Framework for Risk Communication and Community Engagement to Improve Vaccine Uptake for COVID-19 and other Vaccine-Preventable Diseases in Low- and Middle-Income Countries (LMIC).

A framework for guiding risk communication and community engagement (RCCE) during COVID-19 vaccination roll-out is worthwhile in order to guide interventions aimed at improving vaccine uptake. This requires setting up standardised early-warning indicators to predict or detect low uptake; coordination of response activities by all partners, real-time information exchange, innovativeness in designing strategies to deal with arising and anticipated challenges; flexibility to adapt quickly to changing demands and evolving circumstances; and documentation of progress and lessons learnt.

Key Considerations for Successful Risk Communication and Community Engagement (RCCE) Programmes During COVID-19 Pandemic and Other Public Health Emergencies.

Risk communication and community engagement (RCCE) is a key pillar in public health emergency response that ensures accurate health information sharing, adoption of protective behaviours by the affected people, and collaborative participation by all stakeholders, including of the local community structures. The success of RCCE programmes rely on strong partnerships and engagement among affiliated groups; clear programme plans and guidelines; establishment of well-laid down coordination structures; and clear measures for reporting and documentation of programme activities. RCCE activities during public health emergencies must put more emphasis on strengthening local structures and communities to ensure active participation of communities in interrupting disease transmission.

Effects of HIV and non-communicable disease comorbidity on healthcare costs and health experiences in people living with HIV in Zimbabwe.

BACKGROUND: The effects of HIV and non-communicable disease (NCD) comorbidities on healthcare costs and health experiences have been documented in most high-income countries. However, little similar data are available for Zimbabwe and most countries in sub-Saharan Africa. Untreated or under-treated NCDs can potentially negate the gains achieved from the control of HIV. OBJECTIVES: The study sought to determine the effects of HIV-NCD comorbidity on healthcare costs, health experiences and treatment options for people living with HIV (PLWH) in Zimbabwe. METHODS: A repeated-measures, quantitative study was conducted at six antiretroviral therapy (ART) sites in the Gweru District of Zimbabwe. Simple random sampling was used to enrol 100 PLWH concurrently diagnosed with hypertension and/or diabetes mellitus (cases). Cases were matched by age, sex and viral load to an equal number of PLWH without hypertension and/or diabetes mellitus (controls). Quantitative data were collected using an interviewer-administered questionnaire at monthly intervals for 6 months. The questionnaire survey sought to compare healthcare costs, health-related experiences and treatment options between cases and controls. Data were analysed using Stata Version 13.1®. A logistic model was used to examine other factors such as demographic, clinical and behavioural data that were assumed to be unchanged over the study period. A random-effects model, including costs and other covariates, was used to compare groups in the final analysis. RESULTS: Non-communicable disease status was associated with the length of time on ART. Cases spent significantly more on transport (p = 0.0001) and medication (adjusted odds ratio [AOR] = 4.4, 95% confidence interval [CI]: 3.2-7.3); spent more days without doing usual daily activities because of sickness (AOR = 4.2, 95% CI: 3.3-7.6) and were more likely to use alternative medication (AOR = 3.4, 95% CI: 2.3-4.6) when compared with controls. Unemployment, female gender, age of 60 years and above, and living in rural areas were associated with failure to purchase prescribed medication. CONCLUSIONS: HIV-NCD comorbidity causes an additional burden to PLWH because of increased transport costs, NCD prescribed medication expenses and more productive days lost due to illness. The success of HIV programmes does not only rely on improving access to the diagnosis and treatment of HIV. Addressing the complications of HIV-related NCDs, and the long-term costs of ART and its occasional potential for harm will be essential if health outcomes in Zimbabweans living with HIV are to be optimised.

Capacity of antiretroviral therapy sites for managing NCDs in people living with HIV in Zimbabwe.

BACKGROUND: There are marked inconsistencies in prevalence data for human immunodeficiency virus and non-communicable disease (HIV-NCD) comorbidity in Zimbabwe. OBJECTIVES: To explain these discrepancies, we investigated the capacity of antiretroviral therapy (ART) sites in managing hypertension (HTN) and diabetes mellitus (DM) in people living with HIV (PLWH) in Gweru district, Zimbabwe. METHOD: This was a qualitative research design in which key informant interviews were conducted with eight health managers, and 12 focus group discussions (FGDs) were conducted with 72 PLWH concurrently diagnosed with HTN and/or DM. Thematic data analysis was performed in NVivo version 12®. RESULTS: Routine screening for HTN and targeted screening for DM were often interrupted by dysfunctional machines and intermittent supply of necessary consumables, impacting negatively on the capacity of the sites to monitor and screen for the NCDs. Erratic hypertensive and diabetic medication availability at study sites were also reported, forcing patients to turn to other treatment options (medication rationing or overdose or sharing, use of home remedies and traditional medicines, and reliance on faith and traditional healers). CONCLUSION: Findings demonstrate that the quality of observed incidence and prevalence data for HTN and DM in LMICs is a function of the capacity of health centres to screen for NCDs. Given the ageing population of PLWH in sub-Saharan Africa, coupled with increasing trends in the prevalence of NCDs in HIV-infected people, HIV programmes have not evolved with the changing needs of PLWH. Attention to the holistic management of PLWH is long overdue.

