HIV Prevalence In Zimbabwe Research Articles

Validation of the posttraumatic stress disorder checklist \u2013 5 (PCL-5) in a primary care population with high HIV prevalence in Zimbabwe

BackgroundThere is a dearth of validated tools measuring posttraumatic stress disorder (PTSD) in low and middle-income countries in sub-Saharan Africa. We validated the Shona version of the PTSD Checklist for DSM-5 (PCL-5) in a primary health care clinic in Harare, Zimbabwe.MethodAdults aged 18 and above attending the clinic were enrolled over a two-week period in June 2016. After obtaining written consent, trained research assistants administered the tool to eligible participants. Study participants were then interviewed independently using the Clinician Administered PTSD Scale (CAPS-5) as the gold standard by one of five doctors with training in mental health.ResultA total of 204 participants were assessed. Of these, 91 (44.6%) were HIV positive, 100 (49%) were HIV negative, while 13 (6.4%) did not know their HIV status. PTSD was diagnosed in 40 (19.6%) participants using the gold standard procedure. Using the PCL-5 cut-off of ≥33, sensitivity and specificity were 74.5% (95%CI: 60.4–85.7); 70.6% (95%CI: 62.7–77.7), respectively. The area under the ROC curve was 0.78 (95%CI: 0.72–0.83). The Shona version of the PCL-5 demonstrated good internal consistency (Cronbach’s alpha = 0.92).ConclusionThe PCL-5 performed well in this population with a high prevalence of HIV. There is need to explore ways of integrating screening tools for PTSD in interventions delivered by lay health workers in low and middle-income countries (LMIC).

Validation of screening tools for depression and anxiety disorders in a primary care population with high HIV prevalence in Zimbabwe

BackgroundIn low income countries in Sub-Saharan Africa there are few validated tools to screen for common disabling mental disorders such as depression and general anxiety disorder (GAD). ObjectivesWe validated three screening tools: the Shona Symptom Questionnaire for common mental disorders (SSQ-14), the Patient Health Questionnaire for depression (PHQ-9), and the Generalized Anxiety Disorder questionnaire (GAD-7). The study participants were attendees at a primary health care clinic in Harare, Zimbabwe. MethodsConsecutive adults aged 18 and above attending the clinic were enrolled over a two-week period in September 2013. Trained research assistants administered the screening tools to eligible participants after obtaining written consent. Participants were then interviewed by one of four psychiatrists using the Structured Clinical Interview of the DSM-IV (SCID). Performance characteristics were calculated for each tool, against the SCID as the gold standard. ResultsA total of 264 participants were enrolled, of whom 52 (20%) met the SCID criteria for depression alone, 97 (37%) for mixed depression and anxiety and 9 (3%) for anxiety alone. Of the 237 where HIV status was known, 165 (70%) were HIV positive. With the optimal cutoff of ≥9, the sensitivity and specificity for the SSQ-14 against a diagnosis of either depression and/or general anxiety were 84% (95%CI:78–89%) and 73% (95%CI:63–81%) respectively. Internal reliability was high (Cronbach α=0.74). The optimal cutoff for PHQ-9 was ≥11, which provided a sensitivity of 85% (95%CI:78-90%) and specificity of 69% (95%CI:59–77%) against a SCID diagnosis of depression (Cronbach α=0.86). The GAD-7 (optimal cutoff ≥10) had sensitivity and specificity of 89% (95%CI:81–94%) and 73% (95%CI:65–80%) respectively against a SCID diagnosis of GAD (Cronbach α=0.87). ConclusionScreening tools for depression and GAD had good performance characteristics in a primary health care population in Zimbabwe with a high prevalence of HIV. These can be used for research and also in clinical care to screen patients who may benefit from treatment

Multiple imputation for non-response when estimating HIV prevalence using survey data.

