakwashe C. Takarinda, Janet Dzangare, Gloria Gonese, Bekezela B. Khabo, Regis C. Choto, and Tsitsi Apollo
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Medicine ,Science - Abstract
Background: In Zimbabwe, Harare was the first province to implement “Treat All” for people living with human immunodeficiency virus (PLHIV). Since its roll out in July 2016, no study has been conducted to assess the changes in key programme indicators. We compared antiretroviral therapy (ART) uptake, time to ART initiation from diagnosis, and retention before and during “Treat All”. Methods: We conducted an ecological study to assess ART uptake among all PLHIV newly diagnosed before and during “Treat All”. We conducted a cohort study to assess time to ART initiation and retention in care among all PLHIV newly initiated on ART from all electronic patient management system-supported sites (n=50) before and during “Treat All”. Results: ART uptake increased from 65% (n=4619) by the end of quarter one, 2014 to 85% (n=5152) by the end of quarter four, 2018. A cohort of 2289 PLHIV was newly initiated on ART before (April-June 2015) and 1682 during “Treat all” (April-June 2017). Their age and gender distribution was similar. The proportion of PLHIV in early stages of disease was significantly higher during “Treat all” (73.2% vs. 55.6%, p
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- 2020
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18. Emerging priorities for HIV service delivery.
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Nathan Ford, Elvin Geng, Tom Ellman, Catherine Orrell, Peter Ehrenkranz, Izukanji Sikazwe, Andreas Jahn, Miriam Rabkin, Stephen Ayisi Addo, Anna Grimsrud, Sydney Rosen, Isaac Zulu, William Reidy, Thabo Lejone, Tsitsi Apollo, Charles Holmes, Ana Francisca Kolling, Rosina Phate Lesihla, Huu Hai Nguyen, Baker Bakashaba, Lastone Chitembo, Ghion Tiriste, Meg Doherty, and Helen Bygrave
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Medicine - Abstract
Nathan Ford and co-authors discuss global priorities in the provision of HIV prevention and treatment services.
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- 2020
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19. Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster-randomised controlled trial
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Webster Mavhu, PhD, Nicola Willis, MPhil, Juliet Mufuka, MBA, Sarah Bernays, PhD, Maureen Tshuma, MSc, Collin Mangenah, MSc, Hendramoorthy Maheswaran, PhD, Walter Mangezi, MMed, Tsitsi Apollo, MD, Ricardo Araya, ProfPhD, Helen A Weiss, ProfPhD, and Frances M Cowan, ProfMD
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Public aspects of medicine ,RA1-1270 - Abstract
Summary: Background: Adolescents living with HIV face challenges to their wellbeing and antiretroviral therapy adherence and have poor treatment outcomes. We aimed to evaluate a peer-led differentiated service delivery intervention on HIV clinical and psychosocial outcomes among adolescents with HIV in Zimbabwe. Methods: 16 public primary care facilities (clusters) in two rural districts in Zimbabwe (Bindura and Shamva) were randomly assigned (1:1) to provide enhanced HIV care support (the Zvandiri intervention group) or standard HIV care (the control group) to adolescents (aged 13–19 years) with HIV. Eligible clinics had at least 20 adolescents in pre-ART or ART registers and were geographically separated by at least 10 km to minimise contamination. Adolescents were eligible for inclusion if they were living with HIV, registered for HIV care at one of the trial clinics, and either starting or already on ART. Exclusion criteria were being too physically unwell to attend clinic (bedridden), psychotic, or unable to give informed assent or consent. Adolescents with HIV at all clinics received adherence support through adult counsellors. At intervention clinics, adolescents with HIV were assigned a community adolescent treatment supporter, attended a monthly support group, and received text messages, calls, home visits, and clinic-based counselling. Implementation intensity was differentiated according to each adolescent's HIV vulnerability, which was reassessed every 3 months. Caregivers were invited to a support group. The primary outcome was the proportion of adolescents who had died or had a viral load of at least 1000 copies per μL after 96 weeks. In-depth qualitative data were collected and analysed thematically. The trial is registered with Pan African Clinical Trial Registry, number PACTR201609001767322. Findings: Between Aug 15, 2016, and March 31, 2017, 500 adolescents with HIV were enrolled, of whom four were excluded after group assignment owing to testing HIV negative. Of the remaining 496 adolescents, 212 were recruited at Zvandiri intervention sites and 284 at control sites. At enrolment, the median age was 15 years (IQR 14–17), 52% of adolescents were female, 81% were orphans, and 47% had a viral load of at least 1000 copies per μL. 479 (97%) had primary outcome data at endline, including 28 who died. At 96 weeks, 52 (25%) of 209 adolescents in the Zvandiri intervention group and 97 (36%) of 270 adolescents in the control group had an HIV viral load of at least 1000 copies per μL or had died (adjusted prevalence ratio 0·58, 95% CI 0·36–0·94; p=0·03). Qualitative data suggested that the multiple intervention components acted synergistically to improve the relational context in which adolescents with HIV live, supporting their improved adherence. No adverse events were judged to be related to study procedures. Severe adverse events were 28 deaths (17 in the Zvandiri intervention group, 11 in the control group) and 57 admissions to hospital (20 in the Zvandiri intervention group, 37 in the control group). Interpretation: Peer-supported community-based differentiated service delivery can substantially improve HIV virological suppression in adolescents with HIV and should be scaled up to reduce their high rates of morbidity and mortality. Funding: Positive Action for Adolescents Program, ViiV Healthcare.
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- 2020
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20. Effectiveness of a peer-led adolescent mental health intervention on HIV virological suppression and mental health in Zimbabwe: protocol of a cluster-randomised trial
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Silindweyinkosi Chinoda, Abigail Mutsinze, Victoria Simms, Rhulani Beji-Chauke, Ruth Verhey, Joanna Robinson, Taryn Barker, Owen Mugurungi, Tsitsi Apollo, Epiphany Munetsi, Dorcas Sithole, Helen A. Weiss, Dixon Chibanda, and Nicola Willis
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Adolescents ,HIV ,mental health virological suppression ,peer-led ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
AbstractBackgroundAdolescents living with HIV (ALHIV) experience a high burden of mental health disorder which is a barrier to antiretroviral therapy adherence. In Zimbabwe, trained, mentored peer supporters living with HIV (Community Adolescent Treatment Supporters – CATS) have been found to improve adherence, viral suppression and psychosocial well-being among ALHIV. The Friendship Bench is the largest integrated mental health programme in Africa. We hypothesise that combining the CATS programme and Friendship Bench will improve mental health and virological suppression among ALHIV compared with the CATS programme alone.MethodsWe will conduct a cluster-randomised controlled trial in 60 clinics randomised 1:1 in five provinces. ALHIV attending the control arm clinics will receive standard CATS support and clinic support following the Ministry of Health guidelines. Those attending the intervention arm clinics will receive Friendship Bench problem-solving therapy, delivered by trained CATS. Participants with the signs of psychological distress will be referred to the clinic for further assessment and management. The primary outcome is HIV virological failure (≥1000 copies/ml) or death at 48 weeks. Secondary outcomes include the proportion of adolescents with common mental disorder symptoms (defined as Shona Symptom Questionnaire (SSQ-14) score ≥8), proportion with depression symptoms (defined as Patient Health Questionnaire (PHQ-9) score ≥11), symptom severity (mean SSQ-14 and PHQ-9 scores) and EQ-5D score for health-related quality of life.ConclusionsThis trial evaluates the effectiveness of peer-delivery of mental health care on mental health and HIV viral load among ALHIV. If effective this intervention has the potential to be scaled-up to improve these outcomes.Trial registration: PACTR201810756862405. 08 October 2018.
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- 2020
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21. Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study.
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Miriam Rabkin, Michael Strauss, Joanne E Mantell, Munyaradzi Mapingure, Tsitsi B Masvawure, Matthew R Lamb, Jennifer M Zech, Godfrey Musuka, Innocent Chingombe, Martin Msukwa, Rodrigo Boccanera, Clorata Gwanzura, Gavin George, and Tsitsi Apollo
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Medicine ,Science - 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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- 2020
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22. Patient-mix, programmatic characteristics, retention and predictors of attrition among patients starting antiretroviral therapy (ART) before and after the implementation of HIV 'Treat All' in Zimbabwe.
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Richard Makurumidze, Jozefien Buyze, Tom Decroo, Lutgarde Lynen, Madelon de Rooij, Trevor Mataranyika, Ngwarai Sithole, Kudakwashe C Takarinda, Tsitsi Apollo, James Hakim, Wim Van Damme, and Simbarashe Rusakaniko
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Medicine ,Science - Abstract
BackgroundSince the scale-up of the HIV "Treat All" recommendation, evidence on its real-world effect on predictors of attrition (either death or lost to follow-up) is lacking. We conducted a retrospective study using Zimbabwe ART program data to assess the association between "Treat All" and, patient-mix, programmatic characteristics, retention and predictors of attrition.MethodsWe used patient-level data from the electronic patient monitoring system (ePMS) from the nine districts, which piloted the "Treat All" recommendation. We compared patient-mix, programme characteristics, retention and predictors of attrition (lost to follow-up, death or stopping ART) in two cohorts; before (April/May 2016) and after (January/February 2017) "Treat All". Retention was estimated using survival analysis. Predictors of attrition were determined using a multivariable Cox regression model. Interactions were used to assess the change in predictors of attrition before and after "Treat All".ResultsWe analysed 3787 patients, 1738 (45.9%) and 2049 (54.1%) started ART before and after "Treat All", respectively. The proportion of men was higher after "Treat All" (39.4.% vs 36.2%, p = 0.044). Same-day ART initiation was more frequent after "Treat All" (43.2% vs 16.4%; pConclusionAttrition was higher after "Treat All"; being male, WHO Stage 4, and pregnancy predicted attrition in both before and after Treat All. However, pregnancy became a less strong risk factor for attrition after "Treat All" implementation.
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- 2020
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23. Evaluating a multi-component, community-based program to improve adherence and retention in care among adolescents living with HIV in Zimbabwe: study protocol for a cluster randomized controlled trial
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Webster Mavhu, Nicola Willis, Juliet Mufuka, Collin Mangenah, Kudzanayi Mvududu, Sarah Bernays, Walter Mangezi, Tsitsi Apollo, Ricardo Araya, Helen A. Weiss, and Frances M. Cowan
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HIV ,Antiretroviral therapy ,Adolescents ,Adherence ,Zimbabwe ,Psychosocial ,Medicine (General) ,R5-920 - Abstract
Abstract Background World Health Organization (WHO) adolescent HIV-testing and treatment guidelines recommend community-based interventions to support antiretroviral therapy (ART) adherence and retention in care, while acknowledging that the evidence to support this recommendation is weak. This cluster randomized controlled trial aims to evaluate the effectiveness and cost-effectiveness of a psychosocial, community-based intervention on HIV-related and psychosocial outcomes. Methods/design We are conducting the trial in two districts. Sixteen clinics were randomized to either enhanced ART-adherence support or standard of care. Eligible individuals (HIV-positive adolescents aged 13–19 years and eligible for ART) in both arms receive ART and adherence support provided by adult counselors and nursing staff. Adolescents in the intervention arm additionally attend a monthly support group, are allocated to a designated community adolescent treatment supporter, and followed up through a short message service (SMS) and calls plus home visits. The type and frequency of contact is determined by whether the adolescent is “stable” or in need of enhanced support. Stable adolescents receive a monthly home visit plus a weekly, individualized SMS. An additional home visit is conducted if participants miss a scheduled clinic appointment or support-group meeting. Participants in need of further, enhanced, support receive bi-weekly home visits, weekly phone calls and daily SMS. Caregivers of adolescents in the intervention arm attend a caregiver support group. Trial outcomes are assessed through a clinical, behavioral and psychological assessment conducted at baseline and after 48 and 96 weeks. The primary outcome is the proportion who have died or have virological failure (viral load ≥1000 copies/ml) at 96 weeks. Secondary outcomes include virological failure at 48 weeks, retention in care (proportion of missed visits) and psychosocial outcomes at both time points. Statistical analyses will be conducted and reported in line with CONSORT guidelines for cluster randomized trials, including a flowchart. Discussion This study provides a unique opportunity to generate evidence of the impact of the on-going Zvandiri program, for adolescents living with HIV, on virological failure and psychosocial outcomes as delivered in a real-world setting. If found to reduce rates of treatment failure, this would strengthen support for further scale-up across Zimbabwe and likely the region more widely. Trial registration Pan African Clinical Trial Registry database, registration number PACTR201609001767322 (the Zvandiri trial). Retrospectively registered on 5 September 2016.
