Background: Anti-retroviral therapy (ART) has reduced morbidity and mortality among HIV-infected individuals over the last years. The increase in survival of HIV patients has contributed to the emergence of other chro...Background: Anti-retroviral therapy (ART) has reduced morbidity and mortality among HIV-infected individuals over the last years. The increase in survival of HIV patients has contributed to the emergence of other chronic conditions in these individuals, such as hypertension, renal, and cardiovascular disease. Hypertension and HIV infection are both mostly asymptomatic but can lead to fatal and disabling illness. Hypertension among HIV-infected individuals, although not completely elucidated, may be explained by the aging of population, the effect of HIV on vascular tone anti-retroviral therapy and traditional risk factors such as weight gain, smoking, dyslipidemia, and drug abuse. The factors associated with hypertension among ART patients in a predominantly rural setting were studied in this paper. Methods: We conducted an analytical cross sectional study at 13 health facilities in Makonde District a rural district in Mashonaland West Province of Zimbabwe where we systematically selected 393 of 400 ART patients aged 15 years and above. Structured interviewer administered questionnaires were used to collect data on demographic characteristics. Written and informed consent was sought and obtained from all study participants. We obtained parental consent followed by assent from participants younger than 16 years. All enrolled patients had physical measurements done. Chi square test and stratified & logistic regression analysis were done using Epi info version 3.5.1. All calculations were done at 95% confidence interval. Results: Results from 393 participants were analysed. The prevalence and awareness of hypertension were 34.9% and 30% respectively. Only 9.6% were taking medication. Independent risk factors were duration of ART > 2 years (POR 2.23;95%CI: 1.08;4.61), waist to hip ratio (women) > 0.85 (POR 3.45;95%CI: 1.60;5.88), B.M.I > 25 (POR 2.18;95%CI: 1.40;3.8). Protective factors were: Symptomatic HIV disease (POR 0.36;95%CI: 0.14;0.97) and being informally employed (POR 0.67;95%CI: 0.43;0.96). General risk factors were smoking (POR 5.06;95%CI: 2.20;11.60), sedentary recreation (POR 3.16;95%CI: 1.69;5.85) and high salt intake (POR 2.67;95%CI: 1.56;4.59). Conclusions: Hypertension is common among ART clients although it is not routinely screened for in ART care settings in Makonde. Common modifiable risk factors are contributing to the burden of hypertension in Makonde District. Health service providers should routinely screen for hypertension and promote healthy lifestyles among ART clients in Makonde.展开更多
Background: HIV Testing Services (HTS) is a full range of services (e.g. counselling and post-test referrals) that are offered together with HIV testing. It is an important prevention strategy and the gateway to treat...Background: HIV Testing Services (HTS) is a full range of services (e.g. counselling and post-test referrals) that are offered together with HIV testing. It is an important prevention strategy and the gateway to treatment. The national targets in 2016 were to test 1.1 million people of which 54% was achieved. We determined trends of HTS in Zimbabwe from 2007 to 2016. Methods: A secondary dataset analysis was conducted using National Aids Council Core-Output Indicators dataset. Variables captured include total and repeat tests, counselling and referrals. Microsoft excel and Epi Info was used to generate frequencies, percentages and conduct chi square test for trends. Panda-Class Libraries was to attain estimates of HTS uptake till 2020. We used χ2 and p-values for statistical significance. Results: All (10,847.223) records were analysed. HIV tests per year increased from 340,705 in 2007, to 1,974,795 in 2015 (χ2 0.10492, p-value 0.74615). In 2007, 31% (n = 106,884) clients tested positive whilst in 2016 only 7% (n = 121,196) were positive (χ2 0.01166, p-value 0.91402). The 25 - 49 year age-group tested consistently highest throughout the 10year period (χ2 0.0558 p-value 0.813). The 15 - 24 year age-group had the highest yield (11% in 2015). Females (χ2 0.1074, p-value 0.743) consistently tested higher than males (χ2 0.0614, p-value 0.804). From 2007 to 2013 women had higher yields but by September 2016 males had a higher positivity of 8% (p-value χ2 0.658 p-value = 0.417). We estimate that 179,935 people living with HIV will know their status by 2020. Conclusion: HIV tests in Zimbabwe have increased but yield has decreased. Increase in repeat tests may be an indication of exhaustion of particular HTS strategies. Following this analysis it was recommended that HTS utilize various models such as HIV self-test to cater for populations with high yields.展开更多
Background: Prevention of mother-to-child transmission (PMTCT) program includes a cascade of services given to prevent mother-to-child transmission (MTCT) of HIV in-utero, during delivery and during breastfeeding. Zim...Background: Prevention of mother-to-child transmission (PMTCT) program includes a cascade of services given to prevent mother-to-child transmission (MTCT) of HIV in-utero, during delivery and during breastfeeding. Zimbabwe has made tremendous progress in increasing coverage of PMTCT services and reducing MTCT rate. COVID-19 has negatively impacted HIV programs. Murewa was among the districts with the most COVID-19 cases. We evaluated the PMTCT program in Murewa District in the face of COVID-19 challenges. Methods: We assessed inputs, processes, outputs and outcomes of the PMTCT program using the logic model approach. We collected data using interviewer-administered questionnaire, records review, and a