Evaluation of intensified provider initiated testing and counselling program in Harare City, 2017-2018.

BACKGROUND: Knowledge of HIV status remains a challenge despite implementation of various testing strategies including provider-initiated HIV testing (PITC). Harare City intensified provider-initiated HIV testing by targeting testing all eligible clients visiting facilities to achieve the UNAIDS first 95. This study aimed at evaluating the intervention to improve its effectiveness and inform programming decisions for universal access to HIV testing. METHODS: A descriptive cross-sectional study was conducted in Harare from April to June 2019. Evaluation of the intervention was conducted using the logic model approach to assess the inputs, processes and outputs. Health workers were interviewed using an interviewer administered questionnaire. Exit interviews were conducted for eligible clients > 18 years who refused to be tested. A checklist was used to assess the inputs used and a desk review of HIV screening and testing records was done. RESULTS: A total of (n-45) health care workers and (n = 70) clients were interviewed with a response rate of (92%) and (84%) respectively. The median age for clients was 31(Q1 = 24: Q3 = 38) and median years in service for health workers was 2 (Q1 = 1;Q3 = 26). Of the 133,899 clients who were eligible for testing after screening, 98,587 (74%) accepted the test leaving a gap of 35,312 (26%). However, 21/45 (47%) of health workers indicated high workload in the morning as the major reason for the leakage. In addition, 25/70 (36%) of the clients indicated long waiting time as the reason for opting out of HIV testing. CONCLUSION AND RECOMMENDATION: HIV testing coverage for eligible clients was not optimal, 26% opted out. We recommend strengthening of health facility systems such as review of patient flow, re-allocation of staff during busy HIV testing time and scaling up the use of HIV self-test kits for clients concerned with waiting time to improve HIV testing coverage.

Implementation of Antibody Rapid Diagnostic Testing versus Real-Time Reverse Transcription-PCR Sample Pooling in the Screening of COVID-19: a Case of Different Testing Strategies in Africa.

Coronavirus disease 2019 (COVID-19) has wreaked havoc across the globe; although the number of cases in Africa remains lower than in other regions, it is on a gradual upward trajectory. To date, COVID-19 cases have been reported in 54 out of 55 African countries. However, due to limited severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time reverse transcription-PCR (rRT-PCR) testing capacity and scarcity of testing reagents, it is probable that the total number of cases could far exceed published statistics. In this viewpoint, using Ghana, Malawi, South Africa, and Zimbabwe as examples of countries that have implemented different testing strategies, we argue that the implementation of sample pooling for rRT-PCR over antibody rapid diagnostic testing could have a greater impact in assessing disease burden. Sample pooling offers huge advantages compared to single test rRT-PCR, as it reduces diagnostic costs, personnel time, burnout, and analytical run times. Africa is already strained in terms of testing resources for COVID-19; hence, cheaper alternative ways need to be implemented to conserve resources, maximize mass testing, and reduce transmission in the wider population.

Field-based evaluation of malaria outbreak detection and response in Mudzi and Goromonzi districts, Zimbabwe - 2017.

National-level evaluations may fail to identify capacity improvements for detecting and responding to outbreaks which begin and are first detected at the local level. In response to this issue, we conducted a field-based assessment of the malaria outbreak surveillance system in Mashonaland East, Zimbabwe. We visited eleven clinics in Mudzi and Goromonzi districts. Twenty-one interviews were conducted with key informants from the provincial (n = 2), district (n = 7), and clinic (n = 12) levels. Interviews focused on surveillance system activities, preparedness, data quality, timeliness, stability, and usefulness. Main themes were captured utilising standard qualitative data analysis techniques. While the surveillance system detects malaria outbreaks at all levels, we identified several gaps. Clinics experience barriers to timely and reliable reporting of outbreaks to the district level and staff cross-training. Stability of resources, including transportation (33% of informants, n = 7) and staff capacity (48% of informants, n = 10), presented barriers. Strengthening these surveillance barriers may improve staff readiness to detect malaria outbreaks, resulting in timelier outbreak response and a reduction in malaria outbreaks, cases, and deaths. By focusing at the local level, our assessment approach provides a framework for identifying and addressing gaps that may be overlooked when utilising tools that evaluate surveillance capacity at the national level.