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Title:  Data driven HIV prevention: the HIV prevention cascade and beyond

Authors:

Guest Editors: James R Hargreaves, Judith D Auerbach, Bernadette Hensen, Simon Gregson
Supplement Editors: Marlène Bras, Elisa de Castro Alvarez

Abstract:

It is heartening to learn from recent data in multiple settings that decreasing community viral load through “universal test and treat” programmes is having a significant impact on HIV morbidity, mortality and the rate of new HIV infections in some settings. However, focusing only on preventing transmission from a person already living with HIV to one who is not, is only half of the equation and will by itself not “end HIV.” A crucial focus remains preventing acquisition of HIV infection among people at risk. Achieving this requires that we strengthen primary HIV prevention programmes because HIV incidence declines attributable to treatment may be slower than required to meet global goals [4]; treatment as prevention may have less impact where a high proportion of transmission involves those in early stage HIV infection [5]; and, critically, because it is essential that individuals and communities have the autonomy to avoid acquiring HIV if at all possible

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Title: Inequalities in uptake of HIV testing despite scale-up

Authors:

Euphemia L Sibanda, Miriam Taegtmeyer

Abstract

HIV testing is an essential aspect of HIV prevention and treatment services. Since 2008, large-scale initiatives have aimed to increase access to, and uptake of, HIV testing in untested populations at risk. Strategies have included provider-initiated HIV testing and counselling, community-based approaches, and partner notifi-cation. Sub-Saharan Africa, the region worst affected by the HIV epidemic, is also the region most in need of these initiatives. Similar to findings for other health interventions, inequalities in uptake of HIV testing have been recorded, and these inequalities might persist despite intensification of HIV testing efforts and scale-up of treatment.

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Title: Male involvement interventions and improved couples’ emotional relationships in Tanzania and Zimbabwe: ‘When we are walking together, I feel happy’

Authors:

Liz Comrie-Thomson, Webster Mavhu, Christina Makungu, Quamrun Nahar, Rasheda Khan, Jessica Davis, Erica Stillo, Saadya Hamdani, Stanley Luchters & Cathy Vaughan

Abstract:

Male involvement in maternal and child health is recognised as a valuable strategy to improve care-seeking and uptake of optimal home care practices for women and children in low- and middle-income settings. However, the specific mechanisms by which involving men can lead to observed behaviour change are not well substantiated. A qualitative study conducted to explore men’s and women’s experiences of male involvement interventions in Tanzania and Zimbabwe found that, for some women and men, the  interventions had fostered more loving partner relationships. Both male and female participants identified these changes as profoundly meaningful and highly valued. Our findings illustrate key pathways by which male involvement interventions were able to improve couples’ emotional relationships. Findings also indicate that these positive impacts on couple relationships can motivate and support men’s behaviour change, to improve care-seeking and home care practices. Men’s and women’s subjective experiences of partner relationships following male involvement interventions have not been well documented to date. Findings highlight the importance of increased love, happiness and emotional intimacy in couple relationships – both as a wellbeing outcome valued by men and women, and as a contributor to the effectiveness of male involvement interventions.

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Title: Three lessons for the COVID-19 response from pandemic HIV

Author: 

*James Hargreave etal

Abstract:

The HIV pandemic provides lessons for the response to the novel coronavirus disease 2019 (COVID-19) pandemic: no vaccine is available for either and there are no licensed pharmaceuticals for COVID-19, just as there was not for HIV infection in the early years. Population behaviour will determine the pandemic trajectory of COVID-19, just as it did for HIV

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Title: Costs and economies of scale in the accelerated program for prevention of mother-to-child transmission of HIV in Zimbabwe

Authors
IOchoa-Moreno, S. Bautista-Arredondo, S. I. McCoy, R. Buzdugan, C. Mangenah, N. S. Padian, F. M. Cowan

Abstract:

Despite a growing body of literature on HIV service costs in sub-Saharan Africa, only a few studies have estimated the facility-level cost of prevention of Mother-to-Child Transmission (PMTCT) services, and even fewer provide insights into the variation of MTCT costs across facilities. In this study, we present the first empirical costs estimation of the accelerated program for the prevention of mother-to-child transmission of HIV in Zimbabwe and investigate the determinants of heterogeneity of the facility-level average cost per service. To understand such variation, we explored the association between average costs per service and supply-and demand-side characteristics, and quality of services. One aspect of the supply-side we explore carefully is the scale of production—which we define as the annual number of women tested or the yearly number of HIV-positive women on prophylaxis

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Title: Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster-randomised controlled trial

Authors:

Webster Mavhu, Nicola Willis, Juliet Mufuka, Sarah Bernays, Maureen Tshuma, Collin Mangenah, Hendramoorthy Maheswaran, Walter Mangezi, Tsitsi Apollo, Ricardo Araya, Helen A Weiss, Frances M Cowan

Abstract:

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.

