Grant Murewanhema - Academia.edu (original) (raw)
Papers by Grant Murewanhema
International Journal of Gynecologic Cancer
Sub-Saharan Africa has the highest rates of cervical cancer in the world, largely attributed to l... more Sub-Saharan Africa has the highest rates of cervical cancer in the world, largely attributed to low cervical cancer screening coverage. Cervical cancer is the most common cause of death among women in 21 of the 48 countries in sub-Saharan Africa. Close to 100% of all cases of cervical cancer are attributable to Human papillomavirus (HPV). HPV types 16 and 18 cause at least 70% of all cervical cancers globally, while types 31, 33, 45, 52, and 58 cause a further 20% of the cases. Women living with HIV are six times more likely to develop cervical cancer than those without HIV. Considering that sub-Saharan Africa carries the greatest burden of cervical cancer, ways to increase accessibility and use of preventive services are urgently required. With this review, we discuss the preventive measures required to reduce the burden of cervical cancer in sub-Saharan Africa, the challenges to improving accessibility and use of the preventive services, and the recommendations to address these ch...
South African Medical Journal, Apr 1, 2022
Public health sector capacity and resilience building in Zimbabwe: An urgent priority as further ... more Public health sector capacity and resilience building in Zimbabwe: An urgent priority as further waves of COVID-19 are imminent To the Editor: Zimbabwe, like most countries, has experienced several waves since the onset of the global COVID-19 pandemic. The third wave between June and August 2021 was characterised by an exponential increase in incident cases, accompanied by corresponding rapid rises in numbers of patients requiring medical attention, hospitalisation and intensive medical care. The public health sector was overwhelmed and failed to cope with the rapid rise in the case burden. Shortages of human resources, consumables and admission space contributed to the challenges at the clinical level, while the capacity to test, treat and isolate confirmed cases as well as surveillance of active cases were severely compromised. This situation exposed the inadequacy of the public health sector, while the majority of the population cannot afford to obtain treatment from the alternative source of care, the private health sector. As further waves of the COVID-19 pandemic are likely owing to the emergence of newer variants of concern, pandemic fatigue, complacency and increased human mobility, the country needs to build its public health sector capacity and resilience in preparation for absorbing shocks associated with such events. This calls for urgent action on the part of the government, public health authorities and all involved in public healthcare to come up with solutions that ensure accessibility, affordability and sustainability of quality healthcare in the public sector. Scholarly mathematical projections in early 2020 when the COVID-19 public health emergency was declared a global pandemic predicted that sub-Saharan Africa (SSA) would be severely affected by the rapidly spreading virus, which was perceived as a serious global health threat. [1] Healthcare systems in SSA were described as fragile, and it was anticipated that they would fail to cope with sudden surges in the demand for emergency healthcare. [2] It was postulated that direct and indirect mortality from COVID-19 would be disproportionately high in the region. In Zimbabwe, however, throughout the surges referred to as the first and second waves, incident and cumulative cases as well as relative morbidity remained low, with <35 000 cumulative cases and <1 600 deaths by the end of January 2021, when the second wave began to wane. [3] Comparatively, however, the case fatality rate (CFR) was higher, at 3-4%. The third wave, which started around June 2021, behaved differently. Cumulative cases trebled over a 2-month period. At the end of May 2021, these were estimated at ~38 000, but by the end of July 2021, they had risen to 120 000. Owing to under-testing, underreporting and inadequate surveillance, the actual disease burden may be much higher. [4] In November 2021, South Africa (SA) announced the discovery of a mutated Beta variant named Omicron. By early December 2021, the Omicron variant was detected in Zimbabwe, driving a short-lived fourth wave which settled by January 2022. In this letter, I describe the inadequacy of the public health sector in Zimbabwe in handling the previous waves, and stress the need to prepare adequate capacity and resilience to handle further epidemic waves of COVID-19, which are imminent. Public health sector inadequacy The second and third waves in Zimbabwe, which occurred from This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
