Predictors of COVID-19 infection among health care workers in Harare City, Zimbabwe, 2021.

Introduction: preventing COVID-19 infection among health workers maintains the health system capacity and reduces secondary transmission. Of 506 health workers tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Harare City between December 2020 and February 2021 (second wave), 128 (25%) tested positive, affecting service delivery. We investigated factors associated with COVID-19 infection and described breakthrough infections among health workers. Methods: we conducted a cross-sectional study in Harare City. Interviews were conducted with 467 health workers to determine behavioral, occupational, and non-occupational factors associated with COVID-19 infection. Fifteen key informants were interviewed to verify responses. Records and line-list were reviewed to verify cases, outcomes, and vaccination status. Observations were done to check adherence to prevention measures. Epi-info generated means, frequencies, proportions and conducted univariate, bivariate and multivariate analysis. Statistical significance was at p-value<0.05. Results: we interviewed 467 health workers, 166 (35.5%) had a history of COVID-19 infection. Females were the majority 357 (76.4%), mostly nurses 200 (42.8%). Those not trained on infection control measures in the past six months (aOR=2.13; 95%CI 1.06-4.27; p=0.03), not observing social distance at mealtimes (aOR=6.33; 95%CI 3.36-11.89; p<0.01), having a household COVID-19 case (aOR=9.03; 95%CI 3.93-20.76; p<0.01) and not properly wearing facemasks (aOR=16.68; 95%CI 9.39-29.61; p<0.01) were significantly associated COVID-19 infection. Of 378 health workers fully vaccinated, 39 (10.3%) had breakthrough infections. Most with breakthrough infections, 33 (84.6%) had asymptomatic or mild disease. One death was recorded, a female, not vaccinated, with uncontrolled diabetes. Conclusion: predictors of COVID-19 infection among health workers were, no training on infection and prevention and control (IPC) measures, lack of social distancing at mealtimes, improper use of facemasks, and having a COVID-19 case at household level. We conducted refresher training to strengthen infection control measures.

COVID-19 sample management: experiences of Harare City, 2021.

COVID-19 sample management is pivotal in controlling the pandemic. Results of 28/45 (62.2%) cases identified at a high school COVID-19 outbreak in Harare's Northern district were not reported within the recommended 24 hours of notification. This leads to delayed patient management. We evaluated the sample management system for COVID-19 in Harare City. A descriptive cross-sectional study was conducted in Harare City. Health care workers involved in COVID-19 sample management at a high school outbreak in the Northern district namely clinicians, laboratory, environmental and administrative personnel were purposively sampled. Interviewer-administered questionnaires were used to collect data. Quantitative data were analyzed using Epi info version 7. Medians and proportions were generated. A 3-point Likert Scale was used to measure knowledge levels of health care workers on COVID-19 sample management. Thirty health care workers were interviewed and females were 20/30 (66%). Participants had not been trained in sample management. Overall knowledge level was good for 7/30 (23%) of the participants. Of the samples collected, 156/451 (34.6%) were wrongly sent to the national microbiology laboratory and 53/156 (34.0%) of the results were received. Sample management of COVID-19 samples in Harare City was found to affect patient management because of poor knowledge of healthcare workers, lack of transportation and communication means. The need for training cadres involved in the management process and availing adequate resources can improve turnaround time of results hence patient management.

Trends of stillbirths in Harare City, Zimbabwe, 2015-2019: a secondary data analysis.

Introduction: in Zimbabwe, perinatal mortality is a major public health problem. Harare City data showed increase in stillbirth rate trend from 4/1000 live births in 2014 to 6/1000 live births in 2018, failing to meet the country's target of reducing stillbirth rate by 40%. We analysed the characteristics of stillbirths from 2015 to 2019 in Harare City. Methods: we conducted a retrospective analytical cross-sectional study using secondary data from Harare City Health Department's 12 baby-delivery polyclinics. Fourteen key informants were interviewed to verify information obtained. Using Epi-info, descriptive summaries and graphs were generated and bivariate and multivariate logistic regression was conducted. Statistical significance was considered at a p-value <0.05. Results: a total of 700(74.9%) perinatal death notification records were reviewed. The majority were macerated stillbirths 418(59.7%) followed by fresh stillbirths 189(27.0%). The median age for women who had fresh stillbirths was 26 years (Q1=22; Q2=32). Preterm delivery (aOR= 2.15; 95%CI 1.81- 3.89; p<0.01), having delivered by breech presentation (aOR= 3.32; 95%CI 1.72-6.41; p=<0.01), and being HIV positive (aOR= 1.69; 95%CI 1.02-2.79; p=0.04) were associated with preterm delivery. Conclusion: stillbirths in Harare City were increasing and were due to preventable causes. The younger maternal age group was most affected hence preventive activities should focus on them. Improving the quality of antenatal care, delivery, and new-born care can help reduce stillbirths and early neonatal death.

Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing?

BACKGROUND: Despite high antiretroviral (ARV) treatment coverage among pregnant women for prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in Zimbabwe, the MTCT rate is still high. Therefore in 2016, the country adopted World Health Organization recommendations of stratifying pregnant women into "High" or"Low" MTCT risk for subsequent provision of HIV exposed infant (HEI) with appropriate follow-up care according to risk status. OBJECTIVE: The study sought to ascertain, among pregnant women who delivered in clinics of Harare in August 2017: the extent to which high risk MTCT pregnancies were identified at time of delivery; and whether their newborns were initiated on appropriate ARV prophylaxis, cotrimoxazole prophylaxis, subjected to early HIV diagnostic testing and initiated on ARV treatment. METHODS: Cross-sectional study using review of records of routinely collected program data. RESULTS: Of the 1,786 pregnant women who delivered in the selected clinics, HIV status at the time of delivery was known for 1,756 (98%) of whom 197 (11%) were HIV seropositive. Only 19 (10%) could be classified as "high risk" for MTCT and the remaining 90% lacked adequate information to classify them into high or low risk for MTCT due to missing data. Of the 197 live births, only two (1%) infants had a nucleic-acid test (NAT) at birth and 32 (16%) infants had NAT at 6 weeks. Of all 197 infants, 183 (93%) were initiated on single ARV prophylaxis (Nevirapine), 15 (7%) infants' ARV prophylaxis status was not documented and one infant got dual ARV prophylaxis (Nevirapine+Zidovudine). CONCLUSION: There was paucity of data requisite for MTCT risk stratification due to poor recording of data; "high risk" women were missed in the few circumstances where sufficient data were available. Thus "high risk" HEI are deprived of dual ARV prophylaxis and priority HIV NAT at birth and onwards which they require for PMTCT. Health workers need urgent training, mentorship and supportive supervision to master data management and perform MTCT risk stratification satisfactorily.

Enhanced adherence counselling and viral load suppression in HIV seropositive patients with an initial high viral load in Harare, Zimbabwe: Operational issues.

BACKGROUND: In people living with HIV (PLHIV) who are on anti-retroviral therapy (ART), it is essential to identify persons with high blood viral loads (VLs) (≥1000 copies/ml), provide enhanced adherence counselling (EAC) for 3 months and assess for VL suppression (<1000 copies/ml). OBJECTIVE: Our study objectives were to determine the proportion who had a high viral load in those people who underwent viral load testing between 1 August 2016-31 July 2017 at Wilkins Hospital, Harare, Zimbabwe. Of those with high viral load to assess; a) the proportion who enrolled for EAC, the demographic and clinical characteristics associated with enrolment for EAC and, b) the proportion who achieved viral load suppression and demographic, clinical characteristics associated with viral load suppression. DESIGN: Retrospective cohort study using routinely collected programme data. Data was collected from PLHIV who were on ART and had a high viral load from 1 August 2016 to 31 July 2017. RESULTS: Of 5,573 PLHIV on ART between 1 August 2016 and 31 July 2017, 4787 (85.9%) had undergone VL testing and 646 (13.5%) had high VLs. Of these 646, only 489 (75.7%) were enrolled for EAC, of whom 444 (69%) underwent a repeat VL test at ≥ 3 months with 201 (31.2%) achieving VL suppression. The clinical characteristics that were independently associated with higher probability of VL suppression were: a) undergoing 3 sessions of EAC; b) being on 2nd line ART. Initial VL levels >5,000 copies/ml were associated with lower probability of viral suppression. CONCLUSION: The routine VL testing levels were high, but there were major programmatic gaps in enrolling PLHIV with high VLs into EAC and achieving VL suppression. The full potential of EAC on achieving viral load suppression has not been achieved in this setting. The reasons for these gaps need to be assessed in future research studies and addressed by suitable changes in policies/practices.