BackgroundMissing data are a common feature in many areas of research especially those involving survey data in biological, health and social sciences research. Most of the analyses of the survey data are done taking a complete-case approach, that is taking a list-wise deletion of all cases with missing values assuming that missing values are missing completely at random (MCAR). Methods that are based on substituting the missing values with single values such as the last value carried forward, the mean and regression predictions (single imputations) are also used. These methods often result in potential bias in estimates, in loss of statistical information and in loss of distributional relationships between variables. In addition, the strong MCAR assumption is not tenable in most practical instances.MethodsSince missing data are a major problem in HIV research, the current research seeks to illustrate and highlight the strength of multiple imputation procedure, as a method of handling missing data, which comes from its ability to draw multiple values for the missing observations from plausible predictive distributions for them. This is particularly important in HIV research in sub-Saharan Africa where accurate collection of (complete) data is still a challenge. Furthermore the multiple imputation accounts for the uncertainty introduced by the very process of imputing values for the missing observations. In particular national and subgroup estimates of HIV prevalence in Zimbabwe were computed using multiply imputed data sets from the 2010–11 Zimbabwe Demographic and Health Surveys (2010–11 ZDHS) data. A survey logistic regression model for HIV prevalence and demographic and socio-economic variables was used as the substantive analysis model. The results for both the complete-case analysis and the multiple imputation analysis are presented and discussed.ResultsAcross different subgroups of the population, the crude estimates of HIV prevalence are generally not identical but their variations are consistent between the two approaches (complete-case analysis and multiple imputation analysis). The estimates of standard errors under the multiple imputation are predominantly smaller, hence leading to narrower confidence intervals, than under the complete case analysis. Under the logistic regression adjusted odds ratios vary greatly between the two approaches. The model based confidence intervals for the adjusted odds ratios are wider under the multiple imputation which is indicative of the inclusion of a combined measure of the within and between imputation variability.ConclusionsThere is considerable variation between estimates obtained between the two approaches. The use of multiple imputations allows the uncertainty brought about by the imputation process to be measured. This consequently yields more reliable estimates of the parameters of interest and reduce the chances of declaring significant effects unnecessarily (type I error). In addition, the utilization of the powerful and flexible statistical computing packages in R enhances the computations.

Brucellosis and bovine tuberculosis at an animal-human interface in Zimbabwe

Background:TheSouthEast Lowveld (SEL)of Zimbabwe is characterisedbyextensive farmingwhere70%ofhouseholdsowncattle, 88% sheep and 100% goats. The Gonarezhou national park, which is part of the Great Limpopo Transfrontier Park, lies in the SEL. Fences of the park in Zimbabwe were partly removed making the frontier between wildlife and domestic cattle extremely porous. In 2008, the first isolation of bovine tuberculosis (bTB) in buffaloes was reported in Gonarezhou. Brucellosis was also diagnosed in SEL but only in cattle (5-16%). The importance of the interface between wildlife, domestic animals and human in this region revealed a high potential for transmission of zoonoses. This study tackles the zoonotic risk of brucellosis and bTB in SEL. Methods & Materials: A three dimensional risk analysis approach. was the adopted methodology. Results: The study demonstrated that the public and professionals are at risk from zoonoses particularly brucellosis, due to lack of knowledge (57% awareness) combined with risky food consumption habits – 41% and 67% consume raw milk and game meat respectively. Only 36.2% of the professionals received continuous education on zoonoses and just 34.4% of human health workers were aware of brucellosis which could also account for several cases of undiagnosed febrile illnesses. There is lack of collaboration between the custodians of public health, the Department of Livestock Veterinary Services and the (DVS) and the Ministry of Health and Child Care (MoHCC) in public health education. Conclusion: Even though no cattle sampleswere found positive to bovine tuberculosis, given the similarity of modes of transmission to brucellosis, the potential transmission of bTB from wildlife to cattle would constitute an important threat for human population. In addition to these results, HIV prevalence in Zimbabwe is highwith a prevalence of 14.9% amongst adult aged 15 to 49. Therefore the potential of brucellosis and bovine tuberculosis spread into human population is really to be considered. As such strengthening links andpromoting inter-disciplinaryOneHealth collaboration between the two groups of professionals, human and veterinary in the field of public healthwould result in effective zoonoses control.

