Measurement and interpretation of the Harare HIV combination prevention cascade in priority populations: a population survey of adolescent girls and young women and young men in Zimbabwe.

Introduction: HIV-negative adolescent girls and young women (AGYW), and men (ABYM), have disproportionately high HIV incidence in many African countries. We used a new HIV Prevention Cascade (HPC) approach to quantify levels of, and barriers to, prevention method use to guide interventions to increase effective uptake of primary HIV prevention.

Methods: Data from the Manicaland HPC pilot study (2018-19; n=9803) in Zimbabwe were used to measure levels of sexual risk behaviour and construct HPCs for male condom, pre-exposure prophylaxis (females), voluntary medical male circumcision (males) and combination prevention use by HIV-negative sexually active AGYW (15-24 years) and male partners (15-29 years).

Gender Norms and Structural Barriers to Use of HIV Prevention in Unmarried and Married Young Women in Manicaland, Zimbabwe: An HIV Prevention Cascade Analysis.

Background: Gender norms against adolescent girls and young women (AGYW)'s having pre-marital sex and using condoms in marriage are included as barriers to motivation to use condoms in HIV prevention cascades. Representative data on gender norms are needed to test this assumption.

Methods: General-population survey participants in Manicaland, Zimbabwe (ages≥15, N=9803) reported agreement/disagreement with statements on gender norms.

Hospital referral patterns amongst older adults in Zimbabwe: a cross-sectional study.

Over the coming decades Africa is projected to undergo a significant demographic shift towards an older population. Healthcare provision for older adults is made more complex by age-related multimorbidity and frailty, which contribute to older adults more frequently requiring intensive, hospital-based treatment than those in younger age groups. We investigate age and sex-stratified, diagnosis-specific hospital referral patterns in Harare, Zimbabwe to understand referral practices for older adults.

Brief Report: Youth Who Acquired HIV Perinatally Have Poorer Viral Suppression Than Those Who Acquired HIV Later in Life: Findings From a Population Survey in Zimbabwe.

Background: Perinatally acquired HIV may lead to worse health outcomes than later acquisition. We compared the demographic and clinical characteristics of youth diagnosed with HIV in childhood and adulthood, as a proxy for acquisition route (perinatal vs. horizontal).

Emergence of urban malaria and the associated risk factors: a case-control study in Mutare city, Zimbabwe.

Background: Mutare city of Zimbabwe was considered free of autochthonous malaria, until 2017, when the Ministry of Health and Child Care formally confirmed escalating cases of locally transmitted malaria in the city. The current study examined the risk factors for malaria cases in the city to aid in formulation of targeted intervention packages for helping restore malaria-free status.

Methods: The study employed complementary cross-sectional and case-control designs to ascertain the magnitude and risk factors of urban malaria cases presenting at all eight primary health care facilities of Mutare city from 2022 to 2023.

HIV Testing Uptake in a Sexual and Reproductive Health Service for Youth and Impact on Population-Level Prevalence of Undiagnosed HIV in Zimbabwe.

Purpose: High rates of undiagnosed HIV persist among youth. We investigated the uptake of HIV testing within community-based integrated HIV and sexual and reproductive health (SRH) services, and the impact on population-level prevalence of undiagnosed HIV in Zimbabwe.

Methods: A cluster randomized trial (CHIEDZA) was conducted in three provinces (Harare, Bulawayo, and Mashonaland East) with 8 clusters/province randomized 1:1 to integrated HIV/SRH services for youth aged 16-24 years or to routine existing services for 30 months, followed by a population-level outcome survey.

Implications of reference equations for interpretation of spirometry in three African countries: a cross-sectional study.

Background: The Global Lung Function Initiative (GLI) and American Thoracic Society recently endorsed a race-composite spirometry reference equation ("GLI Global"). Africa (outside North Africa) is not represented in the underlying dataset; GLI Global has not been evaluated in the region. We evaluated the fit and diagnostic implications of GLI and African (identified by scoping review) reference equations in three East/Southern African countries.

Ration or compassion? Stakeholder perspectives on the introduction of bedaquiline in South Africa.

Antimicrobial resistance (AMR) is a global health emergency that poses a significant challenge to disease control efforts that rely on antibiotics. Drug-resistant tuberculosis (DR-TB) is a major contributor to global AMR, but its management has historically often remained confined to TB-specific discussions. The emergence of bedaquiline (BDQ), the first novel TB drug in decades, is a moment of potential confluence between AMR and DR-TB.

Effect of long-term azithromycin treatment on gut microbial diversity in children and adolescents with HIV-associated chronic lung disease.

Background: HIV-associated chronic lung disease (HCLD) is common in children and adolescents growing up with HIV. The use of azithromycin (AZM) reduces the rate of acute respiratory exacerbations in this population, however, impact of this treatment on the gut microbiota and associations with blood-derived inflammatory markers have not been studied.

Methods: Children and adolescents with HCLD in Harare, Zimbabwe and Blantyre, Malawi were recruited in a double-blind, placebo-controlled trial of once-weekly AZM or placebo for 48 weeks (BREATHE trial, NCT02426112).

Nutrition Outcomes and Interventions in Older People in Africa: A Systematic Umbrella and Scoping Review.

Africa's older population is rapidly increasing, necessitating the development of healthy aging interventions. Nutrition is a key component of healthy aging. Evidence synthesis on nutrition outcomes of older adults in Africa is emerging but a synthesis on interventions is lacking.

Incidence of and outcomes of pregnancy in adolescents with perinatally-acquired HIV infection in Southern Africa.