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- 2017
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24. Operational Research to Assess the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Health Facilities in Harare, Zimbabwe
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Pruthu Thekkur, Kudakwashe C. Takarinda, Collins Timire, Charles Sandy, Tsitsi Apollo, Ajay M. V. Kumar, Srinath Satyanarayana, Hemant D. Shewade, Mohammed Khogali, Rony Zachariah, I. D. Rusen, Selma Dar Berger, and Anthony D. Harries
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COVID-19 ,Zimbabwe ,Harare ,presumptive tuberculosis ,tuberculosis ,TB treatment outcomes ,Medicine - Abstract
When COVID-19 was declared a pandemic, there was concern that TB and HIV services in Zimbabwe would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in 10 health facilities in Harare to capture trends in TB case detection, TB treatment outcomes and HIV testing and use these data to facilitate corrective action. Aggregate data were collected monthly during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data extracted for the pre-COVID-19 period (March 2019–February 2020). Monthly reports were sent to program directors. During the COVID-19 period, there was a decrease in persons with presumptive pulmonary TB (40.6%), in patients registered for TB treatment (33.7%) and in individuals tested for HIV (62.8%). The HIV testing decline improved in the second 6 months of the COVID-19 period. However, TB case finding deteriorated further, associated with expiry of diagnostic reagents. During the COVID-19 period, TB treatment success decreased from 80.9 to 69.3%, and referral of HIV-positive persons to antiretroviral therapy decreased from 95.7 to 91.7%. Declining trends in TB and HIV case detection and TB treatment outcomes were not fully redressed despite real-time monthly surveillance. More support is needed to transform this useful information into action.
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- 2021
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25. Enhanced adherence counselling and viral load suppression in HIV seropositive patients with an initial high viral load in Harare, Zimbabwe: Operational issues.
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Talent Bvochora, Srinath Satyanarayana, Kudakwashe C Takarinda, Hilda Bara, Prosper Chonzi, Brian Komtenza, Clemence Duri, and Tsitsi Apollo
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Medicine ,Science - Abstract
BACKGROUND:In people living with HIV (PLHIV) who are on anti-retroviral therapy (ART), it is essential to identify persons with high blood viral loads (VLs) (≥1000 copies/ml), provide enhanced adherence counselling (EAC) for 3 months and assess for VL suppression (5,000 copies/ml were associated with lower probability of viral suppression. CONCLUSION:The routine VL testing levels were high, but there were major programmatic gaps in enrolling PLHIV with high VLs into EAC and achieving VL suppression. The full potential of EAC on achieving viral load suppression has not been achieved in this setting. The reasons for these gaps need to be assessed in future research studies and addressed by suitable changes in policies/practices.
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- 2019
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26. Community burden of undiagnosed HIV infection among adolescents in Zimbabwe following primary healthcare-based provider-initiated HIV testing and counselling: A cross-sectional survey.
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Victoria Simms, Ethel Dauya, Subathira Dakshina, Tsitsi Bandason, Grace McHugh, Shungu Munyati, Prosper Chonzi, Katharina Kranzer, Getrude Ncube, Collen Masimirembwa, Roslyn Thelingwani, Tsitsi Apollo, Richard Hayes, Helen A Weiss, and Rashida A Ferrand
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Medicine - Abstract
Children living with HIV who are not diagnosed in infancy often remain undiagnosed until they present with advanced disease. Provider-initiated testing and counselling (PITC) in health facilities is recommended for high-HIV-prevalence settings, but it is unclear whether this approach is sufficient to achieve universal coverage of HIV testing. We aimed to investigate the change in community burden of undiagnosed HIV infection among older children and adolescents following implementation of PITC in Harare, Zimbabwe.Over the course of 2 years (January 2013-January 2015), 7 primary health clinics (PHCs) in southwestern Harare implemented optimised, opt-out PITC for all attendees aged 6-15 years. In February 2015-December 2015, we conducted a representative cross-sectional survey of 8-17-year-olds living in the 7 communities served by the study PHCs, who would have had 2 years of exposure to PITC. Knowledge of HIV status was ascertained through a caregiver questionnaire, and anonymised HIV testing was carried out using oral mucosal transudate (OMT) tests. After 1 participant taking antiretroviral therapy was observed to have a false negative OMT result, from July 2015 urine samples were obtained from all participants providing OMTs and tested for antiretroviral drugs to confirm HIV status. Children who tested positive through PITC were identified from among survey participants using gender, birthdate, and location. Of 7,146 children in 4,251 eligible households, 5,486 (76.8%) children in 3,397 households agreed to participate in the survey, and 141 were HIV positive. HIV prevalence was 2.6% (95% CI 2.2%-3.1%), and over a third of participants with HIV were undiagnosed (37.7%; 95% CI 29.8%-46.2%). Similarly, among the subsample of 2,643 (48.2%) participants with a urine test result, 34.7% of those living with HIV were undiagnosed (95% CI 23.5%-47.9%). Based on extrapolation from the survey sample to the community, we estimated that PITC over 2 years identified between 18% and 42% of previously undiagnosed children in the community. The main limitation is that prevalence of undiagnosed HIV was defined using a combination of 3 measures (OMT, self-report, and urine test), none of which were perfect.Facility-based approaches are inadequate in achieving universal coverage of HIV testing among older children and adolescents. Alternative, community-based approaches are required to meet the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of diagnosing 90% of those living with HIV by 2020 in this age group.
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- 2017
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27. Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa.
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Andrew N Phillips, Valentina Cambiano, Fumiyo Nakagawa, Loveleen Bansi-Matharu, Papa Salif Sow, Peter Ehrenkranz, Deborah Ford, Owen Mugurungi, Tsitsi Apollo, Joseph Murungu, David R Bangsberg, and Paul Revill
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Medicine ,Science - Abstract
BackgroundInterventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost.MethodsAn individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted.FindingsIn the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6% increase in the proportion of ART experienced people with viral load < 1000 cps/mL was cost effective if it cost up to $50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective when costing $23-$32 per year, depending on whether the adherence intervention is used to reduce the level of need for viral load measurement.ConclusionThe cost thresholds identified suggest that there is clear scope for adherence monitoring-based interventions to provide net population health gain, with potential cost-effective use in situations where viral load monitoring is or is not available. Our results guide the implementation of future adherence monitoring interventions found in randomized trials to have health benefit.
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- 2016
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28. Anti-retroviral therapy after “Treat All” in Harare, Zimbabwe: What are the changes in uptake, time to initiation and retention? [version 1; peer review: 2 approved with reservations]
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Takura Matare, Hemant Deepak Shewade, Ronald T. Ncube, Kudzai Masunda, Innocent Mukeredzi, Kudakwashe C. Takarinda, Janet Dzangare, Gloria Gonese, Bekezela B. Khabo, Regis C. Choto, and Tsitsi Apollo
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Research Article ,Articles ,ART outcomes ,test and treat ,universal test and treat ,time to treatment ,HIV ,SORT IT ,Operational research - Abstract
Background: In Zimbabwe, Harare was the first province to implement “Treat All” for people living with human immunodeficiency virus (PLHIV). Since its roll out in July 2016, no study has been conducted to assess the changes in key programme indicators. We compared antiretroviral therapy (ART) uptake, time to ART initiation from diagnosis, and retention before and during “Treat All”. Methods: We conducted an ecological study to assess ART uptake among all PLHIV newly diagnosed before and during “Treat All”. We conducted a cohort study to assess time to ART initiation and retention in care among all PLHIV newly initiated on ART from all electronic patient management system-supported sites (n=50) before and during “Treat All”. Results: ART uptake increased from 65% (n=4619) by the end of quarter one, 2014 to 85% (n=5152) by the end of quarter four, 2018. A cohort of 2289 PLHIV were newly initiated on ART before (April-June 2015) and 1682 during “Treat all” (April-June 2017). Their age and gender distribution was similar. The proportion of PLHIV in early stages of disease was significantly higher during “Treat all” (73.2% vs. 55.6%, p Conclusion: Although there were benefits of early ART initiation during “Treat All”, the programme should consider strategies to improve retention.
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- 2020
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29. Children and adolescents on anti-retroviral therapy in Bulawayo, Zimbabwe: How many are virally suppressed by month six? [version 1; peer review: 2 approved, 1 approved with reservations]
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Silungile Moyo, Ronald Thulani Ncube, Hemant Deepak Shewade, Solwayo Ngwenya, Wedu Ndebele, Kudakwashe Collin Takarinda, Janet Dzangare, Tafadzwa Priscilla Goverwa-Sibanda, and Tsitsi Apollo
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Brief Report ,Articles ,Children living with HIV ,Adolescent living with HIV ,EAC ,Mpilo ,Operational research ,SORT IT - Abstract
Background: Zimbabwe is one of the countries in sub-Saharan Africa disproportionately affected by human immunodeficiency virus. In the “treat all” era, we assessed the gaps in routine viral load (VL) monitoring at six months for children (0-9 years) and adolescents (10-19 years) newly initiated on anti-retroviral therapy (ART) from January 2017 to September 2018 at a large tertiary hospital in Bulawayo. Methods: In this cohort study using secondary data, we considered first VL done within six to nine months of starting therapy as ‘undergoing VL test at six months’. We classified repeat VL≥1000 copies/ml despite enhanced adherence counselling as virally unsuppressed. Results: Of 295 patients initiated on ART, 196 (66%) were children and 99 (34%) adolescents. A total 244 (83%) underwent VL test at six months, with 161 (54%) virally suppressed, 52 (18%) unsuppressed and 82 (28%) with unknown status (due to losses in the cascade). Switch to second line was seen in 35% (18/52). When compared to children, adolescents were less likely to undergo a VL test at six months (73% versus 88%, p=0.002) and more likely to have an unknown VL status (40% versus 22%, p=0.001). Conclusion: At six months of ART, viral suppression was low and losses in the cascade high.
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- 2020
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30. Interrupted Access to and Use of Family Planning Among Youth in a Community‐Based Service in Zimbabwe During the First Year of the COVID‐19 Pandemic
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Constancia V. Mavodza, Sarah Bernays, Constance R.S. Mackworth‐Young, Rangarirayi Nyamwanza, Portia Nzombe, Ethel Dauya, Chido Dziva Chikwari, Mandikudza Tembo, Tsitsi Apollo, Owen Mugurungi, Bernard Madzima, Katharina Kranzer, Rashida Abbas Ferrand, and Joanna Busza
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Zimbabwe ,Adolescent ,Family Planning Services ,COVID-19 ,Humans ,Community Health Services ,Pandemics ,Social Sciences (miscellaneous) ,Demography - Abstract
The COVID-19 pandemic has had serious impacts on economic, social, and health systems, and fragile public health systems have become overburdened in many countries, exacerbating existing service delivery challenges. This study describes the impact of the COVID-19 pandemic on family planning services within a community-based integrated HIV and sexual and reproductive health intervention for youth aged 16-24 years being trialled in Zimbabwe (CHIEDZA). It examines the experiences of health providers and clients in relation to how the first year of the pandemic affected access to and use of contraceptives.
