Publication

Title: Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe

Authors:

Linda Alinafe Sande, Katleho Matsimela, Lawrence Mwenge, Collin Mangenah, Augustine Talumba Choko, Marc d’Elbée, Mohammed Majam, Cyprian Mostert, Inonge Matamwandi, Euphemia Lindelwe Sibanda, Cheryl Johnson, Karin Hatzold, Helen Ayles, Frances M Cowan, Elizabeth Lucy Corbett, Melissa Neuman , Hendramoorthy Maheswaran, Gesine Meyer-Rath, Fern Terris-Prestholt

ABSTRACT

Introduction As countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV selftest (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner’s use) distribution alone or primary (own use) and secondary distribution approaches.

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Title: Secondary HIV self-test distribution increases male partner testing

Authors: Sibanda EL, Mavhu W

Abstract

There is established evidence that men are less likely than women to engage with HIV services; the latest global estimates show that, compared with women, 1 million more men living with HIV do not know their status, 1·8 million know their status but are not on treatment, and 1·6 million are not virally suppressed.1
 Elimination of HIV requires concerted efforts to ensure that men are not left behind. Male partners of pregnant women are particularly important to engage to optimise HIV outcomes for themselves, their pregnant or lactating partners, and their babies, because incident maternal infection during breastfeeding is the largest contributor to postpartum mother-to-child transmission of HIV…

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Title: Effect of peer-distributed HIV self-test kits on demand for biomedical HIV prevention in rural KwaZulu-Natal, South Africa: a three-armed cluster-randomised trial comparing social networks versus direct delivery

Authors:

Shahmanesh M, Mthiyane TN, Herbsst C, Neuman M, Adeagbo O, Mee P, Chimbindi N, Smit T, Okesola N, Harling G, McGrath N, Sherr L, Seeley J, Subedar H, Johnson C, Hatzold K, Terris-Prestholt F, Cowan FM, Corbett EL

Abstract:

Study objective: We investigated two peer distribution models of HIV self-testing (HIVST) in HIV prevention demand creation compared with trained young community members (peer navigators)…

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Title: Innovative demand creation strategies to increase voluntary medical male circumcision uptake: a pragmatic randomised controlled trial in Zimbabwe

Authors: Mavhu W, Neuman M, Hatzold K, Buzuzi S, Maringwa G, Chabata ST, Mangenah C, Taruberekera N, Madidi N, Munjoma M, Ncube G, Xaba S, Mugurungi O, Johnson CC, Corbett EL, Weiss HA, Fielding K, Cowan FM

Abstract:

Reaching men aged 20–35 years, the group at greatest risk of HIV, with voluntary medical male circumcision (VMMC) remains a challenge. We assessed the impact of two VMMC demand creation approaches targeting this age group in a randomised controlled trial (RCT)…

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Title: Relative efficiency of demand creation strategies to increase voluntary medical male circumcision uptake: a study conducted as part of a randomised controlled trial in Zimbabwe.

Authors

Mangenah C, Mavhu W, Garcia DC, Gavi C, Mleya P, Chiwawa P, Chidawanyika S, Ncube G, Xaba S, Mugurungi O, Taruberekera N, Madidi N, Fielding KL, Johnson C, Hatzold K, Terris-Prestholt F, Cowan FM

Abstract

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Title: Adolescent girls who sell sex in Zimbabwe: HIV risk, behaviours and service engagement. Journal of Acquired Immune Deficiency Syndromes (1999).

Authors: Rice, B., Machingura, F., Maringwa, G., Magutshwa, S., Kujeke, T., Jamali, G., Busza, J., de Wit, M., Fearon, E., Hanisch, D. and Yekeye, R., 2022.

Abstract 

Background
To reduce HIV incidence among adolescent girls who sell sex (AGSS) in Zimbabwe, we need to better understand how vulnerabilities intersect with HIV infection and how those living with HIV engage in care.

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Title: Experiences and lessons learned from the real-world implementation of an HIV recent infection testing algorithm in three routine service-delivery settings in Kenya and Zimbabwe.

Authors: Mariken de Wit, Brian Rice, Kathryn Risher, Susie Welty, Wanjiru Waruiru, Sitholubuhle Magutshwa, John Motoku, Daniel Kwaro, Benard Ochieng, Georges Reniers, Frances M Cowan, George Rutherford, James Hargreaves, Gary Murphy. BMC Health Serv Res 21, 596 (2021).

Abstract

Testing for recent HIV infection can distinguish recently acquired infection from long-standing infections. Given current interest in the implementation of recent infection testing algorithms (RITA), we report our experiences in implementing a RITA in three pilot studies and highlight important issues to consider when conducting recency testing in routine settings

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Title: It went through the roof”: an observation study exploring the rise in PrEP uptake among Zimbabwean female sex workers in response to adaptations during Covid-19.

Authors:

Matambanadzo P, Busza J, Mafaune H, Chinyanganya L, Machingura F, Ncube G, Steen R, Phillips A, Cowan FM. 

