'If nurses were in our shoes would they breastfeed their own babies?' A qualitative inquiry on challenges faced by breastfeeding mothers on the PMTCT programme in a rural community in Zimbabwe.

BACKGROUND: The Prevention of Mother to Child Transmission (PMTCT) of HIV programme in Zimbabwe has had remarkable success despite the country's economic challenges. The aim of this study was to explore the challenges faced by breastfeeding mothers on the PMTCT programme. METHOD: Narratives from 15 women (age range 19-35 years) were collected at two rural health facilities in Zimbabwe through in-depth interviews over a period of 6 months. Thematic analysis was used to describe breastfeeding mothers' experiences and challenges of being on the PMTCT programme. RESULTS: The findings suggest that breastfeeding women on the PMTCT programme face challenges that include internal, external and institutional stigma and discrimination. Women reported a sense of powerlessness in decision making on following through with the PMTCT programme and were ambivalent regarding disclosure of their HIV status to their partners and significant others. CONCLUSION: HIV and AIDS programmes should pay attention to women's readiness for interventions. There is need to understand women's life experiences to ensure informed and targeted programming for PMTCT.

Virological failure among adolescents on ART, Harare City, 2017- a case-control study.

BACKGROUND: Zimbabwe is on track towards achieving viral suppression among adults (87%). However, adolescents have only achieved 44% by 2016. In Harare city, 57% of adolescents had attained viral suppression after 12 months on ART compared to 88% among adults. We determined factors associated with virological failure among adolescents (age 10-19 years) on antiretroviral therapy (ART) in Harare city. METHODS: We conducted a one to one unmatched case control study among 102 randomly recruited case: control pairs at the two main infectious disease hospitals in Harare. A case was any adolescent who presented with VL > 1000c/ml after at least 12 months on ART. A control was any adolescent who presented with VL < 1000c/ml after at least 12 months on ART. Interviewer administered questionnaires were used to collect data. Epi Info 7 was used to generate frequencies, means, proportions, ORs and p-values at 95% CI. RESULTS: We interviewed 102 case-control pairs. Poor adherence to ART [aOR = 8.15, 95% CI (2.80-11.70)], taking alcohol [aOR = 8.46, 95% CI (3.22-22.22)] and non- disclosure of HIV status [aOR = 4.56, 95% CI (2.20-9.46)] were independent risk factors for virological failure. Always using a condom [aOR = 0.04, 95% CI (0.01-0.35)], being on second line treatment [aOR = 0.04, 95% CI (0.23-0.81)] and belonging to a support group [aOR = 0.41, 95% CI (0.21-0.80)] were protective. CONCLUSION: Poor adherence, alcohol consumption and non-disclosure increased the odds of virological failure. Based on these findings support should focus on behavior change and strengthening of peer to peer projects to help address issues related to disclosure and adherence. Further operational research should aim to define other components of effective adherence support for adolescents with virological failure.

Prevalence of sexually transmitted infections among pregnant women with known HIV status in northern Tanzania.

OBJECTIVES: To determine the prevalence of sexually transmitted infections (STIs) and other reproductive tract infections (RTIs) among pregnant women in Moshi, Tanzania and to compare the occurrence of STIs/RTIs among human immunodeficiency virus (HIV)-infected and uninfected women. METHODS: Pregnant women in their 3rd trimester (N = 2654) were recruited from two primary health care clinics between June 2002 and March 2004. They were interviewed, examined and genital and blood samples were collected for diagnosis of STIs/RTIs and HIV. RESULTS: The prevalence of HIV, active syphilis and herpes simplex virus - type 2 (HSV-2) were 6.9%, 0.9% and 33.6%, respectively, while 0.5% were positive for N gonorrhoeae, 5.0% for T vaginalis and 20.9% for bacterial vaginosis. Genital tract infections were more prevalent in HIV-seropositive than seronegative women, statistically significant for syphilis (3.3% vs 0.7%), HSV-2 (43.2% vs 32.0%), genital ulcers (4.4% vs 1.4%) and bacterial vaginosis (37.2% vs 19.6%). In comparison with published data, a declining trend for curable STIs/RTIs (syphilis, trichomoniasis and bacterial vaginosis) was noted. CONCLUSION: Rates of STIs and RTIs are still high among pregnant women in Moshi. Where resources allow, routine screening and treatment of STIs/RTIs in the antenatal care setting should be offered. Higher STIs/RTIs in HIV-seropositive women supports the expansion of HIV-counseling and testing services to all centers offering antenatal care. After identification, STIs/RTIs need to be aggressively addressed in HIV-seropositive women, both at antenatal and antiretroviral therapy care clinics.