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- 2022
31. Fidelity, Feasibility and Adaptation of a Family Planning Intervention for Young Women in Zimbabwe: Provider Perspectives and Experiences
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Constancia V. Mavodza, Sarah Bernays, Constance R. S. Mackworth-Young, Rangarirayi Nyamwanza, Portia Nzombe, Ethel Dauya, Chido Dziva Chikwari, Mandikudza Tembo, Tsitsi Apollo, Owen Mugurungi, Bernard Madzima, Dadirai Nguwo, Rashida Abbas Ferrand, and Joanna Busza
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General Medicine - Abstract
The CHIEDZA (Community-based Interventions to improve HIV outcomes in youth: a cluster randomised trial in Zimbabwe) trial evaluated an integrated package of HIV and sexual and reproductive health services for young people aged 16–24 years in Zimbabwe. The family planning component aimed to improve access to information, services, and contraceptives delivered by trained youth-friendly providers within a community-based setting for young women. Responsively adapting the intervention was a part of the intervention design’s rationale. We investigated the factors influencing implementation fidelity, quality, and feasibility using provider experiences and perspectives. We conducted provider interviews (N = 42), non-participant (N = 18), and participant observation (N = 30) of intervention activities. The data was analyzed thematically. CHIEDZA providers were receptive to providing the family planning intervention, but contexts outside of the intervention created challenges to the intervention’s fidelity. Strategic adaptations were required to ensure service quality within a youth-friendly context. These adaptations strengthened service delivery but also resulted in longer wait times, more frequent visits, and variability of Long-Acting Reversible contraceptives (LARCS) provision which depended on target-driven programming by partner organization. This study was a practical example of how tracking adaptations is vital within process evaluation methods in implementation science. Anticipating that changes will occur is a necessary pre-condition of strong evaluations and tracking adaptations ensures that lessons on feasibility of design, contextual factors, and health system factors are responded to during implementation and can improve quality. Some contextual factors are unpredictable, and implementation should be viewed as a dynamic process where responsive adaptations are necessary, and fidelity is not static.Trial registration ClinicalTrials.gov Identifier: NCT03719521.
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- 2023
32. Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models
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Loveleen Bansi-Matharu, Edinah Mudimu, Rowan Martin-Hughes, Matt Hamilton, Leigh Johnson, Debra ten Brink, John Stover, Gesine Meyer-Rath, Sherrie L Kelly, Lise Jamieson, Valentina Cambiano, Andreas Jahn, Frances M Cowan, Collin Mangenah, Webster Mavhu, Thato Chidarikire, Carlos Toledo, Paul Revill, Maaya Sundaram, Karin Hatzold, Aisha Yansaneh, Tsitsi Apollo, Thoko Kalua, Owen Mugurungi, Valerian Kiggundu, Shufang Zhang, Rose Nyirenda, Andrew Phillips, Katharine Kripke, and Anna Bershteyn
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610 Medicine & health ,General Medicine - Abstract
BACKGROUND Voluntary medical male circumcision (VMMC) has been a recommended HIV prevention strategy in sub-Saharan Africa since 2007, particularly in countries with high HIV prevalence. However, given the scale-up of antiretroviral therapy programmes, it is not clear whether VMMC still represents a cost-effective use of scarce HIV programme resources. METHODS Using five existing well described HIV mathematical models, we compared continuation of VMMC for 5 years in men aged 15 years and older to no further VMMC in South Africa, Malawi, and Zimbabwe and across a range of setting scenarios in sub-Saharan Africa. Outputs were based on a 50-year time horizon, VMMC cost was assumed to be US$90, and a cost-effectiveness threshold of US$500 was used. FINDINGS In South Africa and Malawi, the continuation of VMMC for 5 years resulted in cost savings and health benefits (infections and disability-adjusted life-years averted) according to all models. Of the two models modelling Zimbabwe, the continuation of VMMC for 5 years resulted in cost savings and health benefits by one model but was not as cost-effective according to the other model. Continuation of VMMC was cost-effective in 68% of setting scenarios across sub-Saharan Africa. VMMC was more likely to be cost-effective in modelled settings with higher HIV incidence; VMMC was cost-effective in 62% of settings with HIV incidence of less than 0·1 per 100 person-years in men aged 15-49 years, increasing to 95% with HIV incidence greater than 1·0 per 100 person-years. INTERPRETATION VMMC remains a cost-effective, often cost-saving, prevention intervention in sub-Saharan Africa for at least the next 5 years. FUNDING Bill & Melinda Gates Foundation for the HIV Modelling Consortium.
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- 2023
33. Identifying youth at high risk for sexually transmitted infections in community-based settings using a risk prediction tool: a validation study
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Rashida A. Ferrand, Anna Machiha, Getrude Ncube, Chido Dziva Chikwari, Helen A. Weiss, Nicol Redzo, Constancia Mavodza, Tsitsi Bandason, Victoria Simms, Tsitsi Apollo, Ioana D. Olaru, Suzanna C. Francis, Mandikudza Tembo, Ethel Dauya, Kevin Martin, Richard J. Hayes, and Katharina Kranzer
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medicine.medical_specialty ,Adolescent ,Sexual Behavior ,Sexually Transmitted Diseases ,Chlamydia trachomatis ,HIV Infections ,Infectious and parasitic diseases ,RC109-216 ,Logistic regression ,medicine.disease_cause ,Adolescents ,Gonorrhea ,Young Adult ,Pregnancy ,Informed consent ,Prevalence ,medicine ,Sexually transmitted infections ,Humans ,Risk factor ,Reproductive health ,Research ethics ,Receiver operating characteristic ,business.industry ,Risk prediction tool ,Research ,Chlamydia Infections ,medicine.disease ,Neisseria gonorrhoeae ,Infectious Diseases ,Sexual Partners ,Family medicine ,Screening ,Female ,business - Abstract
Background: Chlamydia trachomatis(CT) and Neisseria gonorrhoeae (NG) are the most common bacterial sexually transmitted infections (STIs) worldwide. In the absence of affordable point-of-care STI tests, WHO recommends STI testing based on risk factors. This study aimed to develop a prediction tool with a sensitivity of >90% and efficiency (defined as the percentage of individuals that are eligible for diagnostic testing) of
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- 2021
34. Economic implications of COVID-19 for the HIV epidemic and the response in Zimbabwe
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Charles Birungi, Markus Haacker, Isaac Taramusi, Amon Mpofu, Bernard Madzima, Tsitsi Apollo, Owen Mugurungi, Martin Odiit, and Michael A Obst
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COVID-19 impact ,pandemic response ,southern Africa ,SARS-CoV-2 ,HIV and AIDS ,Infectious Diseases ,Virology ,Public Health, Environmental and Occupational Health ,General Medicine - Abstract
Understanding the economic implications of COVID-19 for the HIV epidemic and response is critical for designing policies and strategies to effectively sustain past gains and accelerate progress to end these colliding pandemics. While considerable cross-national empirical evidence exists at the global level, there is a paucity of such deep-dive evidence at national level. This article addresses this gap. While Zimbabwe experienced fewer COVID-19 cases and deaths than most countries, the pandemic has had profound economic effects, reducing gross domestic product by nearly 7% in 2020. This exacerbates the long-term economic crisis that began in 1998. This has left many households vulnerable to the economic fallout from COVID-19, with the number of the extreme poor having increased to 49% of the population in 2020 (up from 38% in 2019). The national HIV response, largely financed externally, has been one of the few bright spots. Overall, macro-economic and social conditions heavily affected the capacity of Zimbabwe to respond to COVID-19. Few options were available for borrowing the needed sums of money. National outlays for COVID-19 mitigation and vaccination amounted to 2% of GDP, with one-third funded by external donors. Service delivery innovations helped sustain access to HIV treatment during national lockdowns. As a result of reduced access to HIV testing, the number of people initiating HIV treatment declined. In the short term, there are likely to be few immediate health care consequences of the slowdown in treatment initiation due to the country’s already high level of HIV treatment coverage. However, a longer-lasting slowdown could impede national progress towards ending HIV and AIDS. The findings suggest a need to finance the global commons, specifically recognising that investing in health care is investing in economic recovery.
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- 2022
35. High post-exposure prophylaxis uptake but low completion rates and HIV testing follow-up in health workers, Harare, Zimbabwe
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Tsitsi Apollo, Stanley Mungofa, Anthony D. Harries, Tafadzwa Priscilla Goverwa-Sibanda, Hannock Tweya, Fadzai Mushambi, and Collins Timire
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Zimbabwe ,Adult ,Male ,medicine.medical_specialty ,Infectious Disease Transmission, Patient-to-Professional ,Anti-HIV Agents ,medicine.medical_treatment ,Health Personnel ,Occupational injury ,education ,HIV Infections ,Hiv testing ,Microbiology ,Article ,health care workers ,Disease course ,Medication Adherence ,Cohort Studies ,Virology ,Health care ,medicine ,Chi-square test ,Humans ,Post-exposure prophylaxis ,occupational injury ,business.industry ,virus diseases ,operational research ,General Medicine ,Middle Aged ,medicine.disease ,Occupational Injuries ,Infectious Diseases ,Post exposure prophylaxis ,SORT IT ,Relative risk ,Emergency medicine ,cardiovascular system ,Parasitology ,Female ,business ,Post-Exposure Prophylaxis ,Cohort study ,circulatory and respiratory physiology - Abstract
Introduction: Health care workers (HCWs), especially from sub-Saharan Africa, are at risk of occupational exposure to HIV. Post exposure prophylaxis (PEP) can reduce this risk. There is no published information from Zimbabwe, a high HIV burden country, about how PEP works. We therefore assessed how the PEP programme performed at the Parirenyatwa Hospital, Harare, Zimbabwe, from 2017-2018. Methodology: This was a cohort study using secondary data from the staff clinic paper-based register. The chi square test and relative risks were used to assess associations. Results: There were 154 HCWs who experienced occupational injuries. The commonest group was medical doctors (36%) and needle sticks were the most frequent type of occupational injury (74%). The exposure source was identified in 114 (74%) occupational injuries: 91% of source patients were HIV-tested and 77% were HIV-positive. All but two HCWs were HIV-tested, 148 were eligible for PEP and 142 (96%) started triple therapy, all within 48 hours of exposure. Of those starting PEP, 15 (11%) completed 28 days, 13 (9%) completed < 28 days and in the remainder PEP duration was not recorded. There were no HCW characteristics associated with not completing PEP. Of those starting PEP, 9 (6%) were HIV-tested at 6-weeks, 3 (2%) were HIV-tested at 3-months and 1 (< 1%) was HIV-tested at 6-months: all HIV-tests were negative. Conclusions: While uptake of PEP was timely and high, the majority of HCWs failed to complete the 28-day treatment course and even fewer attended for follow-up HIV-tests. Various changes are recommended to promote awareness of PEP and improve adherence to guidelines.
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- 2021
36. Perspectives on the use of modelling and economic analysis to guide HIV programmes in sub-Saharan Africa
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Paul Revill, Ajay Rangaraj, Albert Makochekanwa, Amon Mpofu, Andrea L. Ciaranello, Andreas Jahn, Andrew Gonani, Andrew N. Phillips, Anna Bershteyn, Benson Zwizwai, Brooke E. Nichols, Carel Pretorius, Cliff C. Kerr, Cindy Carlson, Debra Ten Brink, Edinah Mudimu, Edward Kataika, Erik Lamontagne, Fern Terris-Prestholt, Frances M. Cowan, Gerald Manthalu, Gemma Oberth, Gesine Mayer-Rath, Iris Semini, Isaac Taramusi, Jeffrey W. Eaton, Jinjou Zhao, John Stover, Jose A Izazola-Licea, Katherine Kripke, Leigh Johnson, Loveleen Bansi-Matharu, Marelize Gorgons, Michelle Morrison, Newton Chagoma, Owen Mugurungi, Robyn M. Stuart, Rowan Martin-Hughes, Rose Nyirenda, Ruanne V. Barnabas, Sakshi Mohan, Sherrie L. Kelly, Sibusiso Sibandze, Simon Walker, Stephen Banda, R. Scott Braithwaite, Thato Chidarikire, Timothy B. Hallett, Thoko Kalua, Tsitsi Apollo, Valentina Cambiano, UNAIDS, Bill & Melinda Gates Foundation, and Medical Research Council (MRC)
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wa_30 ,Infectious Diseases ,Epidemiology ,Virology ,wc_503_7 ,Immunology ,wc_503_6 ,Humans ,HIV Infections ,wc_503 ,Africa South of the Sahara ,Research Personnel ,11 Medical and Health Sciences - Abstract
HIV modelling and economic analyses have had a prominent role in guiding programmatic responses to HIV in sub-Saharan Africa. We reflect critically how the HIV modelling field might develop in future. We argue for HIV modelling to be more routinely aligned with national government and ministry of health priorities, recognizing their legitimate mandates and stewardship responsibilities, for HIV and other wider health programmes. We also place importance on an environment existing in which collaboration between modellers, and joint approaches to addressing modelling questions, becomes the norm rather than exception. Such an environment can accelerate translation of modelling analyses into policy formulation because areas where models agree can be prioritized for action, whereas areas over which uncertainty prevails can be slated for additional study, data collection and analysis. We also argue the need for HIV modelling to increasingly be integrated with the modelling of health needs beyond HIV, particularly in allocative efficiency analyses, where focusing on one disease over another may lead to worse health overall. Such integration may also enhance partnership with national governments whose mandates extend beyond HIV and to all of health care. Finally, we see a need for there to be substantial and equitable investment in capacity strengthening within African countries, so that African researchers will increasingly be leading modelling exercises. Building a critical mass of expertise, strengthened through external collaboration and knowledge exchange, should be the ultimate goal.