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Title: Changes Over Time in HIV Prevalence and Sexual Behaviour Among Young Female Sex‑Workers in 14 Sites in Zimbabwe, 2013–2016

Authors: Sungai T. Chabata · Bernadette Hensen · Tarisai Chiyaka · Phillis Mushati · Sibongile Mtetwa ·
Dagmar Hanisch · Sue Napierala · Joanna Busza · Sian Floyd · Elizabeth Fearon · Isolde Birdthistle ·
James R. Hargreaves · Frances M. Cowan

Abstract
Young female sex-workers (FSW) aged 18–24 are at high risk of HIV due to high numbers of sexual partners, difficulty negotiating condom use, increased risk of gender-based violence, and limited access to services. Here we describe changes in sexual behaviours among young FSW across Zimbabwe between 2013 and 2016, and risk factors for prevalent HIV in 2013 and 2016. FSW ≥ 18 years were recruited using respondent-driven sampling in 14 sites across Zimbabwe in 2013 and 2016 as part of the SAPPH-IRe trial

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Title: Protocol for the evaluation of the population-level impact of Zimbabwe’s prevention of mother-to-child HIV transmission program option B+: a community based serial cross-sectional study

Authors: Aybuke Koyuncu, Mi-Suk Kang Dufour, Sandra Irene McCoy, Sergio Bautista-Arredondo, Raluca Buzdugan, Constancia Watadzaushe, Jeffrey Dirawo, Angela Mushavi, Agnes Mahomva, Frances Cowan and Nancy Padian

Abstract

WHO recommends that HIV infected women receive antiretroviral therapy (ART) minimally during pregnancy and breastfeeding (“Option B”), or ideally throughout their lives regardless of clinical stage (“Option B+”) (Coovadia et al., Lancet 379:221–228, 2012). Although these recommendations were based on clinical trials demonstrating the efficacy of ART during pregnancy and breastfeeding, the population-level effectiveness of Option B+ is unknown.

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Title: Economy, migrant labour and sex work: interplay of HIV epidemic drivers in Zimbabwe over three decades

Authors: Richard Steena, Jan A.C. Honteleza, Owen Mugurungi, Amon Mpofu, Suzette M. Matthijsse, Sake J. de Vlasa, Gina A. Dallabetta and Frances M. Cowan

Abstract

HIV took off rapidly in Zimbabwe during the 1980s. Yet, between 1998 and 2003, as the economy faltered, HIV prevalence declined abruptly and without clear explanation.

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Title: Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe

Authors: Helen Mebrahtu, Victoria Simms, Zivai Mupambireyi,Andrea M Rehman,Rudo Chingono, Edward Matsikire,Rickie Malaba, Helen A Weiss, Patience Ndlovu, Frances M Cowan, Lorraine Sherr

Abstract

HIV-exposed children show signs of  developmental delay. We assessed the impact of a pragmatic multicomponent intervention for caregivers of HIV-exposed children aged 0–2 years in Zimbabwe.

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Title: Cluster randomised controlled trial to determine the effect of peer delivery HIV self-testing to support linkage to HIV prevention among young women in rural KwaZulu-Natal, South Africa: a study protocol

Authors: Oluwafemi Atanda Adeagbo ,Nondumiso Mthiyane, Carina Herbst, Paul Mee, Melissa Neuman,Jaco Dreyer,Natsayi Chimbindi,Theresa Smit,Nonhlanhla Okesola, Cheryl Johnson, Karin Hatzold,Janet Seeley, Frances Cowan, Liz Corbett, Maryam Shahmanesh

Abstract

A cluster randomised controlled trial (cRCT) to determine whether HIV self-testing (HIVST) delivered by peers either directly or through incentivised peer-networks, could increase the uptake of antiretroviral therapy and pre-exposure prophylaxis (PrEP) among young women (18 to 24 years) is being undertaken in an HIV hyperendemic area in KwaZulu-Natal, South Africa.