HIV among pregnant women in Moshi Tanzania: the role of sexual behavior, male partner characteristics and sexually transmitted infections.

BACKGROUND: Women continue to be disproportionately affected by HIV in Tanzania, and factors contributing to this situation need to be identified. The objective of this study was to determine social, behavioral and biological risk factors of HIV infection among pregnant women in Moshi urban, Tanzania. In 2002-2004, consenting women (N = 2654), attending primary health clinics for routine antenatal care were interviewed, examined and biological samples collected for diagnosis of HIV and other sexually transmitted/reproductive tract infections. RESULTS: The prevalence of HIV was 6.9%. The risk for HIV was greater among women whose male partner; had other sexual partners (adjusted odds ratio [AOR], 15.11; 95% confidence interval [CI], 8.39-27.20), traveled frequently (AOR, 1.79; 95% CI, 1.22-2.65) or consumed alcohol daily (AOR, 1.68; 95% CI, 1.06-2.67). Other independent predictors of HIV were age, number of sex partners, recent migration, and presence of bacterial vaginosis, genital ulcer, active syphilis and herpes simplex virus type 2. CONCLUSION: Development of programs that actively involve men in HIV prevention is important in reducing transmission of HIV in this population. Further, interventions that focus on STI control, the mobile population, sexual risk behavior and responsible alcohol use are required.

HIV and sexually transmitted infections among women presenting at urban primary health care clinics in two cities of sub-Saharan Africa.

In a cross-sectional study, 786 consenting women from two cities in Africa, Harare and Moshi, attending primary health care clinics were interviewed, examined and tested for HIV and other sexually transmitted infections (STIs). The aim of the study was to assess and compare differences in the characteristics that may affect the prevalence of HIV/STIs among women in the two cities. Multivariate analysis was used to generate odds ratio. STIs and behaviour characteristics among this low risk group of women could not fully explain the higher HIV prevalence in Zimbabwe, 29.3% compared to 11.5% in Tanzania (p < 0.01). Interventions should target identified risk factors with particular attention to youths.

Factors associated with access to HIV care and treatment in a prevention of mother to child transmission programme in urban Zimbabwe.

BACKGROUND: This cross-sectional study assessed factors affecting access to antiretroviral therapy (ART) among HIV-positive women from the prevention of mother to child transmission HIV programme in Chitungwiza, Zimbabwe. METHODS: Data were collected between June and August 2008. HIV-positive women attending antenatal clinics who had been referred to the national ART programme from January 2006 until December 2007 were surveyed. The questionnaire collected socio-demographic data, treatment-seeking behaviours, and positive or negative factors that affect access to HIV care and treatment. RESULTS: Of the 147 HIV-positive women interviewed, 95 (65%) had registered with the ART programme. However, documentation of the referral was noted in only 23 (16%) of cases. Of the 95 registered women, 35 (37%) were receiving ART; 17 (18%) had not undergone CD4 testing. Multivariate analysis revealed that participants who understood the referral process were three times more likely to access HIV care and treatment (OR = 3.21, 95% CI 1.89-11.65) and participants enrolled in an HIV support group were twice as likely to access care and treatment (OR = 2.34, 95% CI 1.13-4.88). Those living with a male partner were 60% less likely to access care and treatment (OR = 0.40, 95% CI 0.16-0.99). Participants who accessed HIV care and treatment faced several challenges, including long waiting times (46%), unreliable access to laboratory testing (35%) and high transport costs (12%). Of the 147 clients surveyed, 52 (35%) women did not access HIV care and treatment. Barriers included perceived long queues (50%), competing life priorities, such as seeking food or shelter (33%) and inadequate referral information (15%). CONCLUSIONS: Despite many challenges, the majority of participants accessed HIV care. Development of referral tools and decentralization of CD4 testing to clinics will improve access to ART. Psychosocial support can be a successful entry point to encourage client referral to care and treatment programmes.

Predictors of failure to return for HIV test results among pregnant women in Moshi, Tanzania.

Identification of HIV-infected women is a prerequisite in HIV perinatal prevention programs. The aim of this study was to determine the predictors of failure to return for HIV posttest results among pregnant women (N=2654) receiving antenatal care at primary health clinics in Moshi urban district, Tanzania. Consenting pregnant women, who were in the third trimester of pregnancy, received individual pretest counseling, followed by interview and screening for HIV. Posttest counseling and results were given after 1 week. A total of 182 (7%) failed to return for their HIV test results. Women were less likely to return for test results if their partners did not come for testing (adjusted odds ratio [AOR], 12.6; 95% CI, 3.1-51.4), if their partners consumed alcohol (AOR, 1.8; 95% CI, 1.3-2.7), and if they had never discussed reproductive health matters with their partners (AOR, 1.7; 95% CI, 1.1-2.7). Additionally, the site of recruitment, age, alcohol consumption, and advanced gestation age predicted failure to return for HIV test results. These results indicate that male partner factors were important in determining whether women returned for results. We therefore recommend promotion of antenatal couple counseling and strengthening of community awareness of the availability of perinatal interventions, with special efforts targeting men. Furthermore, the predictors for failure to collect test-results need to be addressed during pretest counseling.