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- 2022
37. Understanding Sustained Retention in HIV/AIDS Care and Treatment: a Synthetic Review
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Roy, Monika, Czaicki, Nancy, Holmes, Charles, Chavan, Saurabh, Tsitsi, Apollo, Odeny, Thomas, Sikazwe, Izukanji, Padian, Nancy, and Geng, Elvin
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- 2016
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38. The impact of community-based integrated HIV and sexual and reproductive health services for youth on population-level HIV viral load and sexually transmitted infections in Zimbabwe: protocol for the CHIEDZA cluster-randomised trial
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Chido Dziva Chikwari, Ethel Dauya, Tsitsi Bandason, Mandikudza Tembo, Constancia Mavodza, Victoria Simms, Constance Mackworth-Young, Tsitsi Apollo, Chris Grundy, Helen Weiss, Katharina Kranzer, Tino Mavimba, Pitchaya Indravudh, Aoife Doyle, Owen Mugurungi, Anna Machiha, Sarah Bernays, Joanna Busza, Bernard Madzima, Fern Terris-Prestholt, Ona McCarthy, Richard Hayes, Suzanna Francis, and Rashida Ferrand
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viruses ,virus diseases ,Medicine (miscellaneous) ,biochemical phenomena, metabolism, and nutrition ,digestive system diseases ,General Biochemistry, Genetics and Molecular Biology - Abstract
Background: Youth have poorer HIV-related outcomes when compared to other age-groups. We describe the protocol for a cluster randomised trial (CRT) to evaluate the effectiveness of community-based, integrated HIV and sexual and reproductive health services for youth on HIV outcomes. Protocol: The CHIEDZA trial is being conducted in three provinces in Zimbabwe, each with eight geographically demarcated areas (clusters) (total 24 clusters) randomised 1:1 to standard of care (existing health services) or to the intervention. The intervention comprises community-based delivery of HIV services including testing, antiretroviral therapy, treatment monitoring and adherence support as well as family planning, syndromic management of sexually transmitted infections (STIs), menstrual health management, condoms and HIV prevention and general health counselling. Youth aged 16-24 years living within intervention clusters are eligible to access CHIEDZA services. A CRT of STI testing (chlamydia, gonorrhoea and trichomoniasis) is nested in two provinces (16 of 24 clusters). The intervention is delivered over a 30-month period by a multidisciplinary team trained and configured to provide high-quality, youth friendly services. Outcomes will be ascertained through a population-based survey of 18–24-year-olds. The primary outcome is HIV viral load Ethics and Dissemination: The trial protocol was approved by the Medical Research Council of Zimbabwe, the Biomedical Research and Training Institute Institutional Review Board and the London School of Hygiene & Tropical Medicine Research Ethics Committee. Results will be submitted to open-access peer-reviewed journals, presented at academic meetings and shared with participating communities and with national and international policy-making bodies. Trial Registration https://clinicaltrials.gov/: NCT03719521
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- 2022
39. Once-daily dolutegravir-based antiretroviral therapy in infants and children living with HIV from age 4 weeks: results from the below 14 kg cohort in the randomised ODYSSEY trial
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Pauline Amuge, Abbas Lugemwa, Ben Wynne, Hilda A Mujuru, Avy Violari, Cissy M Kityo, Moherndran Archary, Ebrahim Variava, Ellen White, Rebecca M Turner, Clare Shakeshaft, Shabinah Ali, Kusum J Nathoo, Lorna Atwine, Afaaf Liberty, Dickson Bbuye, Elizabeth Kaudha, Rosie Mngqibisa, Modehei Mosala, Vivian Mumbiro, Annet Nanduudu, Rogers Ankunda, Lindiwe Maseko, Adeodata R Kekitiinwa, Carlo Giaquinto, Pablo Rojo, Diana M Gibb, Anna Turkova, Deborah Ford, Amina Farhana Mehar (nee Abdulla), Pattamukkil Abraham, Elaine Abrams, Judith Acero, Gerald Muzorah Agaba, Grace Ahimbisibwe, Barbara Ainebyoona, Winnie Akobye, Yasmeen Akhalwaya, Nazim Akoojee, Shabinah S. Ali, Catherine Andrea, Maria Angeles Muñoz Fernandez, Diana Antonia Rutebarika, Suvaporn Anugulruengkitt, Tsitsi Apollo, Ronelle Arendze, Juliet Ategeka, Eunice Atim, Abdel Babiker, Sarah Babirye, Enock Babu, Edward Bagirigomwa, Angella Baita, David Balamusani, Patsy Baliram, David Baliruno, Colin Ball, Henry Balwa, Alasdair Bamford, Srini Bandi, Dominique Barker, Linda Barlow-Mosha, Shazia Begum, Osee Behuhuma, Sarah Bernays, Rogers Besigye, Maria Bester, Joyline Bhiri, Davide Bilardi, Kristien Bird, Pauline Bollen, Chiara Borg, Anne-Marie Borges Da Silva, Jackie Brown, Elena Bruno, Torsak Bunupuradah, David Burger, Nomzamo Buthelezi, Mutsa Bwakura-Dangarembizi, Africanus Byaruhanga, Joanna Calvert, Petronelle Casey, Haseena Cassim, Sphiwee Cebekhulu, Sanuphong Chailert, Suwalai Chalermpantmetagul, Wanna Chamjamrat, Man Chan, Precious Chandiwana, Thannapat Chankun, Sararut Chanthaburanun, Nuttawut Chanto, Ennie Chidziva, Minenhle Chikowore, Joy Chimanzi, Dujrudee Chinwong, Stuart Chitongo, Moses Chitsamatanga, Joshua Choga, Duangrat Chutima, Polly Clayden, Alexandra Coelho, Angela Colbers, Alexandra Compagnucci, Ana Constança Mendes, Magda Conway, Mark F. Cotton, Jane Crawley, Tim R. Cressey, Jacky Crisp, Ana Cristina Matos, Sumaya Dadan, Jacqui Daglish, Siva Danaviah, Tseleng Daniel, Anita De Rossi, Sukanda Denjanta, Els Dobbels, Maria Dowie, Prosper Dube, Benedictor Dube, Nimisha Dudakia, Alice Elwana, Cristina Epalza, David Eram, Juan Erasmus, Peter Erim, Luis Escosa Garcia, Zaakirah Essack, Carolina Estepa, Monica Etima, Alexandre Fernandes, Maite Fernandez, Felicity Fitzgerald, Jacquie Flynn, Claudia Fortuny Guasch, Caroline Foster, George Fourie, Yolandie Fourie, Sophie Foxall, Derusha Frank, Kate Gandhi, India Garcia, Kathleen Gartner, Joshua Gasa, Gugu Gasa, Diana M. Gibb, Coral Gomez Rico, Daniel Gomez-Pena, Secrecy Gondo, Anna Goodman, Maria Gorreti Nakalema, Winnie Gozhora, Pisut Greetanukroh, Biobanco Gregorio Maranon, Tiziana Grossele, Shamiso Gwande, Tapiwa Gwaze, Tsitsi Gwenzi, James Hakim, Emmanuel Hakiza, Abdul Hamid Kaka, Ashley Harley, Mornay Isaacs, Richard Isabirye, Wilber Ishemunyoro, Tom Jacobs, Lungile Jafta, Nasir Jamil, Anita Janse Janse van Rensburg, Vinesh Jeaven, Maria José Mellado Peña, Gonzague Jourdain, Katabalwa Juliet, Thidarat Jumpimai, Raungwit Junkaew, Thidarat Jupimai, Winfred Kaahwa, Mildred Kabasonga, Olivia Kaboggoza, Rose Jacqueline Kadhuba, Ampika Kaewbundit, Kanyanee Kaewmamueng, Bosco Kafufu, Brenda Kakayi, Phakamas Kamboua, Suparat Kanjanavanit, Gladys Kasangaki, Naruporn Kasipong, Miriam Kasozi, Hajira Kataike, Chrispus Katemba, Nkata Kekane, Adeodata R. Kekitiinwa, Edridah Keminyeto, Woottichai Khamduang, Warunee Khamjakkaew, Jiraporn Khamkon, Sasipass Khannak, Orapin Khatngam, Tassawan Khayanchoomnoom, Busi Khumalo, Mirriam Khunene, Suwimon Khusuwan, Phionah Kibalama, Robinah Kibenge, Anthony Kirabira, Cissy M. Kityo, Lameck Kiyimba, Nigel Klein, Soraya Klinprung, Robin Kobbe, Olivia Kobusingye, Josephine Kobusungye, Areerat Kongponoi, Christoph Königs, Olivier Koole, Christelle Kouakam, Nitinart Krueduangkam, Namthip Kruenual, Nuananong Kunjaroenrut, Raymonds Kyambadde, Priscilla Kyobutungi, Flavia Kyomuhendo, Erinah Kyomukama, Reshma Lakha, Cleopatra Langa, Laddawan Laomanit, Emily Lebotsa, Prattana Leenasirimakul, Lawrence Lekku, Sarah Lensen, Valériane Leroy, Jin Li, Juthamas Limplertjareanwanich, Emma Little, Ezra Lutalo, Jose Luis Jimenez, Hermione Lyall, Candice MacDonald, Gladness Machache, Penelope Madlala, Tryphina Madonsela, Nomfundo Maduna, Joel Maena, Apicha Mahanontharit, Collin Makanga, Candice Makola, Shafic Makumbi, Lucille Malgraaf, Angelous Mamiane, Felicia Mantkowski, Wendy Mapfumo, Laura Marques, Agnes Mary Mugagga, Tshepiso Masienyane, Ruth Mathiba, Farai Matimba, Sajeeda Mawlana, Emmanuel Mayanja, Fatima Mayat, Ritah Mbabazi, Nokuthula Mbadaliga, Faith Mbasani, Kathleen McClaughlin, Helen McIlleron, Watchara Meethaisong, Patricia Mendez Garcia, Annet Miwanda, Carlota Miranda, Siphiwe Mkhize, Kgosimang Mmolawa, Fatima Mohamed, Tumelo Moloantoa, Maletsatsi Monametsi, Samuel Montero, Cecilia L. Moore, Rejoice Mosia, Columbus Moyo, Mumsy Mthethwa, Shepherd Mudzingwa, Tawona Mudzviti, Hilda Mujuru, Emmanuel Mujyambere, Trust Mukanganiki, Cynthia Mukisa Williams, Mark Mulder, Disan Mulima, Alice Mulindwa, Zivai Mupambireyi, Alba Murciano Cabeza, Herbert Murungi, Dorothy Murungu, Sandra Musarurwa, Victor Musiime, Alex V. Musiime, Maria Musisi, Philippa