South African Medical Journal, 2021
Ensuring accelerated accessibility and affordability of treatment services for COVID-19 patients ... more Ensuring accelerated accessibility and affordability of treatment services for COVID-19 patients in Zimbabwe: An urgent call to action To the Editor: Timely access to quality healthcare services is a basic human right. Governments globally have a responsibility to ensure wider coverage and access, particularly to essential and lifesaving healthcare services. For these reasons, there has been a strong call for universal health coverage. Private medical insurance promotes inequalities in accessing care, perpetuated by ever-widening socioeconomic gaps. In resource-constrained settings, the lower and more vulnerable social classes suffer more from disparities during crisis times such as the COVID-19 pandemic. Zimbabwe, a country characterised by underinvestment in the public sector and unfavourable conditions for the healthcare workforce, has seen massive outward migration of health service providers to countries such as the UK, Australia, New Zealand, Canada and the USA. [1] As a result, Zimbabwe has been ill-prepared to protect its population from the negative impact of COVID-19. Additionally, the sustained depreciation of the local currency has made conditions untenable for many health workers in the COVID-19 era, where there are increased demands on their jobs. The prevailing hyperinflationary environment has led to the deterioration of equipment and frequent stock outages of essential commodities and consumables in the public sector, making it difficult, and sometimes impossible, for patients to access COVID-19 treatment and care services. Lack of consumables such as personal protective equipment (PPE) has worsened the situation, [2] with PPE only being obtained earlier in the pandemic when health workers took the government to court to compel it to provide this essential equipment. As patients struggle to access treatment services provided by the public sector, they have turned to the private sector, either to use established facilities or for home-based healthcare services. Reports have emerged of exorbitant upfront admission charges for COVID-19 patients, well beyond the reach of the majority, with essential medication also being sold at extortionate prices. For instance, there are reports that the scarce tocilizumab, a drug that has been widely prescribed for COVID-19, is being sold for over USD1 500 per dose, way above its cost on the market. [3] There have been widespread unproven reports of COVID-19 treatment and prevention kits, containing medicines such as ivermectin, doxycycline and azithromycin, being sold for exorbitant prices. [4] There is an urgent need for the government to provide a safety net for the suffering patients, protecting them from over-profiteering in the private sector. More importantly, the government must recognise its role as being central in the provision of quality and accessible healthcare to the people. We therefore call upon the government to prioritise building healthcare capacity and a robust and resilient system ahead of other priorities, as we prepare for inevitable further COVID-19 waves. We also implore the government to urgently address healthcare workers' genuine grievances, including demands for fair remuneration, health and life insurance, and provision of safe and adequate PPE. Disclaimer. The views presented in this letter are those of the authors and do not necessarily represent the position of their institutions.
The European Journal of Public Health, 2003
Frontiers in Public Health
Tropical Medicine and Infectious Disease
HIV and AIDS continue to be major public health concerns globally. Despite significant progress i... more HIV and AIDS continue to be major public health concerns globally. Despite significant progress in addressing their impact on the general population and achieving epidemic control, there is a need to improve HIV testing, particularly among men who have sex with men (MSM). This study applied deep and machine learning algorithms such as recurrent neural networks (RNNs), the bagging classifier, gradient boosting classifier, support vector machines, and Naïve Bayes classifier to predict HIV status among MSM using the dataset from the Zimbabwe Ministry of Health and Child Care. RNNs performed better than the bagging classifier, gradient boosting classifier, support vector machines, and Gaussian Naïve Bayes classifier in predicting HIV status. RNNs recorded a high prediction accuracy of 0.98 as compared to the Gaussian Naïve Bayes classifier (0.84), bagging classifier (0.91), support vector machine (0.91), and gradient boosting classifier (0.91). In addition, RNNs achieved a high precisio...