The rise and fall of HIV prevalence in Zimbabwe: the social, political and economic context

For more than 10 years Zimbabwe has experienced social, political and economic instability, including the near collapse in 2008 of its health system. Paradoxically, this period has also seen a fall in estimated HIV prevalence, from 25.6% in 1996 to 13.7% in 2009. This article examines this development in a socio-political and historical context. We focus on the complex interplay of migration, mortality, individual behaviour change, and economic patterns in shaping the presumed epidemiological waning of HIV prevalence in Zimbabwe and explore the evolution and management of the country's HIV/AIDS response. Our assessment of the role that the Zimbabwean state has played in this development leads to the conclusion that a decline in HIV prevalence has been as much an artefact of dire social, political and economic conditions as the outcome of deliberate interventions. Lastly, we propose the need to contextualise available epidemiological data through qualitative research into the social aspects of HIV and the everyday lives of individuals affected by it.

P1-S5.19 Marriage dissolution and HIV prevalence in rural Zimbabwe 2003-2008

<h3>Background</h3> Over the past decade, HIV prevalence in Zimbabwe has significantly declined, with recent research attributing this decline to wide-spread behaviour change such as reductions in extramarital sexual partnerships. Despite these reductions in risky sexual Behaviours, infections could still be transmitted from one marital union to another as divorced or widowed HIV-positive persons remarry. <h3>Methods</h3> Using information collected through face-to-face interviews in 2003–2005 AND 2006–2008, we compared HIV prevalence and basic demographics among women and their spouses (married, or in a long-term or cohabiting relationship for &gt;12 months) in Manicaland, Zimbabwe. We used logistic regression to assess differences in marital history and basic demographics between HIV seronegative concordant couples, HIV serodiscordant couples and HIV seropositive concordant couples. <h3>Results</h3> In nearly one-third of the 2836 (27.8%) of marital unions interviewed, at least one member was infected with HIV (n=787); both members were HIV positive in 372 couples (13%). Of the 415 serodiscordant couples, 157 (5.5%) were serodiscordant female positive. Overall, compared to those in seronegative concordant (NC) partnerships, women in female-positive discordant (FP) or seropositive concordant (PC) partnerships were older (25–34 years vs 15–24; OR 1.7, 95% CI 1.17 to 2.47; OR 3.35, 2.52 to 4.45, respectively), more likely to been divorced (FP OR 4.19, 2.83 to 6.20; PC OR 4.12, 3.10 to 5.48), and more likely to have been widowed (FP OR 7.83, 3.65 to 16.76; PC OR 7.86, 4.30 to 14.36). Similar but weaker trends in divorce/widowhood were observed among men in male-positive discordant relationships compared to men in SN relationships. Women in FP and PC partnerships both were nearly three times as likely to report &gt;1 lifetime sex partners than women in SN partnerships (FP OR 2.82, 2.02 to 3.92; PC OR 2.86, 2.27 to 3.59); mean lifetime sex partners reported by women in FP and PC partnerships was similar (FP: 2.11 lifetime partners; PC 2.06). <h3>Conclusions</h3> HIV prevalence is high among persons in long-term, stable partnerships, and strongly associated with one or both partners reporting a history of divorce or being widowed. In particular, widowed and divorced women may play an important role in ongoing HIV transmission dynamics. VCT services and other interventions that target couples should be promoted among divorced and widowed individuals.

Factors Associated With Repeat Pregnancy Among Women in an Area of High HIV Prevalence in Zimbabwe