Seroprevalence and correlates of herpes simplex virus type 2 among urban Tanzanian women.

BACKGROUND: Data on herpes simplex virus type 2 (HSV-2) among women in the general population of developing countries are limited. GOALS: The goal of the study was to determine the seroprevalence of HSV-2 and to identify clinical, demographic, and behavioral correlates among women attending primary health care clinics. STUDY DESIGN: This was a cross-sectional survey of 382 randomly chosen women aged 15 to 49 years. RESULTS: The seroprevalence of HSV-2 was 39%. Only 2% had a history of genital herpes. HSV-2 was associated with antibody to HIV-1 (OR=2.3 [CI, 1.1-4.7]), syphilis (OR=4.7 [CI, 1.4-4.7]), and genital ulcers (OR=9.7 [CI 2.5-36.9]). Age, sexual debut, number of sex partners, and history of spontaneous abortion were found to be significantly associated with HSV-2. Eighty-two percent of the women with genital ulcers were HSV-2-seropositive, while syphilis accounted for 6% of cases. HSV-2 may thus be the most common cause of genital ulcers in this population. CONCLUSION: In view of the high HSV-2 seroprevalence and its association with HIV-1 and genital ulcers, integration of HSV-2 therapeutic management in STD syndromic algorithms is recommended. Counseling on symptom recognition, asymptomatic shedding, and preventive measures is needed.

Reproductive tract infections and the risk of HIV among women in Moshi, Tanzania.

OBJECTIVES: The objectives of the study were to determine the prevalence of HIV and reproductive tract infections (RTIs); to compare the occurrence of RTIs among HIV-infected and non-infected women; and to assess the association of HIV with RTIs and behavioral factors among women aged 15-49 years. METHODS: A cross-sectional study was conducted in late 1999 among 382 consenting women attending three primary healthcare clinics. They were interviewed and screened for HIV-1 and RTIs. RESULTS: The prevalence of HIV-1 was 11.5%. Sixty-four percent of the women had one ongoing treatable RTI. Endogenous and sexually transmitted RTIs were higher in HIV-positive than negative women and 84% of the HIV seropositive women were co-infected with one treatable RTI. HIV was significantly associated with cervicitis (chlamydial or gonococcal) [OR = 3.2 (CI 1.1-13.2)], HSV-2 [OR = 2.6 (CI 1.3-5.1)], bacterial vaginosis [OR = 1.9 (CI 1.1-4.1)], genital warts [OR = 4.8 (CI 1.1-22.2)], and presence of vaginal discharge [OR = 2.7 (CI 1.3-5.2)]. Having more than one lifetime sexual partner, a history of infant mortality or a partner who had other wives or resided away from home > 6 months, were risk factors for HIV infection. CONCLUSION: HIV-1 and RTIs are a major public health problem among women in this population. Integration of routine screening and treatment of RTIs in the reproductive health clinics will be an important strategy to combat HIV in the area. Further, innovative behavior interventions targeting both men and women, preferably as couples are needed.

Female genital cutting in Kilimanjaro, Tanzania: changing attitudes?

OBJECTIVES: To study the prevalence, type, social correlates and attitudes towards female genital cutting (FGC) among urban women in Kilimanjaro, Tanzania; and to examine the association between FGC and gynaecological problems, reproductive tract infections (RTIs) and HIV. METHODS: In 1999, 379 women attending reproductive health care clinics were interviewed and underwent pelvic examination. Specimens for RTI/HIV diagnosis were taken. RESULTS: Seventeen per cent had undergone FGC, mostly clitoridectomy (97%). Female genital cutting prevalence was significantly lower among educated, Christian and Chagga women. Women aged >or=35 were twice as likely to be cut as those < 25 years. Seventy-six per cent of those who had undergone FGC intend not to perform the procedure on their daughters. Age < 25 years (P < 0.0001) and low parity (P < 0.01) were predictors of that intention. There was no association between RTIs, HIV or hepatitis B and FGC. CONCLUSION: FGC is still fairly common but there is evidence of a change of attitude towards the practice, especially among young women. The opportunity to educate women who attend reproductive health care facilities on FGC should be taken.