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1.
BMJ Open ; 10(5): e033035, 2020 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-32371506

RESUMO

OBJECTIVES: WHO recommended strengthening the linkages between various HIV prevention programmes and adolescent sexual reproductive health (ASRH) services. The Smart-LyncAges project piloted in Bulawayo city and Mt Darwin district of Zimbabwe established a referral system to link the voluntary medical male circumcision (VMMC) clients to ASRH services provided at youth centres. Since its inception in 2016, there has been no assessment of the performance of the referral system. Thus, we aimed to assess the proportion of young (10-24 years) VMMC clients getting 'successfully linked' to ASRH services and factors associated with 'not being linked'. DESIGN: This was a cohort study using routinely collected secondary data. SETTING: All three VMMC clinics of Mt Darwin district and Bulawayo province. PRIMARY OUTCOME MEASURES: The proportion of 'successfully linked' was summarised as the percentage with a 95% CI. Adjusted relative risks (aRR) using a generalised linear model was calculated as a measure of association between client characteristics and 'not being linked'. RESULTS: Of 1773 young people registered for VMMC services, 1478 (83%) were referred for ASRH services as they had not registered for ASRH previously. Of those referred for ASRH services, the mean (SD) age of study participants was 13.7 (4.3) years and 427 (28.9%) were out of school. Of the referred, 463 (31.3%, 95% CI: 30.0 to 33.8) were 'successfully linked' to ASRH services and the median (IQR) duration for linkage was 6 (0-56) days. On adjusted analysis, receiving referral from Bulawayo circumcision clinic (aRR: 1.5 (95% CI: 1.3 to 1.7)) and undergoing circumcision at outreach sites (aRR: 1.2 (95% CI: 1.1 to 1.3)) were associated with 'not being linked' to ASRH services. CONCLUSION: Linkage to ASRH services from VMMC is feasible as one-third VMMC clients were successfully linked. However, there is need to explore reasons for not accessing ASRH services and take corrective actions to improve the linkages.


Assuntos
Circuncisão Masculina , Infecções por HIV , Saúde Reprodutiva , Adolescente , Estudos de Coortes , Infecções por HIV/prevenção & controle , Humanos , Masculino , Encaminhamento e Consulta , Comportamento Sexual , Adulto Jovem , Zimbábue
2.
PLoS One ; 15(4): e0230848, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353043

RESUMO

BACKGROUND: Zimbabwe is one of the thirty countries globally with a high burden of multidrug-resistant tuberculosis (TB) or rifampicin-resistant TB (MDR/RR-TB). Since 2010, patients diagnosed with MDR/RR-TB are being treated with 20-24 months of standardized second-line drugs (SLDs). The profile, management and factors associated with unfavourable treatment outcomes of MDR/RR TB have not been systematically evaluated in Zimbabwe. OBJECTIVE: To assess treatment outcomes and factors associated with unfavourable outcomes among MDR/RR-TB patients registered and treated under the National Tuberculosis Programme in all the district hospitals and urban healthcare facilities in Zimbabwe between January 2010 and December 2015. METHODS: A cohort study using routinely collected programme data. The 'death', 'loss to follow-up' (LTFU), 'failure' and 'not evaluated' were considered as "unfavourable outcome". A generalized linear model with a log-link and binomial distribution or a Poisson distribution with robust error variances were used to assess factors associated with "unfavourable outcome". The unadjusted and adjusted relative risks were calculated as a measure of association. A 𝑝value< 0.05 was considered statistically significant. RESULTS: Of the 473 patients in the study, the median age was 34 years [interquartile range, 29-42] and 230 (49%) were males. There were 352 (74%) patients co-infected with HIV, of whom 321 (91%) were on antiretroviral therapy (ART). Severe adverse events (SAEs) were recorded in 118 (25%) patients; mostly hearing impairments (70%) and psychosis (11%). Overall, 184 (39%) patients had 'unfavourable' treatment outcomes [125 (26%) were deaths, 39 (8%) were lost to follow-up, 4 (<1%) were failures and 16 (3%) not evaluated]. Being co-infected with HIV but not on ART [adjusted relative risk (aRR) = 2.60; 95% CI: 1.33-5.09] was independently associated with unfavourable treatment outcomes. CONCLUSION: The high unfavourable treatment outcomes among MDR/RR-TB patients on standardized SLDs were coupled with a high occurrence of SAEs in this predominantly HIV co-infected cohort. Switching to individualized all oral shorter treatment regimens should be considered to limit SAEs and improve treatment outcomes. Improving the ART uptake and timeliness of ART initiation can reduce unfavourable outcomes.