Musoke, Barbara Musoke Nakirya, Godfrey Musoro, Sharif Musumba, Sobia Mustafa, Shirley Mutsai, Phyllis Mwesigwa Rubondo, Mariam Naabalamba, Immaculate Nagawa, Allemah Naidoo, Shamim Nakabuye, Sarah Nakabuye, Sarah Nakalanzi, Justine Nalubwama, Annet Nalugo, Stella Nalusiba, Clementine Namajja, Sylvia Namanda, Paula Namayanja, Esther Nambi, Rachael Kikabi Namuddu, Stella Namukwaya, Florence Namuli, Josephine Namusanje, Rosemary Namwanje, Anusha Nanan-kanjee, Charity Nankunda, Joanita Nankya Baddokwaya, Maria Nannungi, Winnie Nansamba, Kesdao Nanthapisal, Juliet Nanyonjo, Sathaporn Na-Rajsima, Claire Nasaazi, Helena Nascimento, Eleni Nastouli, Wipaporn Natalie Songtaweesin, Kusum Nathoo, Ian Natuhurira, Rashidah Nazzinda, Thabisa Ncgaba, Milly Ndigendawani, Makhosonke Ndlovu, Georgina Nentsa, Chaiwat Ngampiyaskul, Ntombenhle Ngcobo, Nicole Ngo Giang Huong, Pia Ngwaru, Ruth Nhema, Emily Ninsiima, Gloria Ninsiima, Misheck Nkalo Phiri, Antoni Noguera Julian, Monica Nolan, Thornthun Noppakaorattanamanee, Muzamil Nsibuka Kisekka, Eniola Nsirim, Rashina Nundlal, Rosita Nunes, Lungile Nyantsa, Mandisa Nyati, Sean O'Riordan, Paul Ocitti Labeja, Denis Odoch, Rachel Oguntimehin, Martin Ojok, Geoffrey Onen, Wilma Orange, Pradthana Ounchanum, Benson Ouma, Andreia Padrao, Deborah Pako, Anna Parker, Malgorzata Pasko-Szcech, Reena Patel, Rukchanok Peongjakta, Turian Petpranee, Tasmin Phillips, Jackie Philps, Laura Picault, Sonja Pieterse, Helena Pinheiro, Supawadee Pongprapass, Anton Pozniak, Andrew Prendergast, Luis Prieto Tato, Patcharee Puangmalai, Thanyawee Puthanakit, Modiehi Rakgokong, Helena Ramos, Nastassja Ramsagar, Cornelius Rau, Yoann Riault, Pablo Rojo Conejo, Basiimwa Roy Clark, Eddie Rubanga, Baker Rubinga, Chutima Ruklao, Pattira Runarassamee, Chalermpong Saenjum, Chayakorn Saewtrakool, Yacine Saidi, Talia Sainz Costa, Chutima Saisaengjan, Rebecca Sakwa, Tatiana Sarfati, Noshalaza Sbisi, Dihedile Scheppers, Stephan Schultze-Strasser, Ulf Schulze-Sturm, Karen Scott, Janet Seeley, Robert Serunjogi, Leora Sewnarain, Subashinie Sidhoo, Mercy Shibemba, Delane Shingadia, Sheleika Singh, Wasna Sirirungsi, Sibongile Sithebe, Theresa Smit, Kurt Smith, Marlize Smuts, Moira Spyer, Worathip Sripaoraya, Ussanee Srirompotong, Warunee Srisuk, Mark Ssenyonga, Patamawadee Sudsaard, Praornsuda Sukrakanchana, Pathanee Tearsansern, Carla Teixeira, Kanchana Than-in-at, Thitiwat Thapwai, Yupawan Thaweesombat, Jutarat Thewsoongnoen, Rodolphe Thiébaut, Margaret Thomason, Laura Thrasyvoulou, Khanungnit Thungkham, Judith Tikabibamu, Gloria Tinago, Ketmookda Trairat, Gareth Tudor-Williams, Mercy Tukamushaba, Deogratiuos Tukwasibwe, Julius Tumusiime, Joana Tuna, Rebecca Turner, Arttasid Udomvised, Aasia Vadee, Hesti Van Huyssteen, Nadine Van Looy, Yvonne Vaughan-Gordon, Giulio Vecchia, Richard Vowden, Hylke Waalewijn, Rebecca Wampamba, Steve Welch, Ian Weller, Sibusisiwe Weza, Ian White, Kaja Widuch, Helen Wilkes, Sookpanee Wimonklang, Pacharaporn Yingyong, Zaam Zinda Nakawungu, and Peter Zuidewind
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Adult ,Epidemiology ,Pyridones ,Anti-HIV Agents ,Immunology ,HIV Infections ,3-Ring ,Piperazines ,Heterocyclic Compounds ,Virology ,Oxazines ,Humans ,Protease Inhibitors ,Child ,Preschool ,Infant, Newborn ,Infant ,Bayes Theorem ,Viral Load ,Newborn ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Infectious Diseases ,Child, Preschool ,Heterocyclic Compounds, 3-Ring ,Treatment Outcome - Abstract
Contains fulltext : 283099.pdf (Publisher’s version ) (Open Access) BACKGROUND: Young children living with HIV have few treatment options. We aimed to assess the efficacy and safety of dolutegravir-based antiretroviral therapy (ART) in children weighing between 3 kg and less than 14 kg. METHODS: ODYSSEY is an open-label, randomised, non-inferiority trial (10% margin) comparing dolutegravir-based ART with standard of care and comprises two cohorts (children weighing ≥14 kg and
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- 2022
40. Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial
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Anna Turkova, Hylke Waalewijn, Man K Chan, Pauline D J Bollen, Mutsa F Bwakura-Dangarembizi, Adeodata R Kekitiinwa, Mark F Cotton, Abbas Lugemwa, Ebrahim Variava, Grace Miriam Ahimbisibwe, Ussanee Srirompotong, Vivian Mumbiro, Pauline Amuge, Peter Zuidewind, Shabinah Ali, Cissy M Kityo, Moherndran Archary, Rashida A Ferrand, Avy Violari, Diana M Gibb, David M Burger, Deborah Ford, Angela Colbers, Amina Farhana Mehar (nee Abdulla), Pattamukkil Abraham, Elaine Abrams, Judith Acero, Gerald Muzorah Agaba, Grace Ahimbisibwe, Barbara Ainebyoona, Winnie Akobye, Yasmeen Akhalwaya, Nazim Akoojee, Shabinah S. Ali, Catherine Andrea, Maria Angeles Muñoz Fernandez, Rogers Ankunda, Diana Antonia Rutebarika, Suvaporn Anugulruengkitt, Tsitsi Apollo, Ronelle Arendze, Juliet Ategeka, Eunice Atim, Lorna Atwine, Abdel Babiker, Sarah Babirye, Enock Babu, Edward Bagirigomwa, Angella Baita, David Balamusani, Patsy Baliram, David Baliruno, Colin Ball, Henry Balwa, Alasdair Bamford, Srini Bandi, Dominique Barker, Linda Barlow-Mosha, Dickson Bbuye, Shazia Begum, Osee Behuhuma, Sarah Bernays, Rogers Besigye, Maria Bester, Joyline Bhiri, Davide Bilardi, Kristien Bird, Pauline Bollen, Chiara Borg, Anne-Marie Borges Da Silva, Jackie Brown, Elena Bruno, Torsak Bunupuradah, David Burger, Nomzamo Buthelezi, Mutsa Bwakura-Dangarembizi, Africanus Byaruhanga, Joanna Calvert, Petronelle Casey, Haseena Cassim, Sphiwee Cebekhulu, Sanuphong Chailert, Suwalai Chalermpantmetagul, Wanna Chamjamrat, Man Chan, Precious Chandiwana, Thannapat Chankun, Sararut Chanthaburanun, Nuttawut Chanto, Ennie Chidziva, Minenhle Chikowore, Joy Chimanzi, Dujrudee Chinwong, Stuart Chitongo, Moses Chitsamatanga, Joshua Choga, Duangrat Chutima, Polly Clayden, Alexandra Coelho, Alexandra Compagnucci, Ana Constança Mendes, Magda Conway, Mark F. Cotton, Jane Crawley, Tim R. Cressey, Jacky Crisp, Ana Cristina Matos, Sumaya Dadan, Jacqui Daglish, Siva Danaviah, Tseleng Daniel, Anita De Rossi, Sukanda Denjanta, Els Dobbels, Maria Dowie, Prosper Dube, Benedictor Dube, Nimisha Dudakia, Alice Elwana, Cristina Epalza, David Eram, Juan Erasmus, Peter Erim, Luis Escosa Garcia, Zaakirah Essack, Carolina Estepa, Monica Etima, Alexandre Fernandes, Maite Fernandez, Felicity Fitzgerald, Jacquie Flynn, Claudia Fortuny Guasch, Caroline Foster, George Fourie, Yolandie Fourie, Sophie Foxall, Derusha Frank, Kate Gandhi, India Garcia, Kathleen Gartner, Joshua Gasa, Gugu Gasa, Carlo Giaquinto, Diana M. Gibb, Coral Gomez Rico, Daniel Gomez-Pena, Secrecy Gondo, Anna Goodman, Maria Gorreti Nakalema, Winnie Gozhora, Pisut Greetanukroh, Biobanco Gregorio Maranon, Tiziana Grossele, Shamiso Gwande, Tapiwa Gwaze, Tsitsi Gwenzi, James Hakim, Emmanuel Hakiza, Abdul Hamid Kaka, Ashley Harley, Mornay Isaacs, Richard Isabirye, Wilber Ishemunyoro, Tom Jacobs, Lungile Jafta, Nasir Jamil, Anita Janse Janse van Rensburg, Vinesh Jeaven, Maria José Mellado Peña, Gonzague Jourdain, Katabalwa Juliet, Thidarat Jumpimai, Raungwit Junkaew, Thidarat Jupimai, Winfred Kaahwa, Mildred Kabasonga, Olivia Kaboggoza, Rose Jacqueline Kadhuba, Ampika Kaewbundit, Kanyanee Kaewmamueng, Bosco Kafufu, Brenda Kakayi, Phakamas Kamboua, Suparat Kanjanavanit, Gladys Kasangaki, Naruporn Kasipong, Miriam Kasozi, Hajira Kataike, Chrispus Katemba, Elizabeth Kaudha, Nkata Kekane, Adeodata R. Kekitiinwa, Edridah Keminyeto, Woottichai Khamduang, Warunee Khamjakkaew, Jiraporn Khamkon, Sasipass Khannak, Orapin Khatngam, Tassawan Khayanchoomnoom, Busi Khumalo, Mirriam Khunene, Suwimon Khusuwan, Phionah Kibalama, Robinah Kibenge, Anthony Kirabira, Cissy M. Kityo, Lameck Kiyimba, Nigel Klein, Soraya Klinprung, Robin Kobbe, Olivia Kobusingye, Josephine Kobusungye, Areerat Kongponoi, Christoph Königs, Olivier Koole, Christelle Kouakam, Nitinart Krueduangkam, Namthip Kruenual, Nuananong Kunjaroenrut, Raymonds Kyambadde, Priscilla Kyobutungi, Flavia Kyomuhendo, Erinah Kyomukama, Reshma Lakha, Cleopatra Langa, Laddawan Laomanit, Emily Lebotsa, Prattana Leenasirimakul, Lawrence Lekku, Sarah Lensen, Valériane Leroy, Jin Li, Afaaf Liberty, Juthamas Limplertjareanwanich, Emma Little, Ezra Lutalo, Jose Luis Jimenez, Hermione Lyall, Candice MacDonald, Gladness Machache, Penelope Madlala, Tryphina Madonsela, Nomfundo Maduna, Joel Maena, Apicha Mahanontharit, Collin Makanga, Candice Makola, Shafic Makumbi, Lucille Malgraaf, Angelous Mamiane, Felicia Mantkowski, Wendy Mapfumo, Laura Marques, Agnes Mary Mugagga, Lindiwe Maseko, Tshepiso Masienyane, Ruth Mathiba, Farai Matimba, Sajeeda Mawlana, Emmanuel Mayanja, Fatima Mayat, Ritah Mbabazi, Nokuthula