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Title:The impact and cost-effectiveness of community-based HIV self-testing in sub-Saharan Africa: a health economic and modelling analysis

Authors: Valentina Cambiano, Cheryl C Johnson, Karin Hatzold, Fern Terris-Prestholt, Hendy Maheswaran, Harsha Thirumurthy, Carmen Figueroa, Frances M Cowan, Euphemia L Sibanda, Getrude Ncube, Paul Revill, Rachel C Baggaley, Elizabeth L Corbett, Andrew Phillips for Working Group on Cost Effectiveness of HIV self-testing in Southern Africa

Abstract

The prevalence of undiagnosed HIV is declining in Africa, and various HIV testing approaches are finding lower positivity rates. In this context, the epidemiological impact and cost-effectiveness of community-based HIV self-testing (CBHIVST)
is unclear. We aimed to assess this in different sub-populations and across scenarios characterized by different adult HIV prevalence and antiretroviral treatment programmes in sub-Saharan Africa.

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Title: Applying user preferences to optimize the contribution of HIV self-testing to reaching the “first 90” target of UNAIDS Fast-track strategy: results from discrete choice experiments in Zimbabwe

Authors: Euphemia L Sibanda, Marc d’Elbee, Galven Maringwa, Nancy Ruhode, Mary Tumushime, Claudius Madanhire, Jason J Ong, Pitchaya Indravudh,  Constancia Watadzaushe, Cheryl C Johnson, Karin Hatzold7, Miriam Taegtmeyer, James R Hargreaves, Elizabeth L Corbett, Frances M Cowan and Fern Terris-Prestholt

Abstract

New HIV testing strategies are needed to reach the United Nations’ 90-90-90 target. HIV self-testing (HIVST) can increase uptake, but users’ perspectives on optimal models of distribution and post-test services are uncertain. We used discrete choice experiments (DCEs) to explore the impact of service characteristics on uptake along the testing cascade.

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Title: Strengthening the scale-up and uptake of effective  interventions for sex workers for population impact in Zimbabwe

Authors: Frances M Cowan , Sungai T Chabata , Sithembile Musemburi , Elizabeth Fearon , Calum Davey ,Tendayi Ndori-Mharadze , Loveleen Bansi-Matharu , Valentina Cambiano , Richard Steen , Joanna Busza , Raymond Yekeye, Owen Mugurungi, James R Hargreaves and Andrew N Phillips

Abstract

UNAIDS’ goal of ending AIDS by 2030 is unreachable without better targeting of testing, prevention and care. Female sex workers (FSW) in Zimbabwe are at high risk of HIV acquisition and transmission. Here, we report on collated programme and research data from Zimbabwe’s national sex work programme. We also assess the potential for wider population impact of FSW programmes by modelling the impact on HIV incidence of eliminating transmission through FSW (i.e. calculate the population attributable fraction of incidence attributable to sex work).

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Title: HIV risk among young women who sell sex by whether they identify as sex workers: analysis of respondent-driven sampling surveys, Zimbabwe, 2017

Authors: Bernadette Hensen , Sungai T Chabata , Sian Floyd, Tarisai Chiyaka, Phillis Mushati, Joanna Busza, Isolde Birdthistle , James R Hargreaves and Frances M Cowan

Abstract

Across sub-Saharan Africa, selling sex puts young women at high risk of HIV. Some young women who sell sex (YWSS) may self-identify as sex workers, while others may not, having implications for how to reach them with HIV prevention. We describe characteristics, sexual behaviours and health service use of YWSS in Zimbabwe, comparing women who identified as female sex workers (FSW) and women who did not (non-identifying-YWSS), and explore factors associated with HIV infection.

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Title: Is the PrePex device an alternative for surgical male circumcision in adolescents ages 13–17 years? Findings from routine service delivery during active surveillance in Zimbabwe

Authors: Webster Mavhu, Karin Hatzold, Ngonidzashe Madidi, Brian Maponga,Roy Dhlamini, Malvern Munjoma, Sinokuthemba Xaba, Getrude Ncube,Owen Mugurungi, Frances M. Cowan

Abstract

Male circumcision devices have the potential to accelerate adolescent voluntary medical male circumcision roll-out. Here, we present findings on safety, acceptability and satisfaction from active surveillance of PrePex implementation among 618 dolescent males (13–17 years) circumcised in Zimbabwe.

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