Background This study examined predictors of repeat pregnancy among women from the Prevention of Mother-to-Child Transmission of HIV (PMTCT) program in Zimbabwe. Methods The study was conducted at urban antenatal clinics in Chitungwiza, a high HIV prevalence urban town on the outskirts of Harare, Zimbabwe. Using a cross-sectional design, 79 HIV-positive and 80 HIV-negative women who had participated in a PMTCT program in their index pregnancy were interviewed in Shona using a standardized questionnaire 24 months after delivery of their index pregnancy. Logistic regression was used to determine whether a relationship exists between repeat pregnancy and HIV status, socioeconomic status, age, Fertility Attitude Score, and previous pregnancy outcomes. Results In multivariate analysis, factors associated with an increased likelihood of repeat pregnancy were death of a child (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.25–12.52; p = .0019), miscarriage (OR, 3.4; 95% CI, 1.23–9.34; p = .019), and each additional child (OR, 4.6; 95% CI, 1.89–11.52; p = .001). Decreased likelihood of repeat pregnancy was associated with decreased rank order of living conditions (OR, −0.75; 95% CI, 0.55–0.95; p = .021), each additional year of age (OR, −0.86; 95% CI, 0.77–0.97; p = .012), and higher Fertility Attitude Score (OR, −0.76; 95% CI, 0.64–0.91; p = .002). Conclusion HIV status alone was not significant as a predictor of repeat pregnancy. Women’s childbearing intentions are not influenced by the risk of mother-to-child transmission of HIV (MTCT) in this population. Future research is needed to address the cultural attitudes and sexual practices of HIV-positive women in order to minimize the threat of MTCT.

HIV prevalence in Zimbabwe dropping like a stone

HIV prevalence in Zimbabwe dropping like a stone HIV in Zimbabwe is disappearing like ‘snow in the desert’, in dramatic contrast to its neighbouring countries, mystifying epidemiologists, one of whom firmly believes the anomaly can be attributed to the country’s relatively high level of education. Brian Williams of the South African Centre for Epidemiological Modelling (SACEMA), was speaking at the 2nd Consortium to Respond Effectively to the AIDS/TB epidemic (CREATE), in Cape Town during the first week of November. He said reliable data showed that HIV/AIDS prevalence in Zimbabwe had halved over the past 12 years, dropping from 30% in 1998 to 15% now.1 He suggested this could be put down to the country’s population having benefited from a superior education that enabled them to ‘absorb and respond to prevention messages’. ‘My theory is that Zimbabwe had the best educated population in southern Africa -- and prevention messages only work if people are able to understand, internalise and act on them,’ he added.

When Did HIV Incidence Peak in Harare, Zimbabwe? Back-Calculation from Mortality Statistics

HIV prevalence has recently begun to decline in Zimbabwe, a result of both high levels of AIDS mortality and a reduction in incident infections. An important component in understanding the dynamics in HIV prevalence is knowledge of past trends in incidence, such as when incidence peaked and at what level. However, empirical measurements of incidence over an extended time period are not available from Zimbabwe or elsewhere in sub-Saharan Africa. Using mortality data, we use a back-calculation technique to reconstruct historic trends in incidence. From AIDS mortality data, extracted from death registration in Harare, together with an estimate of survival post-infection, HIV incidence trends were reconstructed that would give rise to the observed patterns of AIDS mortality. Models were fitted assuming three parametric forms of the incidence curve and under nine different assumptions regarding combinations of trends in non-AIDS mortality and patterns of survival post-infection with HIV. HIV prevalence was forward-projected from the fitted incidence and mortality curves. Models that constrained the incidence pattern to a cubic spline function were flexible and produced well-fitting, realistic patterns of incidence. In models assuming constant levels of non-AIDS mortality, annual incidence peaked between 4 and 5% between 1988 and 1990. Under other assumptions the peak level ranged from 3 to 8% per annum. However, scenarios assuming increasing levels of non-AIDS mortality resulted in implausibly low estimates of peak prevalence (11%), whereas models with decreasing underlying crude mortality could be consistent with the prevalence and mortality data. HIV incidence is most likely to have peaked in Harare between 1988 and 1990, which may have preceded the peak elsewhere in Zimbabwe. This finding, considered alongside the timing and location of HIV prevention activities, will give insight into the decline of HIV prevalence in Zimbabwe.

HIV prevalence and trends from data in Zimbabwe, 1997–2004

Background: This paper brings together data from a variety of reports to provide a basis for assessing future steps for responding to and monitoring the HIV epidemic in Zimbabwe. Method:...

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.