Mbadaliga, Faith Mbasani, Kathleen McClaughlin, Helen McIlleron, Watchara Meethaisong, Patricia Mendez Garcia, Annet Miwanda, Carlota Miranda, Siphiwe Mkhize, Kgosimang Mmolawa, Rosie Mngqibisa, Fatima Mohamed, Tumelo Moloantoa, Maletsatsi Monametsi, Samuel Montero, Cecilia L. Moore, Rejoice Mosia, Columbus Moyo, Mumsy Mthethwa, Shepherd Mudzingwa, Tawona Mudzviti, Hilda Mujuru, Emmanuel Mujyambere, Trust Mukanganiki, Cynthia Mukisa Williams, Mark Mulder, Disan Mulima, Alice Mulindwa, Zivai Mupambireyi, Alba Murciano Cabeza, Herbert Murungi, Dorothy Murungu, Sandra Musarurwa, Victor Musiime, Alex V. Musiime, Maria Musisi, Philippa Musoke, Barbara Musoke Nakirya, Godfrey Musoro, Sharif Musumba, Sobia Mustafa, Shirley Mutsai, Phyllis Mwesigwa Rubondo, Mariam Naabalamba, Immaculate Nagawa, Allemah Naidoo, Shamim Nakabuye, Sarah Nakabuye, Sarah Nakalanzi, Justine Nalubwama, Annet Nalugo, Stella Nalusiba, Clementine Namajja, Sylvia Namanda, Paula Namayanja, Esther Nambi, Rachael Kikabi Namuddu, Stella Namukwaya, Florence Namuli, Josephine Namusanje, Rosemary Namwanje, Anusha Nanan-kanjee, Annet Nanduudu, Charity Nankunda, Joanita Nankya Baddokwaya, Maria Nannungi, Winnie Nansamba, Kesdao Nanthapisal, Juliet Nanyonjo, Sathaporn Na-Rajsima, Claire Nasaazi, Helena Nascimento, Eleni Nastouli, Wipaporn Natalie Songtaweesin, Kusum Nathoo, Ian Natuhurira, Rashidah Nazzinda, Thabisa Ncgaba, Milly Ndigendawani, Makhosonke Ndlovu, Georgina Nentsa, Chaiwat Ngampiyaskul, Ntombenhle Ngcobo, Nicole Ngo Giang Huong, Pia Ngwaru, Ruth Nhema, Emily Ninsiima, Gloria Ninsiima, Misheck Nkalo Phiri, Antoni Noguera Julian, Monica Nolan, Thornthun Noppakaorattanamanee, Muzamil Nsibuka Kisekka, Eniola Nsirim, Rashina Nundlal, Rosita Nunes, Lungile Nyantsa, Mandisa Nyati, Sean O'Riordan, Paul Ocitti Labeja, Denis Odoch, Rachel Oguntimehin, Martin Ojok, Geoffrey Onen, Wilma Orange, Pradthana Ounchanum, Benson Ouma, Andreia Padrao, Deborah Pako, Anna Parker, Malgorzata Pasko-Szcech, Reena Patel, Rukchanok Peongjakta, Turian Petpranee, Tasmin Phillips, Jackie Philps, Laura Picault, Sonja Pieterse, Helena Pinheiro, Supawadee Pongprapass, Anton Pozniak, Andrew Prendergast, Luis Prieto Tato, Patcharee Puangmalai, Thanyawee Puthanakit, Modiehi Rakgokong, Helena Ramos, Nastassja Ramsagar, Cornelius Rau, Yoann Riault, Pablo Rojo Conejo, Basiimwa Roy Clark, Eddie Rubanga, Baker Rubinga, Chutima Ruklao, Pattira Runarassamee, Chalermpong Saenjum, Chayakorn Saewtrakool, Yacine Saidi, Talia Sainz Costa, Chutima Saisaengjan, Rebecca Sakwa, Tatiana Sarfati, Noshalaza Sbisi, Dihedile Scheppers, Stephan Schultze-Strasser, Ulf Schulze-Sturm, Karen Scott, Janet Seeley, Robert Serunjogi, Leora Sewnarain, Clare Shakeshaft, Subashinie Sidhoo, Mercy Shibemba, Delane Shingadia, Sheleika Singh, Wasna Sirirungsi, Sibongile Sithebe, Theresa Smit, Kurt Smith, Marlize Smuts, Moira Spyer, Worathip Sripaoraya, Warunee Srisuk, Mark Ssenyonga, Patamawadee Sudsaard, Praornsuda Sukrakanchana, Pathanee Tearsansern, Carla Teixeira, Kanchana Than-in-at, Thitiwat Thapwai, Yupawan Thaweesombat, Jutarat Thewsoongnoen, Rodolphe Thiébaut, Margaret Thomason, Laura Thrasyvoulou, Khanungnit Thungkham, Judith Tikabibamu, Gloria Tinago, Ketmookda Trairat, Gareth Tudor-Williams, Mercy Tukamushaba, Deogratiuos Tukwasibwe, Julius Tumusiime, Joana Tuna, Rebecca Turner, Arttasid Udomvised, Aasia Vadee, Hesti Van Huyssteen, Nadine Van Looy, Yvonne Vaughan-Gordon, Giulio Vecchia, Richard Vowden, Rebecca Wampamba, Steve Welch, Ian Weller, Sibusisiwe Weza, Ellen White, Ian White, Kaja Widuch, Helen Wilkes, Sookpanee Wimonklang, Ben Wynne, Pacharaporn Yingyong, and Zaam Zinda Nakawungu
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Male ,Adolescent ,Pyridones ,Epidemiology ,Immunology ,Infant ,HIV Infections ,3-Ring ,Piperazines ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Infectious Diseases ,Child ,Child, Preschool ,Female ,Heterocyclic Compounds, 3-Ring ,Humans ,Oxazines ,Rifampin ,Uganda ,HIV-1 ,Tuberculosis ,Heterocyclic Compounds ,Virology ,Preschool - Abstract
Contains fulltext : 282959.pdf (Publisher’s version ) (Open Access) BACKGROUND: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. METHODS: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to
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- 2022
41. Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster-randomised controlled trial
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Walter Mangezi, Nicola Willis, Maureen Tshuma, Collin Mangenah, Hendramoorthy Maheswaran, Tsitsi Apollo, Helen A. Weiss, Frances M. Cowan, Juliet Mufuka, Ricardo Araya, Sarah Bernays, and Webster Mavhu
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Male ,Zimbabwe ,medicine.medical_specialty ,Adolescent ,Anti-HIV Agents ,medicine.medical_treatment ,030231 tropical medicine ,HIV Infections ,wa_395 ,wc_503 ,Support group ,Medication Adherence ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Cluster Analysis ,Humans ,Medicine ,030212 general & internal medicine ,Cluster randomised controlled trial ,Young adult ,Adverse effect ,wa_105 ,business.industry ,lcsh:Public aspects of medicine ,lcsh:RA1-1270 ,General Medicine ,Viral Load ,Clinical trial ,Treatment Outcome ,Adolescent Behavior ,Family medicine ,Female ,ws_460 ,business ,Viral load ,Psychosocial - Abstract
Summary Background Adolescents living with HIV face challenges to their wellbeing and antiretroviral therapy adherence and have poor treatment outcomes. We aimed to evaluate a peer-led differentiated service delivery intervention on HIV clinical and psychosocial outcomes among adolescents with HIV in Zimbabwe. Methods 16 public primary care facilities (clusters) in two rural districts in Zimbabwe (Bindura and Shamva) were randomly assigned (1:1) to provide enhanced HIV care support (the Zvandiri intervention group) or standard HIV care (the control group) to adolescents (aged 13–19 years) with HIV. Eligible clinics had at least 20 adolescents in pre-ART or ART registers and were geographically separated by at least 10 km to minimise contamination. Adolescents were eligible for inclusion if they were living with HIV, registered for HIV care at one of the trial clinics, and either starting or already on ART. Exclusion criteria were being too physically unwell to attend clinic (bedridden), psychotic, or unable to give informed assent or consent. Adolescents with HIV at all clinics received adherence support through adult counsellors. At intervention clinics, adolescents with HIV were assigned a community adolescent treatment supporter, attended a monthly support group, and received text messages, calls, home visits, and clinic-based counselling. Implementation intensity was differentiated according to each adolescent's HIV vulnerability, which was reassessed every 3 months. Caregivers were invited to a support group. The primary outcome was the proportion of adolescents who had died or had a viral load of at least 1000 copies per μL after 96 weeks. In-depth qualitative data were collected and analysed thematically. The trial is registered with Pan African Clinical Trial Registry, number PACTR201609001767322. Findings Between Aug 15, 2016, and March 31, 2017, 500 adolescents with HIV were enrolled, of whom four were excluded after group assignment owing to testing HIV negative. Of the remaining 496 adolescents, 212 were recruited at Zvandiri intervention sites and 284 at control sites. At enrolment, the median age was 15 years (IQR 14–17), 52% of adolescents were female, 81% were orphans, and 47% had a viral load of at least 1000 copies per μL. 479 (97%) had primary outcome data at endline, including 28 who died. At 96 weeks, 52 (25%) of 209 adolescents in the Zvandiri intervention group and 97 (36%) of 270 adolescents in the control group had an HIV viral load of at least 1000 copies per μL or had died (adjusted prevalence ratio 0·58, 95% CI 0·36–0·94; p=0·03). Qualitative data suggested that the multiple intervention components acted synergistically to improve the relational context in which adolescents with HIV live, supporting their improved adherence. No adverse events were judged to be related to study procedures. Severe adverse events were 28 deaths (17 in the Zvandiri intervention group, 11 in the control group) and 57 admissions to hospital (20 in the Zvandiri intervention group, 37 in the control group). Interpretation Peer-supported community-based differentiated service delivery can substantially improve HIV virological suppression in adolescents with HIV and should be scaled up to reduce their high rates of morbidity and mortality. Funding Positive Action for Adolescents Program, ViiV Healthcare.
