Acceptability and feasibility of implementing thermal ablation as a preventive cervical cancer treatment and the comparison of treatment outcome with cryotherapy in Zimbabwe.

Introduction and background: Thermal ablation, a technique that destroys precancerous cervical cells by extreme heat or cold, is predominantly used as a preventive cervical cancer treatment modality in high-income countries. Compared to other treatment methods thermal ablation has numerous advantages in its portability, minimal electricity use and comparable treatment rates, which is convenient for use in low- and middle-income countries (LMICs). Therefore, it is important to understand acceptability among providers and clients and the feasibility of achieving comparable treatment outcomes with other methods in LMICs. Methodology: We conducted a prospective longitudinal, open-label two-arm study from June 2021 to April 2022 at seven health delivery points. In this study, 182 clients were enrolled to receive preventive cancer treatment at baseline and followed up 6 months later to measure treatment outcomes and experiences on the procedure. Eligible consented clients were elected to a preferred method (either thermal ablation as an intervention or cryotherapy as a control group). We also conducted qualitative interviews with 14 service providers in either static or outreach settings. Results: At the 6-month follow-up, the efficacy was comparable among the two groups, 96.5% (95% CI 86.7%-99.1%) clients in the intervention group had successful lesion treatment rate compared to 80.8% (95% CI 69.9%-99.1%) of the control group. Furthermore, 99% of clients in the intervention group would recommend thermal ablation to their family members or peers. Service providers preferred thermal ablation due to its ease of use, lower costs, portability and lower likelihood of adverse events compared to cryotherapy. Conclusion: The study showed the feasibility of implementing thermal ablation as a new preventive cervical cancer treatment modality in Zimbabwe. Furthermore, service providers indicated their preference for thermal ablation due to its ease of use, portability at static settings and lower likelihood of adverse events occurrence. Therefore, we recommend scaling up thermal ablation both at static and outreach sites.

Time taken to link newly identified HIV positive clients to care following a home-base index case HIV testing: Experience from two provinces in Zimbabwe.

BACKGROUND: Homebased index case HIV testing (HHTC) has shown higher uptake and good yield than traditional HIV testing methods. World Health Organization has called for increased operational research to evaluate HIV care processes particularly linkage to care. In this paper, we present project results of the time taken to link newly identified PLHIV to care after HHTC in the Manicaland and Midlands provinces of Zimbabwe. METHODS: We retrospectively reviewed community-facility referral data from the Zimbabwe HIV Care and Treatment project for newly diagnosed PLHIV for the period March-September 2016. A referral slip was given to a client after receiving a positive HIV results and was presented and filed upon reaching a health facility. In July 2016, the project started working with trained expert clients to assist with linkage to care. Data was entered in a spreadsheet and then imported for descriptive statistical analysis with EpiInfoTM Version 7.2.0.1. Odd ratios were used to identify factors associated with linkage to care within seven days. RESULTS: Out of 1004 newly identified PLHIV between March and September 2016, 650 (64.7%) were linked to care. The median time taken to be linked to care was four days (Interquartile range 19 days). Overall, 63.1% (410) of PLHIV were linked to care within seven days of diagnosis and 85% within 30 days. PLHIV were more likely to be linked to care within seven days of diagnosis between July and September 2016 (OR = 4.1; p< 0.001), a period when ZHCT started working with expert clients to support linkage to care. CONCLUSION: HHTC resulted in almost 63% of newly diagnosed PLHIV being linked into care within seven days, and 85% within 30 days. Linkage to care within seven days was significantly associated with the period of engaging expert clients in the project. We recommend community based HIV testing programs to work with expert clients to ensure timely linkages of new PLHIV.

Barriers to HIV service utilisation by people living with HIV in two provinces of Zimbabwe: Results from 2016 baseline assessment.

BACKGROUND: The emergence of antiretroviral therapy (ART) transformed HIV from a terminal illness to a chronic disease. However, limited access to health services remains one of many barriers to HIV service utilisation by people living with HIV (PLHIV) in low-resource settings. The goal of this study was to describe the barriers to HIV service utilisation in two provinces of Zimbabwe. METHODS: A qualitative descriptive study was conducted with PLHIV and village health workers (VHW) in eight districts within the two provinces. Convenience sampling was used to select the participants. This sampling was limited to communities supported by health facilities with more than 500 PLHIV enrolled into HIV care and treatment. Interviews were audio-recorded and transcripts were subjected to thematic content analysis. RESULTS: A total of 22 community focus group discussions (FGDs) were conducted. Barriers to using HIV services cited in PLHIV and VHW FGDs were similar. These were categorised as health system-related barriers, which include user fees, long waiting times, lack of confidentiality and negative attitudes by healthcare providers, and lack of consistent community-based HIV services. Community-related barriers cited were stigma and discrimination, food insecurity, distance to facilities and counterproductive messaging from religious sectors. Client-related factors reported were inadequate male involvement in HIV-related activities and defaulting after symptoms improved. CONCLUSION: Our assessment has indicated that there are several barriers to the utilisation of HIV services by PLHIV in the two provinces of Zimbabwe. As new strategies and programmes are being introduced in the current resource-constrained era, efforts should be made to understand the needs of the clients. If programmes are designed with an effort to address some of these challenges, there is a possibility that countries will quickly achieve the 90-90-90 targets set by The Joint United Nations Programme on HIV/AIDS.