Journal of Infection
Decrease in overall newborn immunisation service utilisation by 28.5% from the pre-COVID-19 numbe... more Decrease in overall newborn immunisation service utilisation by 28.5% from the pre-COVID-19 numbers to the COVID-19 period. Balogun et al. 9 descriptive Cross-sectional study Clients: women of reproductive age who had just received RMNCH services at the heatlh facilities. Structured questionnaire used to conduct exit interviews. Childhood immunisation was the most frequently received service (42.02%) since the COVID-19 outbreak. Wanyana et al. 5 cross-sectional quanitative Provincial level MCH indicators extracted from the Rwanda Health Management Information System (HMIS). Not specified but assume the data was exported to a spreadsheet then to SPSS for statistical analysis. Significant decreases noted in the following vaccinations; BCG, polio zero, polio 1, polio 2, diptheria, tetanus, pertussis, hepatitis B and hemophilus influenza (DTP_HepB_Hib) 1, DTP_HepB_Hib 2, pneumococcus 1, pneumococcus 2, rotavirus 1 and rotavirus 2 BCG and polio zero vaccination services utilization decreased in three out of five provinces. Despite the overall decline in service utilization, the utilisation in the Southern Province of measles and rubella (MR) 1 vaccination services increased with variations probably due to the continuation of community-based interventions in the region. Adelekan, 2021 cross-sectional study Health workers (head nurses/midwives) in health facilities.
South African Medical Journal
Prioritising preventive cancer services in Zimbabwe as the country struggles with unaffordable he... more Prioritising preventive cancer services in Zimbabwe as the country struggles with unaffordable healthcare To the Editor: The health system in Zimbabwe has collapsed, mainly owing to underfunding and the migration of skilled personnel. [1] Treatment services have consequently become unaffordable to those in need, especially the poor, who make up more than 80% of the population. Of particular focus for this letter, Zimbabwe has not been spared from the rising burden of cancers globally. Cancers account for over a third of premature deaths from noncommunicable diseases in Zimbabwe, compared with South Africa, where they account for a fifth. [2] There are currently concerns regarding inadequate capacity to provide quality cancer care in Zimbabwe. [3] A significant number of deaths from cancers that are treatable if identified early enough, such as cervical and breast cancer, continue to be reported. Unfortunately, reports suggest that patients are struggling to access treatment services in the public sector, and are therefore resorting to alternative sources of treatment such as traditional medicine practitioners, or remote mission hospitals which, even if better staffed and equipped than hospitals in the public sector, offer substandard surgical treatments in inadequately worked up cancer patients. These externally funded mission hospitals are overwhelmed and do not offer adequate follow-up treatment services, including chemotherapy and radiotherapy, to all their clients. Several barriers prevent timely and appropriate cancer treatment in Zimbabwe. Firstly, the lack of medical insurance for the majority of the country's citizens results in delays in seeking diagnostic services for potentially cancerous diseases. It is estimated that at least 90% of the country's population is not medically insured. Owing to the prevailing harsh socioeconomic conditions, they may also not have money to pay cash for services. [4] Secondly, the country has a shortage of medical specialists in fields that include early diagnosis of cancer. Many patients are seen by specialists at provincial and tertiary hospitals when they already have advanced disease. The country has fewer than 15 clinical oncologists, [5] who practise only in the country's two major cities, Harare and Bulawayo. Thirdly, the country imports all the medicines used in the treatment of cancer, including chemotherapeutic agents and biological treatments. With the scarcity of foreign currency in the country, importing these medicines is often a challenge. Fourthly, the country has a huge backlog of cancer patients requiring surgical intervention, owing to lack of operating theatre time, equipment and staff. The ongoing attrition of nurses, worsened by the COVID-19 pandemic, has included hordes of experienced theatre nurses leaving the country. Finally, the country has very few operational radiotherapy machines in the public sector, only available at the Parirenyatwa Group of Hospitals radiotherapy centre. Patients from all over the country must travel to the capital for cancer treatment services. Ultimately, addressing the public health sector caveats highlighted above will be critical for improving cancer outcomes in Zimbabwe; in the interim, however, reducing the burden of cancer in the country through primordial, primary and secondary prevention is key. Prevention with evidence-based interventions is a cost-effective strategy, with tangible results as witnessed elsewhere. Primordial This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
South African Medical Journal, 2021
Disaster Medicine and Public Health Preparedness
Public Health in Practice
Transfusion Clinique et Biologique
Tropical Medicine and Infectious Disease
Sub-Saharan Africa carries the highest burden of HIV-1 and AIDS. About 39% of all new infections ... more Sub-Saharan Africa carries the highest burden of HIV-1 and AIDS. About 39% of all new infections in the world in 2020 were in this region. Oral PrEP was found to be very effective in reducing the risk of HIV-1 transmission. However, its effectiveness is highly dependent on users adhering to the drugs. The availability of long-acting injectable PrEP that eliminates the need for a daily pill may increase PrEP uptake and adherence in people who struggle to adhere to oral PrEP. The USA’s FDA approved long-acting cabotegravir (CAB-LA) for PrEP of HIV-1 in December 2021. In this review, we discussed the implementation challenges to the successful roll-out of CAB-LA in Africa and measures to address these implementation challenges. Some health system-level challenges include the cost of the drug, its refrigeration requirement, and the shortage of healthcare providers trained to administer parenteral medicines. In contrast, client challenges include lack of knowledge, accessibility of the d...