BackgroundThe scale-up of antiretroviral therapy (ART) has enabled more children living with HIV to reach adolescence and become sexually active. We investigated pregnancy incidence and outcomes among adolescents with perinatally acquired HIV enrolled in a multi-country trial of vitamin D and calcium carbonate supplementation (VITALITY; PACTR202009897660297).MethodsBetween February and November 2021, 842 adolescents aged 11-19 years from Zambia and Zimbabwe on ART for at least 6 months were enrolled.

Integrated community-based HIV and sexual and reproductive health services for youth: a cluster-randomized trial.

Human immunodeficiency virus (HIV) viral suppression rates are disproportionately worse in youth compared to other age groups, and improving this will require addressing the whole HIV cascade, including HIV testing, linkage to care and support to maintain viral suppression. We conducted a cluster-randomized trial of community-based services incorporating HIV testing, treatment and adherence support integrated with sexual and reproductive health (SRH) services for youth (16-24 years) in Zimbabwe. Our hypothesis was that integrated services in community-based settings would increase demand and access.

Gaps in the Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials: a citation analysis reveals a need for updated ethics guidelines.

Background: Although commonly used to evaluate health interventions, cluster randomized trials raise difficult ethical issues. Recognizing this, the Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials, published in 2012, provides 15 recommendations to address ethical issues across seven domains. But due to several developments in the design and implementation of cluster randomized trials, there are new issues requiring guidance.

Aplastic Anaemia Disease Burden From the Patient Perspective and Quality of Life in Zimbabwe by A. .

Purpose: Aplastic Anaemia (AA) is a critical haematological disorder characterized by pancytopenia and marrow hypoplasia. It is generally regarded as a rare disease albeit with multiple symptoms. The aim of the study was to get the patients' perspective to evaluate the disease burden and their knowledge, attitude, practices, and adherence to treatment.

Protocol for the development and validation of a Core Set for exercise-based rehabilitation of adults with multiple long-term conditions (multimorbidity) based on the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) framework.

Background: Core outcome sets for people with multiple long-term conditions (multimorbidity) intervention studies offer an opportunity to compare data across studies and countries. However, a key research gap remains: the development of the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set for multimorbidity rehabilitation. ICF Core Sets are a selection of essential categories from the full ICF classification that are considered most relevant for describing the functioning of a person with a specific health condition or in a specific healthcare context.

Awareness, access to and uptake of HIV prevention interventions among youth in Zimbabwe: a population-based survey.

Background: Youth in southern Africa continue to be at high risk of HIV infection. We investigated the awareness of, access to, and uptake of HIV prevention interventions (pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), voluntary medical male circumcision and condoms) among youth in Zimbabwe.

Methods: A population-based survey of youth aged 18-24 years in 24 communities across three provinces was conducted between October 2021 and June 2022.

Enhancing the methodology of clinical trials in older people: A scoping review with global perspective.

As people age, they are more likely to develop chronic diseases, experience physical and mental impairments, and face social issues. This complexity makes traditional research protocols challenging, leading to the exclusion of older individuals in clinical trials (CTs) and limiting the applicability of evidence-based medicine, especially in low- and middle-income countries (LMICs). A scoping review of the literature (based on PubMed, Embase, and Scopus) was conducted to identify recommendations to improve the methodology of CTs involving older persons.

The influence of HIV on body composition and its relationship with physical function in mid-life women: a cross-sectional study from Zimbabwe.

Objective: Menopause-related changes in body composition and physical function are unclear in Southern Africa, particularly in the context of a generalized HIV epidemic with high antiretroviral therapy (ART) coverage.

Method: A total of 263 Zimbabwean women (53% women living with HIV [WLH]) aged 40-60 years provided data on menopause, ART use, anthropometry, body composition (appendicular lean mass [ALM], muscle area, fat mass), handgrip strength (HGS) and gait speed. Linear regression determined relationships between body composition and physical function, unadjusted and age-menopause-adjusted, stratified by HIV status.

Randomization procedures in parallel-arm cluster randomized trials in low- and middle-income countries: a review of 300 trials published between 2017-2022.

Objectives: Cluster randomized trials (CRTs) are frequently used to evaluate interventions in low- and middle-income countries (LMICs). Robust execution and transparent reporting of randomization procedures are essential for successful implementation and accurate interpretation of CRTs. Our objectives were to review the quality of reporting and implementation of randomization procedures in a sample of parallel-arm CRTs conducted in LMICs.

Barriers to and facilitators of linkage to care following hypertension and diabetes screening among health workers in Zimbabwe: A mixed method study.

The benefits of screening for any condition are only realised if individuals who screen positive link to care services. We investigated linkage to hypertension and diabetes care by healthcare workers accessing a comprehensive health check service. We also explored facilitators and barriers to linkage to care.

Multimorbidity and health system priorities in Zimbabwe: A participatory ethnographic study.

Multimorbidity, increasingly recognised as a global health challenge, has recently emerged on the health agendas of many countries experiencing rapid epidemiological change, including in Africa. Yet with its conceptual origins in the global North, its meaning and possible utility in African contexts remains abstract. This study drew together policymakers, public health practitioners, academics, health informaticians, health professionals, and people living with multimorbidity (PLWMM) in Zimbabwe to understand: What is the transformative potential and possible limitations of elevating multimorbidity as a priority in this setting? To bring these different perspectives into conversation, we used a participatory ethnographic design that involved a health facility survey, participant-observation, in-depth interviews, audio-visual diaries, and participatory workshops.

Body mass index trajectories and association with tuberculosis risk in a cohort of household contacts in Southern Africa.

Background: Studies have demonstrated an inverse log-linear relationship between body mass index (BMI) and tuberculosis incidence. However, a person's BMI is dynamic and longitudinal changes may be more informative than cross-sectional assessments. We evaluate the association between cross-sectional and changing BMI and risk of tuberculosis and describe longitudinal trajectories in a high-risk cohort.