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- 2020
42. Integrating HIV services and other health services: A systematic review and meta-analysis
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Jan A. C. Hontelez, Anna Yakusik, Erik Lamontagne, Caroline A. Bulstra, Wafaa El-Sadr, Moritz Otto, Anna Stepanova, Tsitsi Apollo, Miriam Rabkin, Till Bärnighausen, Rifat Atun, Heidelberg Institute of Global Health, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Joint United Nations Programme On HIV and AIDS, Aix-Marseille Sciences Economiques (AMSE), École des hautes études en sciences sociales (EHESS)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), Columbia University [New York], United Nations Joint Programme on HIV/AIDS, Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Medical Faculty, and École des hautes études en sciences sociales (EHESS)-Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS)
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business.industry ,030503 health policy & services ,1. No poverty ,General Medicine ,Publication bias ,Cost-effectiveness analysis ,medicine.disease ,[SHS.ECO]Humanities and Social Sciences/Economics and Finance ,3. Good health ,Men who have sex with men ,03 medical and health sciences ,0302 clinical medicine ,Systematic review ,Acquired immunodeficiency syndrome (AIDS) ,SDG 3 - Good Health and Well-being ,Meta-analysis ,Environmental health ,Health care ,medicine ,Medicine ,030212 general & internal medicine ,0305 other medical science ,business ,Reproductive health - Abstract
Background Integration of HIV services with other health services has been proposed as an important strategy to boost the sustainability of the global HIV response. We conducted a systematic and comprehensive synthesis of the existing scientific evidence on the impact of service integration on the HIV care cascade, health outcomes, and cost-effectiveness. Methods and findings We reviewed the global quantitative empirical evidence on integration published between 1 January 2010 and 10 September 2021. We included experimental and observational studies that featured both an integration intervention and a comparator in our review. Of the 7,118 unique peer-reviewed English-language studies that our search algorithm identified, 114 met all of our selection criteria for data extraction. Most of the studies (90) were conducted in sub-Saharan Africa, primarily in East Africa (55) and Southern Africa (24). The most common forms of integration were (i) HIV testing and counselling added to non-HIV services and (ii) non-HIV services added to antiretroviral therapy (ART). The most commonly integrated non-HIV services were maternal and child healthcare, tuberculosis testing and treatment, primary healthcare, family planning, and sexual and reproductive health services. Values for HIV care cascade outcomes tended to be better in integrated services: uptake of HIV testing and counselling (pooled risk ratio [RR] across 37 studies: 1.67 [95% CI 1.41–1.99], p < 0.001), ART initiation coverage (pooled RR across 19 studies: 1.42 [95% CI 1.16–1.75], p = 0.002), time until ART initiation (pooled RR across 5 studies: 0.45 [95% CI 0.20–1.00], p = 0.050), retention in HIV care (pooled RR across 19 studies: 1.68 [95% CI 1.05–2.69], p = 0.031), and viral suppression (pooled RR across 9 studies: 1.19 [95% CI 1.03–1.37], p = 0.025). Also, treatment success for non-HIV-related diseases and conditions and the uptake of non-HIV services were commonly higher in integrated services. We did not find any significant differences for the following outcomes in our meta-analyses: HIV testing yield, ART adherence, HIV-free survival among infants, and HIV and non-HIV mortality. We could not conduct meta-analyses for several outcomes (HIV infections averted, costs, and cost-effectiveness), because our systematic review did not identify sufficient poolable studies. Study limitations included possible publication bias of studies with significant or favourable findings and comparatively weak evidence from some world regions and on integration of services for key populations in the HIV response. Conclusions Integration of HIV services and other health services tends to improve health and health systems outcomes. Despite some scientific limitations, the global evidence shows that service integration can be a valuable strategy to boost the sustainability of the HIV response and contribute to the goal of ‘ending AIDS by 2030’, while simultaneously supporting progress towards universal health coverage. Caroline Bulstra and co-workers assess evidence on the benefits of service integration in the HIV care cascade. Author summary Why was this study done? The rapid scale-up of HIV testing and antiretroviral therapy (ART) in many countries and communities over the past 2 decades has been largely achieved with stand-alone HIV programmes. Increasing life expectancy and the side effects of ART are leading to more co-morbidities among people living with HIV, suggesting that ART programmes that also offer other treatments could improve both healthcare effectiveness and the patient experience. Other reasons for integration of services include the hope that joint delivery of services will increase coverage and reduce costs. The global evidence on integration of HIV services and other health services, to our knowledge, has never been synthesised, and it is thus unclear what the empirical effects of integration are. What did the researchers do and find? We conducted a systematic review and meta-analysis to synthesise the results of integrating HIV services and other health services for HIV care cascade outcomes (testing, linkage to care, treatment initiation, treatment adherence, retention, and viral suppression), HIV health outcomes (new infections and mortality), non-HIV health outcomes, and costs and cost-effectiveness. In most of the 114 studies that our systematic review identified most outcomes were better in integrated compared to separate services. What do these findings mean? Integration of HIV services and other health services tends to improve health and health systems outcomes. The success of integration strategies is highly context-specific, and more evidence is needed on integration in specific geographical areas and for key populations in the HIV response. Despite such limitations, our systematic review and meta-analysis support the case for integration as a valuable and viable strategy to boost the sustainability of the HIV response and contribute to the goal of ‘ending AIDS by 2030’, while simultaneously supporting progress towards universal health coverage.
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- 2021
43. When healthcare providers are supportive, 'I'd rather not test alone': Exploring uptake and acceptability of HIV self-testing for youth in Zimbabwe - A mixed method study
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Sarah Bernays, Ethel Dauya, Getrude Ncube, Mandikudza Tembo, Constancia Mavodza, Tsitsi Bandason, Chido Dziva Chikwari, Constance R. S. Mackworth-Young, Rashida A. Ferrand, Tsitsi Apollo, and Katharina Kranzer
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Test strategy ,Zimbabwe ,Adolescent ,Health Personnel ,Context (language use) ,HIV Infections ,sequential explanatory mixed method design ,Nursing ,Medicine ,Humans ,Mass Screening ,Confidentiality ,Research Articles ,HIV self‐testing ,preferences ,Reproductive health ,youth ,Descriptive statistics ,business.industry ,Public Health, Environmental and Occupational Health ,Focus group ,Test (assessment) ,Infectious Diseases ,Self-Testing ,decision‐making ,Thematic analysis ,business ,Research Article - Abstract
Introduction: In sub-Saharan Africa, less than half of young people know their HIV status. HIV self-testing (HIVST) is a testing strategy with the potential to offer privacy and autonomy. We aimed to understand the uptake and acceptability of different HIV testing options for youth in Harare, Zimbabwe. Methods: This study was nested within a cluster randomised trial of a youth-friendly community-based integrated HIV and sexual and reproductive health intervention for youth aged 16-24 years. Three HIV testing options were offered: i) provider-delivered testing; ii) HIVST on-site in a private booth without a provider present, and iii) provision of a test kit to test off-site. Descriptive statistics and proportions were used to investigate the uptake of HIV testing in a client sample. A focus group discussion (FGD) with intervention providers alongside in-depth interviews, paired interviews and FGDs with a selected sample of youth clients explored uptake and acceptability of the different HIV testing strategies. Thematic analysis was used to analyse the qualitative data. Results: Between April and June 2019, 951 eligible clients were tested for HIV: 898 (94.4%) chose option 1, 30 (3.25%) chose option 2 and 23 (2.4%) chose option 3. Option 1 clients cited their trust in the service and a desire for immediate counselling, support, and guidance from trusted providers as the reasons for their choice. Young people were not confident in their expertise to conduct HIVST. Concerns about limited privacy, confidentiality, and lack of support in the event of an HIV positive result were barriers for off-site HIVST. Conclusions: In the context of supportive, trusted, and youth-friendly providers, youth clients overwhelmingly preferred provider-delivered HIV testing over client-initiated HIVST or HIVST off-site. This highlights the importance of listening to youth to improve engagement in testing. While young people want autonomy in choosing when, where and how to test, they do not want to necessarily test on their own. They desire quality in-person counselling, guidance, and support, alongside privacy and confidentiality. To increase the appeal of HIVST for youth, greater provision of access to private spaces is required, and accessible pre- and post-test counselling and support may improve uptake.
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- 2021
44. Risk factors for HIV virological non‐suppression among adolescents with common mental disorder symptoms in Zimbabwe: a cross‐sectional study
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Silindweyinkosi Chinoda, Dorcas Sithole, Tsitsi Apollo, Rhulani Beji-Chauke, Owen Mugurungi, Ruth Verhey, Helen A. Weiss, Nicola Willis, Dixon Chibanda, Victoria Simms, Sarah Bernays, and Abigail Mutsinze
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Adult ,Male ,Zimbabwe ,Pediatrics ,medicine.medical_specialty ,viral suppression ,Adolescent ,Cross-sectional study ,Anti-HIV Agents ,HIV Infections ,law.invention ,Social support ,Randomized controlled trial ,law ,Risk Factors ,medicine ,gender ,Humans ,adherence ,adolescents ,Child ,Depression (differential diagnoses) ,Research Articles ,business.industry ,Mental Disorders ,Public Health, Environmental and Occupational Health ,Odds ratio ,social support ,Viral Load ,Mental health ,Infectious Diseases ,Cross-Sectional Studies ,Africa ,Anxiety ,Female ,medicine.symptom ,business ,Viral load ,Research Article - Abstract
Introduction Adolescents are at increased risk of HIV virological non‐suppression compared to adults and younger children. Common mental disorders such as anxiety and depression are a barrier to adherence and virological suppression. The aim of this study was to identify factors associated with virological non‐suppression among adolescents living with HIV (ALWH) in Zimbabwe who had symptoms of common mental disorders. Methods We utilized baseline data from a cluster‐randomized controlled trial of a problem‐solving therapy intervention to improve mental health and HIV viral suppression of ALWH. Sixty clinics within 10 districts were randomized 1:1 to either the intervention or control arm, with the aim to recruit 14 adolescents aged 10 to 19 per clinic. Adolescents were eligible if they scored ≥7 on the Shona Symptom Questionnaire measuring symptoms of common mental disorders. Multivariable mixed‐effects logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with non‐suppression, defined as viral load ≥1000 copies/mL. Results Between 2 January and 21 March 2019 the trial enrolled 842 participants aged 10 to 19 years (55.5% female, 58.8% aged
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- 2021
45. Feasibility and Accuracy of HIV Testing of Children by Caregivers Using Oral Mucosal Transudate HIV Tests
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Hilda Mujuru, Sarah Bernays, Karen Webb, Tsitsi Apollo, Rudo Chikodzore, Rashida A. Ferrand, Chido Dziva Chikwari, Stefanie Dringus, Katharina Kranzer, Victoria Simms, Nicol Redzo, Getrude Ncube, Helen A. Weiss, Karin Hatzold, and Edwin Sibanda
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Adult ,Male ,Zimbabwe ,medicine.medical_specialty ,Adolescent ,Human immunodeficiency virus (HIV) ,HIV Infections ,Hiv testing ,030312 virology ,medicine.disease_cause ,Logistic regression ,HIV Testing ,Young Adult ,03 medical and health sciences ,children ,Humans ,Mass Screening ,Medicine ,Pharmacology (medical) ,adolescents ,Child ,caregiver ,Implementation Science ,0303 health sciences ,business.industry ,Mouth Mucosa ,HIV ,Exudates and Transudates ,Odds ratio ,Middle Aged ,Checklist ,Transudate ,Confidence interval ,Test (assessment) ,Self-Testing ,Infectious Diseases ,Caregivers ,Child, Preschool ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Physical therapy ,Feasibility Studies ,Female ,business - Abstract
Supplemental Digital Content is Available in the Text., 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.
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- 2021
46. Operational Research to Assess the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Health Facilities in Harare, Zimbabwe
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Srinath Satyanarayana, I. D. Rusen, Ajay M. V. Kumar, Anthony D. Harries, Tsitsi Apollo, Kudakwashe C. Takarinda, Rony Zachariah, Selma Dar Berger, Mohammed Khogali, Collins Timire, Pruthu Thekkur, Hemant Deepak Shewade, and Charles Sandy
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0301 basic medicine ,Zimbabwe ,Tuberculosis ,Referral ,Coronavirus disease 2019 (COVID-19) ,Harare ,030106 microbiology ,antiretroviral therapy ,Human immunodeficiency virus (HIV) ,medicine.disease_cause ,Article ,03 medical and health sciences ,presumptive tuberculosis ,0302 clinical medicine ,Environmental health ,Pandemic ,medicine ,In patient ,030212 general & internal medicine ,Hiv services ,General Immunology and Microbiology ,business.industry ,Public Health, Environmental and Occupational Health ,HIV ,operational research ,COVID-19 ,TB treatment outcomes ,medicine.disease ,Antiretroviral therapy ,Infectious Diseases ,tuberculosis ,Medicine ,business ,EpiCollect5 - Abstract
When COVID-19 was declared a pandemic, there was concern that TB and HIV services in Zimbabwe would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in 10 health facilities in Harare to capture trends in TB case detection, TB treatment outcomes and HIV testing and use these data to facilitate corrective action. Aggregate data were collected monthly during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data extracted for the pre-COVID-19 period (March 2019–February 2020). Monthly reports were sent to program directors. During the COVID-19 period, there was a decrease in persons with presumptive pulmonary TB (40.6%), in patients registered for TB treatment (33.7%) and in individuals tested for HIV (62.8%). The HIV testing decline improved in the second 6 months of the COVID-19 period. However, TB case finding deteriorated further, associated with expiry of diagnostic reagents. During the COVID-19 period, TB treatment success decreased from 80.9 to 69.3%, and referral of HIV-positive persons to antiretroviral therapy decreased from 95.7 to 91.7%. Declining trends in TB and HIV case detection and TB treatment outcomes were not fully redressed despite real-time monthly surveillance. More support is needed to transform this useful information into action.