Public Health in Practice
Southern African Journal of Infectious Diseases
International Journal of Gynecologic Cancer
Sub-Saharan Africa has the highest rates of cervical cancer in the world, largely attributed to l... more Sub-Saharan Africa has the highest rates of cervical cancer in the world, largely attributed to low cervical cancer screening coverage. Cervical cancer is the most common cause of death among women in 21 of the 48 countries in sub-Saharan Africa. Close to 100% of all cases of cervical cancer are attributable to Human papillomavirus (HPV). HPV types 16 and 18 cause at least 70% of all cervical cancers globally, while types 31, 33, 45, 52, and 58 cause a further 20% of the cases. Women living with HIV are six times more likely to develop cervical cancer than those without HIV. Considering that sub-Saharan Africa carries the greatest burden of cervical cancer, ways to increase accessibility and use of preventive services are urgently required. With this review, we discuss the preventive measures required to reduce the burden of cervical cancer in sub-Saharan Africa, the challenges to improving accessibility and use of the preventive services, and the recommendations to address these ch...
South African Medical Journal, Apr 1, 2022
Public health sector capacity and resilience building in Zimbabwe: An urgent priority as further ... more Public health sector capacity and resilience building in Zimbabwe: An urgent priority as further waves of COVID-19 are imminent To the Editor: Zimbabwe, like most countries, has experienced several waves since the onset of the global COVID-19 pandemic. The third wave between June and August 2021 was characterised by an exponential increase in incident cases, accompanied by corresponding rapid rises in numbers of patients requiring medical attention, hospitalisation and intensive medical care. The public health sector was overwhelmed and failed to cope with the rapid rise in the case burden. Shortages of human resources, consumables and admission space contributed to the challenges at the clinical level, while the capacity to test, treat and isolate confirmed cases as well as surveillance of active cases were severely compromised. This situation exposed the inadequacy of the public health sector, while the majority of the population cannot afford to obtain treatment from the alternative source of care, the private health sector. As further waves of the COVID-19 pandemic are likely owing to the emergence of newer variants of concern, pandemic fatigue, complacency and increased human mobility, the country needs to build its public health sector capacity and resilience in preparation for absorbing shocks associated with such events. This calls for urgent action on the part of the government, public health authorities and all involved in public healthcare to come up with solutions that ensure accessibility, affordability and sustainability of quality healthcare in the public sector. Scholarly mathematical projections in early 2020 when the COVID-19 public health emergency was declared a global pandemic predicted that sub-Saharan Africa (SSA) would be severely affected by the rapidly spreading virus, which was perceived as a serious global health threat. [1] Healthcare systems in SSA were described as fragile, and it was anticipated that they would fail to cope with sudden surges in the demand for emergency healthcare. [2] It was postulated that direct and indirect mortality from COVID-19 would be disproportionately high in the region. In Zimbabwe, however, throughout the surges referred to as the first and second waves, incident and cumulative cases as well as relative morbidity remained low, with <35 000 cumulative cases and <1 600 deaths by the end of January 2021, when the second wave began to wane. [3] Comparatively, however, the case fatality rate (CFR) was higher, at 3-4%. The third wave, which started around June 2021, behaved differently. Cumulative cases trebled over a 2-month period. At the end of May 2021, these were estimated at ~38 000, but by the end of July 2021, they had risen to 120 000. Owing to under-testing, underreporting and inadequate surveillance, the actual disease burden may be much higher. [4] In November 2021, South Africa (SA) announced the discovery of a mutated Beta variant named Omicron. By early December 2021, the Omicron variant was detected in Zimbabwe, driving a short-lived fourth wave which settled by January 2022. In this letter, I describe the inadequacy of the public health sector in Zimbabwe in handling the previous waves, and stress the need to prepare adequate capacity and resilience to handle further epidemic waves of COVID-19, which are imminent. Public health sector inadequacy The second and third waves in Zimbabwe, which occurred from This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