checklist to assess availability of inputs, processes carried out and outputs realized from the program. We randomly selected health workers and program recipients. We used Epi info 7 to compute frequencies, means and proportions. Results: Murewa District had 58 health workers in post against an establishment of 92. Seven out of 16 facilities reported having HIV test-kit stockout. Only 4/16 were conducting postnatal clinics. No PMTCT training were conducted. Only 1872/5693 (33%) of HIV consumables including HIV test kits and CD4 count reagents were procured. The reasons reported for low PMTCT coverage in Murewa were fear of contracting COVID-19 at health facilities 33/43 (77%), lack of bus fare 28/43 (65%) and unavailability of medical consumables 26/43 (60%). Conclusion: The PMTCT program in Murewa District failed to meet targets for inputs, processes, and outputs worsened by the impact of the COVID-19 pandemic. The reasons for low PMTCT coverage in Murewa District were reported to be due to fear of contracting COVID-19, unavailability of medical consumables and COVID-19 travelling restrictions. We recommended development of guidelines on provision of PMTCT services amid the COVID-19 pandemic. We gave health education to program recipients on the importance to access PMTCT services even amid public health emergencies like COVID-19.展开更多
Western Kenya suffers a highly endemic and also very heterogeneous epidemic of human immunodeficiency virus(HIV).Although female sex workers(FSW)and their male clients are known to be at high risk for HIV,HIV prevalen...Western Kenya suffers a highly endemic and also very heterogeneous epidemic of human immunodeficiency virus(HIV).Although female sex workers(FSW)and their male clients are known to be at high risk for HIV,HIV prevalence across regions inWestern Kenya is not strongly correlated with the fraction of women engaged in commercial sex.An agentbased network model of HIV transmission,geographically stratified at the county level,was fit to the HIV epidemic,scale-up of interventions,and populations of FSW in Western Kenya under two assumptions about the potential mobility of FSW clients.In the first,all clients were assumed to be resident in the same geographies as their interactions with FSW.In the second,some clients were considered non-resident and engaged only in interactions with FSW,but not in longer-term non-FSW partnerships in these geographies.Under both assumptions,the model successfully reconciled disparate geographic patterns of FSW and HIV prevalence.Transmission patterns in the model suggest a greater role for FSW in local transmission when clients were resident to the counties,with 30.0%of local HIV transmissions attributable to current and former FSW and clients,compared to 21.9%when mobility of clients was included.Nonetheless,the overall epidemic drivers remained similar,with risky behavior in the general population dominating transmission in highprevalence counties.Our modeling suggests that co-location of high-risk populations and generalized epidemics can further amplify the spread of HIV,but that large numbers of formal FSW and clients are not required to observe or mechanistically explain high HIV prevalence in the general population.展开更多
文摘Background: Anti-retroviral therapy (ART) has reduced morbidity and mortality among HIV-infected individuals over the last years. The increase in survival of HIV patients has contributed to the emergence of other chronic conditions in these individuals, such as hypertension, renal, and cardiovascular disease. Hypertension and HIV infection are both mostly asymptomatic but can lead to fatal and disabling illness. Hypertension among HIV-infected individuals, although not completely elucidated, may be explained by the aging of population, the effect of HIV on vascular tone anti-retroviral therapy and traditional risk factors such as weight gain, smoking, dyslipidemia, and drug abuse. The factors associated with hypertension among ART patients in a predominantly rural setting were studied in this paper. Methods: We conducted an analytical cross sectional study at 13 health facilities in Makonde District a rural district in Mashonaland West Province of Zimbabwe where we systematically selected 393 of 400 ART patients aged 15 years and above. Structured interviewer administered questionnaires were used to collect data on demographic characteristics. Written and informed consent was sought and obtained from all study participants. We obtained parental consent followed by assent from participants younger than 16 years. All enrolled patients had physical measurements done. Chi square test and stratified & logistic regression analysis were done using Epi info version 3.5.1. All calculations were done at 95% confidence interval. Results: Results from 393 participants were analysed. The prevalence and awareness of hypertension were 34.9% and 30% respectively. Only 9.6% were taking medication. Independent risk factors were duration of ART > 2 years (POR 2.23;95%CI: 1.08;4.61), waist to hip ratio (women) > 0.85 (POR 3.45;95%CI: 1.60;5.88), B.M.I > 25 (POR 2.18;95%CI: 1.40;3.8). Protective factors were: Symptomatic HIV disease (POR 0.36;95%CI: 0.14;0.97) and being informally employed (POR 0.67;95%CI: 0.43;0.96). General risk factors were smoking (POR 5.06;95%CI: 2.20;11.60), sedentary recreation (POR 3.16;95%CI: 1.69;5.85) and high salt intake (POR 2.67;95%CI: 1.56;4.59). Conclusions: Hypertension is common among ART clients although it is not routinely screened for in ART care settings in Makonde. Common modifiable risk factors are contributing to the burden of hypertension in Makonde District. Health service providers should routinely screen for hypertension and promote healthy lifestyles among ART clients in Makonde.