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- 2021
47. Provision of HIV viral load testing services in Zimbabwe: Secondary data analyses using data from health facilities using the electronic Patient Monitoring System
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Andrew N. Phillips, Tsitsi Apollo, Chiratidzo E. Ndhlovu, Frances M. Cowan, and Kudakwashe C. Takarinda
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RNA viruses ,Male ,Quality management ,Remote patient monitoring ,Human immunodeficiency virus (HIV) ,wc_503 ,HIV Infections ,030204 cardiovascular system & hematology ,Pathology and Laboratory Medicine ,Adolescents ,medicine.disease_cause ,Geographical Locations ,Families ,0302 clinical medicine ,Immunodeficiency Viruses ,Medicine and Health Sciences ,Electronic Health Records ,Medicine ,Public and Occupational Health ,030212 general & internal medicine ,Child ,Children ,Virus Testing ,Multidisciplinary ,HIV diagnosis and management ,Viral Load ,Middle Aged ,Vaccination and Immunization ,Anti-Retroviral Agents ,Medical Microbiology ,Viral Pathogens ,Child, Preschool ,Viruses ,Female ,Pathogens ,Viral load ,Research Article ,Zimbabwe ,Adult ,medicine.medical_specialty ,Adolescent ,Science ,Immunology ,MEDLINE ,Antiretroviral Therapy ,wa_395 ,Microbiology ,Retrospective data ,03 medical and health sciences ,Antiviral Therapy ,Diagnostic Medicine ,Virology ,Retroviruses ,Humans ,c941fbbd ,Microbial Pathogens ,Retrospective Studies ,business.industry ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,Antiretroviral therapy ,Health Care ,VIROLOGIC FAILURE ,Health Care Facilities ,Age Groups ,People and Places ,Africa ,Emergency medicine ,HIV-1 ,Population Groupings ,Preventive Medicine ,wc_503_41 ,business ,Viral Transmission and Infection - Abstract
Introduction Routine viral load (VL) testing among persons living with Human Immunodeficiency Virus (PLHIV) enables earlier detection of sub-optimal antiretroviral therapy (ART) adherence and for appropriate management of treatment failure. Since adoption of this policy by Zimbabwe in 2016, the extent of implementation is unclear. Therefore we set out to determine among PLHIV ever enrolled on ART from 2004–2017 and in ART care for ≥12 months at health facilities providing ART in Zimbabwe: numbers (proportions) with VL testing uptake, VL suppression and subsequently switched to 2nd-line ART following confirmed virologic failure. Materials and methods We used retrospective data from the electronic Patient Monitoring System (ePMS) in which PLHIV on ART are registered at 525 public and 4 private health facilities. Results Among the 392,832 PLHIV in ART care for ≥12 months, 99,721 (25.4%) had an initial VL test done and results available of whom 81,932 (82%) were virally suppressed. Among those with a VL>1000 copies/mL; 6,689 (37.2%) had a follow-up VL test and 4,086 (61%) had unsuppressed VLs of whom only 1,749 (42.8%) were switched to 2nd-line ART. Lower age particularly adolescents (10–19 years) were more likely (ARR 1.34; 95%CI: 1.25–1.44) to have virologic failure. Conclusion The study findings provide insights to implementation gaps including limitations in VL testing; low identification of high- risk PLHIV in care and lack of prompt utilization of test results. The use of electronic patient-level data has demonstrated its usefulness in assessing the performance of the national VL testing program. By end of 2017 implementation of VL testing was sub-optimal, and virological failure was relatively common, particularly among adolescents. Of concern is evidence of failure to act on VL test results that were received. A quality improvement initiative has been planned in response to these findings and its effect on patient management will be monitored.
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- 2021
48. Evaluation of the Zimbabwe HIV case surveillance pilot project, 2019
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Ngwarai Sithole, Brian Komtenza, Owen Mugurungi, Alex Gasasira, Brian Moyo, Anesu Chimwaza, Simbarashe Mabaya, David Lowrance, Regis Choto, Leon Mbano, Thandekile Ntombikayise Moyo, Takura Matare, Tsitsi Apollo, Daniel Low-Beer, Peter Nsubuga, and Kudakwashe C. Takarinda
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Zimbabwe ,medicine.medical_specialty ,patient monitoring ,Developing country ,Context (language use) ,HIV Infections ,Pilot Projects ,Computer-assisted web interviewing ,Health informatics ,Health facility ,Environmental health ,Surveys and Questionnaires ,Global health ,HIV, case surveillance, informatics, electronic health records, continuum of care, patient monitoring ,Medicine ,informatics ,Humans ,Public Health Surveillance ,business.industry ,Public health ,HIV ,General Medicine ,Viral Load ,continuum of care ,Test (assessment) ,electronic health records ,Cross-Sectional Studies ,case surveillance ,Workshop Report ,business - Abstract
INTRODUCTION: Zimbabwe has a high burden of HIV (i.e., estimated 1.3 million HIV-infected and 13.8% HIV incidence in 2017). In 2017 the country developed and implemented a pilot of HIV case surveillance (CS) based on the 2017 World Health Organisation (WHO) person-centred HIV patient monitoring (PM) and case surveillance guidelines. At the end of the pilot phase an evaluation was conducted to inform further steps. METHODS: The pilot was conducted in two districts (i.e., Umzingwane in Matabeleland South Province and Mutare in Manicaland Province) from August 2017 to December 2018. A mixed-methods cross-sectional study of stakeholders and health facility staff was used to assess the design and operations, performance, usefulness, sustainability, and scalability of the CS system. A total of 13 stakeholders responded to an online questionnaire, while 33 health facility respondents were interviewed in 11 health facilities in the two districts. RESULTS: The HIV CS system was adequately designed for Zimbabwe´s context, integrated within existing health information systems at the facility level. However, the training was minimal, and an opportunity to train the data entry clerks in data analysis was missed. The system performed well in terms of surveillance and informatics attributes. However, viral load test results return was a significant problem. CONCLUSION: The HIV CS system was found useful at the health facility level and should be rolled out in a phased manner, beginning in Manicaland and Matabeleland South provinces. An electronic link needs to be made between the health facilities and the laboratory to reduce viral load test results delays.
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- 2020
49. Comparison of index-linked HIV testing for children and adolescents in health facility and community settings in Zimbabwe: findings from the interventional B-GAP study
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Stefanie Dringus, Nicol Redzo, Getrude Ncube, Chido Dziva Chikwari, Helen A. Weiss, Victoria Simms, Rashida A. Ferrand, Katharina Kranzer, Karen Webb, Barbara Engelsmann, Hilda Mujuru, Rudo Chikodzore, Edwin Sibanda, Tsitsi Apollo, Karen Hatzold, and Tsitsi Bandason
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Adult ,Male ,Zimbabwe ,0301 basic medicine ,medicine.medical_specialty ,Index (economics) ,Adolescent ,Epidemiology ,Immunology ,MEDLINE ,HIV Infections ,Logistic regression ,HIV Testing ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Health facility ,Residence Characteristics ,Virology ,medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,Young adult ,Child ,Rapid diagnostic test ,business.industry ,Articles ,Odds ratio ,Middle Aged ,030112 virology ,Infectious Disease Transmission, Vertical ,Test (assessment) ,Infectious Diseases ,Child, Preschool ,Family medicine ,Female ,Health Facilities ,business - Abstract
Summary Background Index-linked HIV testing, whereby children of individuals with HIV are targeted for testing, increases HIV yield but relies on uptake. Community-based testing might address barriers to testing access. In the Bridging the Gap in HIV testing and care for children in Zimbabwe (B-GAP) study, we investigated the uptake and yield of index-linked testing in children and the uptake of community-based vs facility-based HIV testing in Zimbabwe. Methods B-GAP was an interventional study done in the city of Bulawayo and the province of Matabeleland South between Jan 29 and Dec 12, 2018. All HIV-positive attendees (index patients) at six urban and three rural primary health-care clinics were offered facility-based or community-based HIV testing for children (age 2–18 years) living in their households who had never been tested or had tested as HIV-negative more than 6 months ago. Community-based options involved testing in the home by either a trained lay worker with a blood-based rapid diagnostic test (used in facility-based testing), or by the child's caregiver with an oral HIV test. Among consenting individuals, the primary outcome was testing uptake in terms of the proportion of eligible children tested. Secondary outcomes were uptake of the different HIV testing methods, HIV yield (proportion of eligible children who tested positive), and HIV prevalence (proportion of HIV-positive children among those tested). Logistic regression adjusting for within-index clustering was used to investigate index patient and child characteristics associated with testing uptake, and the uptake of community-based versus facility-based testing. Findings Overall, 2870 index patients were linked with 6062 eligible children (3115 [51·4%] girls [sex unknown in seven], median age 8 years [IQR 5–13]). Testing was accepted by index patients for 5326 (87·9%) children, and 3638 were tested with a known test outcome, giving an overall testing uptake among 6062 eligible children of 60·0%. 39 children tested positive for HIV, giving an HIV prevalence among the 3638 children of 1·1% and an HIV yield among 6062 eligible children of 0·6%. Uptake was positively associated with female sex in the index patient (adjusted odds ratio [aOR] 1·56 [95% CI 1·38–1·77], p
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- 2020
50. Patient-mix, programmatic characteristics, retention and predictors of attrition among patients starting antiretroviral therapy (ART) before and after the implementation of HIV 'Treat All' in Zimbabwe
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Jozefien Buyze, Madelon de Rooij, Tsitsi Apollo, Tom Decroo, Lutgarde Lynen, Wim Van Damme, Ngwarai Sithole, James Hakim, Richard Makurumidze, Simbarashe Rusakaniko, Trevor Mataranyika, Kudakwashe C. Takarinda, and Faculty of Medicine and Pharmacy
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RNA viruses ,Bacterial Diseases ,Male ,Epidemiology ,Maternal Health ,HIV Infections ,Pathology and Laboratory Medicine ,infectious diseases ,Cohort Studies ,Medical Conditions ,Immunodeficiency Viruses ,Pregnancy ,Risk Factors ,Antiretroviral Therapy, Highly Active ,Medicine and Health Sciences ,Medicine ,Public and Occupational Health ,Attrition ,Young adult ,Virus Testing ,Medicine(all) ,Multidisciplinary ,Hazard ratio ,Obstetrics and Gynecology ,Vaccination and Immunization ,Antiretroviral therapy ,Medical Microbiology ,Viral Pathogens ,Viruses ,Female ,Pathogens ,Art ,Research Article ,Adult ,Zimbabwe ,medicine.medical_specialty ,Anti-HIV Agents ,Science ,Immunology ,Microbiology ,Medication Adherence ,Sex Factors ,Antiviral Therapy ,Diagnostic Medicine ,Internal medicine ,Retroviruses ,Adults ,Tuberculosis ,Humans ,Risk factor ,Microbial Pathogens ,Survival analysis ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Proportional hazards model ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,Retrospective cohort study ,Tropical Diseases ,medicine.disease ,Survival Analysis ,CD4 Lymphocyte Count ,Young Adults ,Health Care ,Age Groups ,Health Care Facilities ,Medical Risk Factors ,People and Places ,Women's Health ,Population Groupings ,Lost to Follow-Up ,Preventive Medicine ,Geriatrics and Gerontology ,business - Abstract
BackgroundSince the scale-up of the HIV "Treat All" recommendation, evidence on its real-world effect on predictors of attrition (either death or lost to follow-up) is lacking. We conducted a retrospective study using Zimbabwe ART program data to assess the association between "Treat All" and, patient-mix, programmatic characteristics, retention and predictors of attrition.MethodsWe used patient-level data from the electronic patient monitoring system (ePMS) from the nine districts, which piloted the "Treat All" recommendation. We compared patient-mix, programme characteristics, retention and predictors of attrition (lost to follow-up, death or stopping ART) in two cohorts; before (April/May 2016) and after (January/February 2017) "Treat All". Retention was estimated using survival analysis. Predictors of attrition were determined using a multivariable Cox regression model. Interactions were used to assess the change in predictors of attrition before and after "Treat All".ResultsWe analysed 3787 patients, 1738 (45.9%) and 2049 (54.1%) started ART before and after "Treat All", respectively. The proportion of men was higher after "Treat All" (39.4.% vs 36.2%, p = 0.044). Same-day ART initiation was more frequent after "Treat All" (43.2% vs 16.4%; pConclusionAttrition was higher after "Treat All"; being male, WHO Stage 4, and pregnancy predicted attrition in both before and after Treat All. However, pregnancy became a less strong risk factor for attrition after "Treat All" implementation.
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- 2020
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