Prevalence of diabetes mellitus and hypertension in people living with human immunodeficiency virus on antiretroviral therapy in Gweru district, Zimbabwe.

BACKGROUND: While antiretroviral therapy (ART) has markedly increased survival in people living with human immunodeficiency virus (PLHIV), emerging trends of co-existence of non-communicable diseases (NCDs) and HIV could negate the gains already achieved in controlling HIV. AIM: The study aimed to determine the prevalence of hypertension and diabetes mellitus in PLHIV on ART in Gweru district. SETTING: Six high-volume ART sites in Gweru district under Midlands province in Zimbabwe. METHODS: This was a cross-sectional study. Screening and data collection occurred over a 3-month cycle when all patients were expected to have visited the ART sites for their monthly ART drug supply. The process also allowed the identification of health system challenges regarding data management for HIV-NCD comorbidity. Poisson regression analysis was used to calculate NCD prevalence ratio (PR) in PLHIV. RESULTS: Nearly 18 000 PLHIV registered for ART were identified. Hypertension (19.5%) and diabetes mellitus (8.4%) were the most common NCDs identified with a high proportion of those who did not know their diagnosis (over 50%). The prevalence of hypertension and/or diabetes mellitus among women was 74.9% compared to 25.1% in men (PR 3.22; 95% CI: 3.07-5.51, p = 0.0000). Other factors associated with increased prevalence of hypertension and/or diabetes mellitus were age group of ≥ 60 years (PR 2.5; 95% CI: 1.42-3.22, p = 0.00023), and duration of ≥ 5 years on ART (PR 6.4; 95% CI: 4.70-8.01, p = 0.0011). Separate data collection for NCDs and HIV was a key challenge affecting quantification of magnitude of HIV-NCDs comorbidity and subsequently management of NCDs in PLHIV. CONCLUSIONS: Indications of increasing prevalence of NCDs in PLHIV call for integrated electronic data management for HIV, TB and NCDs. This will allow active NCD case finding, and eventually improve prevalence data and treatment for HIV-NCD comorbidity. Future studies should focus on the health experiences and access to treatment in PLHIV diagnosed with NCDs; and to establish the accurate manner in which HIV status, ART and NCDs might be associated, through conducting a case control or cohort study.

Prevalence, healthcare costs and management of non-communicable diseases in people living with human immunodeficiency virus: A scoping review.

BACKGROUND: Coexistence of human immunodeficiency virus (HIV) and non-communicable diseases (NCDs) is an important public health issue of increasing concern. However, the prevalence, healthcare costs and management protocols for NCDs in people living with HIV (PLHIV) remain unclear in most settings. AIM: To scope evidence on prevalence, healthcare costs and disease management protocols associated with NCDs in PLHIV from studies published before July 2019. METHODS: Electronic databases were searched for published articles, and reference lists were checked for relevant studies. Key terms included were HIV/AIDS, co-morbidity or multi-morbidity, NCDs, healthcare costs, treatment protocols, diabetes mellitus, hypertension in various combinations. RESULTS: A total of 152 records were assessed, and thereafter 25 studies were included in the final review after all the elimination. Twelve of the 25 studies mostly reported prevalence of NCDs in PLHIV, 4 reported impact of HIV-NCD co-morbidity on healthcare costs and 1 reported management protocols and capacity of antiretroviral therapy (ART) sites to manage HIV-NCD co-morbidity. CONCLUSIONS: Results showed higher prevalence rates of diabetes mellitus and hypertension in PLHIV compared with HIV-negative people. However, there was inconsistency in NCD prevalence data from studies conducted in sub-Saharan African (SSA) countries, and limited research evidence on capacity of ART sites to manage NCDs in PLHIV. Low prevalence rates of NCDs reported in SSA countries could be an indication of limited capacity to screen for NCDs because of the influence of health system and/or patient-level factors. Most studies were generally limited to cross-sectional studies, with very few interventional, longitudinal studies.

Determinants of Weaning Practices Among Mothers of Infants Aged Below 12 Months in Masvingo, Zimbabwe.

BACKGROUND: Poor weaning practices have been reported to contribute to high infant mortality and morbidity rates especially in developing countries. OBJECTIVES: This study sought to determine factors related to weaning that predispose, reinforce and enable mothers of infants younger than age 12 months to comply or not to comply with the World Health Organization (WHO) 2009 guidelines on appropriate infant feeding. METHODS: The present study was a descriptive cross-sectional study. An interviewer-administered questionnaire was used to collect data on weaning and infant feeding practices from a sample of 300 mothers of infants aged younger than 12 months, resident in the Rujeko community, and registered and seen at the Rujeko Council Clinic during the study time. FINDINGS: The study results indicated that noncompliance with WHO infant feeding guidelines was high among the study participants. The rate of exclusive breastfeeding in the first 6 months was very low (14.8%), with the mean age of introduction of complementary foods to infants of 5 weeks (range 1-24 weeks). Early supplementation of breast milk was not associated with mother's age, level of education, and religion. Scheduled breastfeeding was more prevalent among the mothers who worked outside the home (P = .018). Provision of formal advice and influence from health care workers was found to improve young child feeding and weaning practices among mothers (P = .011). CONCLUSIONS: Various weaning methods were used, and mothers identified numerous factors as impeding their efforts to follow proper breastfeeding practices. The findings highlight the need to develop personal skills among mothers to prepare nutritionally balanced diets.