South African Medical Journal, 2021
Ensuring accelerated accessibility and affordability of treatment services for COVID-19 patients ... more Ensuring accelerated accessibility and affordability of treatment services for COVID-19 patients in Zimbabwe: An urgent call to action To the Editor: Timely access to quality healthcare services is a basic human right. Governments globally have a responsibility to ensure wider coverage and access, particularly to essential and lifesaving healthcare services. For these reasons, there has been a strong call for universal health coverage. Private medical insurance promotes inequalities in accessing care, perpetuated by ever-widening socioeconomic gaps. In resource-constrained settings, the lower and more vulnerable social classes suffer more from disparities during crisis times such as the COVID-19 pandemic. Zimbabwe, a country characterised by underinvestment in the public sector and unfavourable conditions for the healthcare workforce, has seen massive outward migration of health service providers to countries such as the UK, Australia, New Zealand, Canada and the USA. [1] As a result, Zimbabwe has been ill-prepared to protect its population from the negative impact of COVID-19. Additionally, the sustained depreciation of the local currency has made conditions untenable for many health workers in the COVID-19 era, where there are increased demands on their jobs. The prevailing hyperinflationary environment has led to the deterioration of equipment and frequent stock outages of essential commodities and consumables in the public sector, making it difficult, and sometimes impossible, for patients to access COVID-19 treatment and care services. Lack of consumables such as personal protective equipment (PPE) has worsened the situation, [2] with PPE only being obtained earlier in the pandemic when health workers took the government to court to compel it to provide this essential equipment. As patients struggle to access treatment services provided by the public sector, they have turned to the private sector, either to use established facilities or for home-based healthcare services. Reports have emerged of exorbitant upfront admission charges for COVID-19 patients, well beyond the reach of the majority, with essential medication also being sold at extortionate prices. For instance, there are reports that the scarce tocilizumab, a drug that has been widely prescribed for COVID-19, is being sold for over USD1 500 per dose, way above its cost on the market. [3] There have been widespread unproven reports of COVID-19 treatment and prevention kits, containing medicines such as ivermectin, doxycycline and azithromycin, being sold for exorbitant prices. [4] There is an urgent need for the government to provide a safety net for the suffering patients, protecting them from over-profiteering in the private sector. More importantly, the government must recognise its role as being central in the provision of quality and accessible healthcare to the people. We therefore call upon the government to prioritise building healthcare capacity and a robust and resilient system ahead of other priorities, as we prepare for inevitable further COVID-19 waves. We also implore the government to urgently address healthcare workers' genuine grievances, including demands for fair remuneration, health and life insurance, and provision of safe and adequate PPE. Disclaimer. The views presented in this letter are those of the authors and do not necessarily represent the position of their institutions.
The European Journal of Public Health, 2003
Frontiers in Public Health
Tropical Medicine and Infectious Disease
HIV and AIDS continue to be major public health concerns globally. Despite significant progress i... more HIV and AIDS continue to be major public health concerns globally. Despite significant progress in addressing their impact on the general population and achieving epidemic control, there is a need to improve HIV testing, particularly among men who have sex with men (MSM). This study applied deep and machine learning algorithms such as recurrent neural networks (RNNs), the bagging classifier, gradient boosting classifier, support vector machines, and Naïve Bayes classifier to predict HIV status among MSM using the dataset from the Zimbabwe Ministry of Health and Child Care. RNNs performed better than the bagging classifier, gradient boosting classifier, support vector machines, and Gaussian Naïve Bayes classifier in predicting HIV status. RNNs recorded a high prediction accuracy of 0.98 as compared to the Gaussian Naïve Bayes classifier (0.84), bagging classifier (0.91), support vector machine (0.91), and gradient boosting classifier (0.91). In addition, RNNs achieved a high precisio...