Abstract:

Introduction: Sisters with a Voice (Sisters), a programme providing community-led differentiated HIV prevention and treatment services, including condoms, HIV testing, pre-exposure prophylaxis (PrEP) and antiretroviral therapy linkage for sex workers, reached over 26,000 female sex workers (FSW) across Zimbabwe in 2020. Zimbabwe’s initial Covid “lockdown” in March 2020 and associated movement restrictions interrupted clinical service provision for 6 weeks, particularly in mobile clinics, triggering the adaptation of services for the Covid-19 context and a scale up of differentiated service delivery (DSD) models. PrEP service delivery decentralized with shifts from clinical settings towards community/home-based, peer-led PrEP services to expand and maintain access. We hypothesize that peer-led community-based provision of PrEP services influenced both demand and supply-side determinants of PrEP uptake. We observed the effect of these adaptations on PrEP uptake among FSW accessing services in Sisters in 2020.

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Title: Potential Reduction in Female Sex Workers’ Risk of Contracting HIV during Covid-19

Authors 

Fortunate Machingura, Sungai T Chabata, Joanna Busza, Gracious Jamali, Memory Makamba, Jeffrey Dirawo, Raymond Yekeye, Owen Mugurungi, Primrose Matambanadzo, Frances Mary Cowan

Abstract

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Title: ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data

Authors: 

Neuman M, Fielding KL, Ayles H, Cowan FM, Hensen B, Indravudh PP, Johnson C, Sibanda EL, Hatzold K, Corbett EL.

Abstract

Title: Efficiency in PrEP Delivery: Estimating the Annual Costs of Oral PrEP in Zimbabwe

Authors: 

Mangenah C, Nhamo D, Gudukeya S, Gwavava E, Gavi C, Chiwawa P, Chidawanyika S, Muleya P, Taruberekera N, Madidi N, Ncube G, Bara H, Napierala S, Dunbar M, Hoke T, Kripke K, Cowan FM, Torjesen K, Terris-Prestholt F

Abstract

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Title: Comparison of community-led distribution of HIV self-tests kits with distribution by paid distributors: a cluster randomised trial in rural Zimbabwean communities

Authors:

Sibanda EL, Mangenah C, Neuman M, Tumushime M, Watadzaushe C, Mutseta MN, Maringwa G, Dirawo J, Fielding KL, Johnson C, Ncube G, Taegtmeyer M, Hatzold K, Corbett EL, Terris-Prestholt F, Cowan FM.

Abstract

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Title: Community-based HIV self-testing: a cluster-randomised trial of supply-side financial incentives and time-trend analysis of linkage to antiretroviral therapy in Zimbabwe.

Authors:

Sibanda EL, Neuman M, Tumushime M, Mangenah C, Hatzold K, Watadzaushe C, Mutseta MN, Dirawo J, Napierala S, Ncube G, Terris-Prestholt F, Taegtmeyer M, Johnson C, Fielding KL, Weiss HA, Corbett E, Cowan FM.

Title: Values and preferences of contraceptive methods: a mixed-methods study among sex workers from diverse settings.

Authors:

Sibanda E, Shapiro A, Mathers B, Verster A, Baggaley R, Gaffield ME, Macdonald V. 

Title: Child disciplinary practices, abuse, and neglect: Findings from a formative study in Chitungwiza, Zimbabwe.

Authors:

Patel SN, Shanmugam I, Obong’o C, Mupambireyi Z, Kasese C, Bangani Z, Miller KS.

Title: Provision of HIV viral load testing services in Zimbabwe: Secondary data analyses using data from health facilities using the electronic Patient Monitoring System.

Authors:

Apollo T, Takarinda KC, Phillips A, Ndhlovu C, Cowan FM.

Title: How Can We Support the Use of Oral PrEP Among Young Women who Sell Sex? A PrEP Cascade Analysis.

Authors:

Hensen B, Machingura F, Busza J, Birdthistle I, Chabata ST, Chiyaka T, Floyd S, Jamali G, Mushati P, Hargreaves J, Cowan FM.

Title: The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study.

Authors:

Chabata ST, Hensen B, Chiyaka T, Mushati P, Musemburi S, Dirawo J, Busza J, Floyd S, Birdthistle I, Hargreaves JR, Cowan FM

Title: Antiretroviral therapy dispensing for patients who are clinically stable.

Authors:

Sibanda E, Taegtmeyer M.

Title: ‘I was trying to get there, but I couldn’t’: social norms, vulnerability and lived experiences of home delivery in Mashonaland Central Province, Zimbabwe.

Authors;

Webb KA, Mavhu W, Langhaug L, Chitiyo V, Matyanga P, Charashika P, Patel D, Prost A, Ferrand RA, Bernays S, Cislaghi B, Neuman M.

Title: What’s in a Name? A Mixed Method Study on How Young Women Who Sell Sex Characterize Male Partners and Their Use of Condoms.

Authors:

Busza J, Hensen B, Birdthistle I, Chabata ST, Hargreaves JR, Floyd S, Chiyaka T, Mushati P, Cowan FM. J 

Title: Feasibility and acceptability of a peer-led HIV self-testing model among female sex workers in Malawi: a qualitative study.

Authors:

Kumwenda MK, Mavhu W, Lora WS, Chilongosi R, Sikwese S, Taegtmeyer M, Hatzold K, Johnson CC, Corbett EL, Desmond N.

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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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