文摘Background: HIV Testing Services (HTS) is a full range of services (e.g. counselling and post-test referrals) that are offered together with HIV testing. It is an important prevention strategy and the gateway to treatment. The national targets in 2016 were to test 1.1 million people of which 54% was achieved. We determined trends of HTS in Zimbabwe from 2007 to 2016. Methods: A secondary dataset analysis was conducted using National Aids Council Core-Output Indicators dataset. Variables captured include total and repeat tests, counselling and referrals. Microsoft excel and Epi Info was used to generate frequencies, percentages and conduct chi square test for trends. Panda-Class Libraries was to attain estimates of HTS uptake till 2020. We used χ2 and p-values for statistical significance. Results: All (10,847.223) records were analysed. HIV tests per year increased from 340,705 in 2007, to 1,974,795 in 2015 (χ2 0.10492, p-value 0.74615). In 2007, 31% (n = 106,884) clients tested positive whilst in 2016 only 7% (n = 121,196) were positive (χ2 0.01166, p-value 0.91402). The 25 - 49 year age-group tested consistently highest throughout the 10year period (χ2 0.0558 p-value 0.813). The 15 - 24 year age-group had the highest yield (11% in 2015). Females (χ2 0.1074, p-value 0.743) consistently tested higher than males (χ2 0.0614, p-value 0.804). From 2007 to 2013 women had higher yields but by September 2016 males had a higher positivity of 8% (p-value χ2 0.658 p-value = 0.417). We estimate that 179,935 people living with HIV will know their status by 2020. Conclusion: HIV tests in Zimbabwe have increased but yield has decreased. Increase in repeat tests may be an indication of exhaustion of particular HTS strategies. Following this analysis it was recommended that HTS utilize various models such as HIV self-test to cater for populations with high yields.
文摘Background: Prevention of mother-to-child transmission (PMTCT) program includes a cascade of services given to prevent mother-to-child transmission (MTCT) of HIV in-utero, during delivery and during breastfeeding. Zimbabwe has made tremendous progress in increasing coverage of PMTCT services and reducing MTCT rate. COVID-19 has negatively impacted HIV programs. Murewa was among the districts with the most COVID-19 cases. We evaluated the PMTCT program in Murewa District in the face of COVID-19 challenges. Methods: We assessed inputs, processes, outputs and outcomes of the PMTCT program using the logic model approach. We collected data using interviewer-administered questionnaire, records review, and a checklist to assess availability of inputs, processes carried out and outputs realized from the program. We randomly selected health workers and program recipients. We used Epi info 7 to compute frequencies, means and proportions. Results: Murewa District had 58 health workers in post against an establishment of 92. Seven out of 16 facilities reported having HIV test-kit stockout. Only 4/16 were conducting postnatal clinics. No PMTCT training were conducted. Only 1872/5693 (33%) of HIV consumables including HIV test kits and CD4 count reagents were procured. The reasons reported for low PMTCT coverage in Murewa were fear of contracting COVID-19 at health facilities 33/43 (77%), lack of bus fare 28/43 (65%) and unavailability of medical consumables 26/43 (60%). Conclusion: The PMTCT program in Murewa District failed to meet targets for inputs, processes, and outputs worsened by the impact of the COVID-19 pandemic. The reasons for low PMTCT coverage in Murewa District were reported to be due to fear of contracting COVID-19, unavailability of medical consumables and COVID-19 travelling restrictions. We recommended development of guidelines on provision of PMTCT services amid the COVID-19 pandemic. We gave health education to program recipients on the importance to access PMTCT services even amid public health emergencies like COVID-19.
文摘Western Kenya suffers a highly endemic and also very heterogeneous epidemic of human immunodeficiency virus(HIV).Although female sex workers(FSW)and their male clients are known to be at high risk for HIV,HIV prevalence across regions inWestern Kenya is not strongly correlated with the fraction of women engaged in commercial sex.An agentbased network model of HIV transmission,geographically stratified at the county level,was fit to the HIV epidemic,scale-up of interventions,and populations of FSW in Western Kenya under two assumptions about the potential mobility of FSW clients.In the first,all clients were assumed to be resident in the same geographies as their interactions with FSW.In the second,some clients were considered non-resident and engaged only in interactions with FSW,but not in longer-term non-FSW partnerships in these geographies.Under both assumptions,the model successfully reconciled disparate geographic patterns of FSW and HIV prevalence.Transmission patterns in the model suggest a greater role for FSW in local transmission when clients were resident to the counties,with 30.0%of local HIV transmissions attributable to current and former FSW and clients,compared to 21.9%when mobility of clients was included.Nonetheless,the overall epidemic drivers remained similar,with risky behavior in the general population dominating transmission in highprevalence counties.Our modeling suggests that co-location of high-risk populations and generalized epidemics can further amplify the spread of HIV,but that large numbers of formal FSW and clients are not required to observe or mechanistically explain high HIV prevalence in the general population.