Assuntos
Rifampina/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem , Zimbábue
3.
BMJ Open ; 10(3): e034436, 2020 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-32152171

RESUMO

OBJECTIVE: Peer education is an intervention within the voluntary medical male circumcision (VMMC)-adolescent sexual reproductive health (ASRH) linkages project in Bulawayo and Mount Darwin, Zimbabwe since 2016. Little is known if results extend beyond increasing knowledge. We therefore assessed the extent of and factors affecting referral by peer educators and receipt of HIV testing services (HTS), contraception, management of sexually transmitted infections (STIs) and VMMC services by young people (10-24 years) counselled. DESIGN: A cohort study involving all young people counselled by 95 peer educators during October-December 2018, through secondary analysis of routinely collected data. SETTING: All ASRH and VMMC sites in Mt Darwin and Bulawayo. PARTICIPANTS: All young people counselled by 95 peer educators. OUTCOME MEASURES: Censor date for assessing receipt of services was 31 January 2019. Factors (clients' age, gender, marital and schooling status, counselling type, location, and peer educators' age and gender) affecting non-referral and non-receipt of services (dependent variables) were assessed by log-binomial regression. Adjusted relative risks (aRRs) were calculated. RESULTS: Of the 3370 counselled (66% men), 65% were referred for at least one service. 58% of men were referred for VMMC. Other services had 5%-13% referrals. Non-referral for HTS decreased with clients' age (aRR: ~0.9) but was higher among group-counselled (aRR: 1.16). Counselling by men (aRR: 0.77) and rural location (aRR: 0.61) reduced risks of non-referral for VMMC, while age increased it (aRR ≥1.59). Receipt of services was high (64%-80%) except for STI referrals (39%). Group counselling and rural location (aRR: ~0.52) and male peer educators (aRR: 0.76) reduced the risk of non-receipt of VMMC. Rural location increased the risk of non-receipt of contraception (aRR: 3.18) while marriage reduced it (aRR: 0.20). CONCLUSION: We found varying levels of referral ranging from 5.1% (STIs) to 58.3% (VMMC) but high levels of receipt of services. Type of counselling, peer educators' gender and location affected receipt of services. We recommend qualitative approaches to further understand reasons for non-referrals and non-receipt of services.


Assuntos
Educação em Saúde/organização & administração , Grupo Associado , Saúde Reprodutiva/educação , Adolescente , Fatores Etários , Criança , Circuncisão Masculina/métodos , Anticoncepção/métodos , Aconselhamento , Feminino , Infecções por HIV/diagnóstico , Humanos , Masculino , Encaminhamento e Consulta , Características de Residência , Fatores Sexuais , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/prevenção & controle , Fatores Socioeconômicos , Adulto Jovem , Zimbábue
4.
Glob Health Sci Pract ; 7(4): 575-584, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31852741

RESUMO

BACKGROUND: Africaid Zvandiri, in partnership with the Ministry of Health and Child Care (MOHCC) in Zimbabwe, implemented a comprehensive, peer-led program, focused on children, adolescents, and young adults living with HIV aged 0-24 years. The peers, known as community adolescent treatment supporters (CATS), are people living with HIV (PLHIV) aged 18-24 years who are trained and mentored to support their peers throughout the HIV care continuum through support groups, home visits, phone call reminders, and messages. We report the HIV care continuum outcomes (HIV testing uptake, antiretroviral therapy [ART] uptake, retention, and viral suppression) in a cohort of household contacts and sexual partners (aged younger than 25 years) of index children, adolescents, and young adults living with HIV identified by CATS from October 2017 to September 2018 in 24 districts of Zimbabwe. METHODS: This was a retrospective cohort study involving analysis of routine program data, extracted from electronic databases consisting of data on contacts of index PLHIV and ART outcomes. We used April 30, 2019, as the censor date for all analyses. RESULTS: A total of 15,223 household contacts and sexual partners with unknown HIV status (linked to 9,353 index PLHIV) were identified and referred for HIV testing. Of these, 12,114 (79.6%) were tested and 1,193 (9.8%) were HIV-positive. Of the latter, 1,153 (96.6%) were initiated on ART with 99% starting on the day of diagnosis. Of those on ART, 1,151 (99.8%) were alive on ART at 6 months and 2 (0.2%) died. A total of 1,044 (91%) children, adolescents, and young people living with HIV underwent viral load testing at 6 months or later, of whom 1,037 (99.3%) were virally suppressed (<1000 copies/ml). CONCLUSION: These findings add to the global evidence demonstrating the effectiveness of peer-led interventions in children, adolescents, and young adults living with HIV and justify the decision of the MOHCC in Zimbabwe to scale-up the model nationally. Future research should aim to understand the reasons for the gaps in HIV testing and viral load testing using qualitative research.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêutico , Serviços de Saúde Comunitária/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Infecções por HIV/tratamento farmacológico , Grupo Associado , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem , Zimbábue
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