Journal of Infection
Decrease in overall newborn immunisation service utilisation by 28.5% from the pre-COVID-19 numbe... more Decrease in overall newborn immunisation service utilisation by 28.5% from the pre-COVID-19 numbers to the COVID-19 period. Balogun et al. 9 descriptive Cross-sectional study Clients: women of reproductive age who had just received RMNCH services at the heatlh facilities. Structured questionnaire used to conduct exit interviews. Childhood immunisation was the most frequently received service (42.02%) since the COVID-19 outbreak. Wanyana et al. 5 cross-sectional quanitative Provincial level MCH indicators extracted from the Rwanda Health Management Information System (HMIS). Not specified but assume the data was exported to a spreadsheet then to SPSS for statistical analysis. Significant decreases noted in the following vaccinations; BCG, polio zero, polio 1, polio 2, diptheria, tetanus, pertussis, hepatitis B and hemophilus influenza (DTP_HepB_Hib) 1, DTP_HepB_Hib 2, pneumococcus 1, pneumococcus 2, rotavirus 1 and rotavirus 2 BCG and polio zero vaccination services utilization decreased in three out of five provinces. Despite the overall decline in service utilization, the utilisation in the Southern Province of measles and rubella (MR) 1 vaccination services increased with variations probably due to the continuation of community-based interventions in the region. Adelekan, 2021 cross-sectional study Health workers (head nurses/midwives) in health facilities.
South African Medical Journal
Prioritising preventive cancer services in Zimbabwe as the country struggles with unaffordable he... more Prioritising preventive cancer services in Zimbabwe as the country struggles with unaffordable healthcare To the Editor: The health system in Zimbabwe has collapsed, mainly owing to underfunding and the migration of skilled personnel. [1] Treatment services have consequently become unaffordable to those in need, especially the poor, who make up more than 80% of the population. Of particular focus for this letter, Zimbabwe has not been spared from the rising burden of cancers globally. Cancers account for over a third of premature deaths from noncommunicable diseases in Zimbabwe, compared with South Africa, where they account for a fifth. [2] There are currently concerns regarding inadequate capacity to provide quality cancer care in Zimbabwe. [3] A significant number of deaths from cancers that are treatable if identified early enough, such as cervical and breast cancer, continue to be reported. Unfortunately, reports suggest that patients are struggling to access treatment services in the public sector, and are therefore resorting to alternative sources of treatment such as traditional medicine practitioners, or remote mission hospitals which, even if better staffed and equipped than hospitals in the public sector, offer substandard surgical treatments in inadequately worked up cancer patients. These externally funded mission hospitals are overwhelmed and do not offer adequate follow-up treatment services, including chemotherapy and radiotherapy, to all their clients. Several barriers prevent timely and appropriate cancer treatment in Zimbabwe. Firstly, the lack of medical insurance for the majority of the country's citizens results in delays in seeking diagnostic services for potentially cancerous diseases. It is estimated that at least 90% of the country's population is not medically insured. Owing to the prevailing harsh socioeconomic conditions, they may also not have money to pay cash for services. [4] Secondly, the country has a shortage of medical specialists in fields that include early diagnosis of cancer. Many patients are seen by specialists at provincial and tertiary hospitals when they already have advanced disease. The country has fewer than 15 clinical oncologists, [5] who practise only in the country's two major cities, Harare and Bulawayo. Thirdly, the country imports all the medicines used in the treatment of cancer, including chemotherapeutic agents and biological treatments. With the scarcity of foreign currency in the country, importing these medicines is often a challenge. Fourthly, the country has a huge backlog of cancer patients requiring surgical intervention, owing to lack of operating theatre time, equipment and staff. The ongoing attrition of nurses, worsened by the COVID-19 pandemic, has included hordes of experienced theatre nurses leaving the country. Finally, the country has very few operational radiotherapy machines in the public sector, only available at the Parirenyatwa Group of Hospitals radiotherapy centre. Patients from all over the country must travel to the capital for cancer treatment services. Ultimately, addressing the public health sector caveats highlighted above will be critical for improving cancer outcomes in Zimbabwe; in the interim, however, reducing the burden of cancer in the country through primordial, primary and secondary prevention is key. Prevention with evidence-based interventions is a cost-effective strategy, with tangible results as witnessed elsewhere. Primordial This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
South African Medical Journal, 2021
Disaster Medicine and Public Health Preparedness
Public Health in Practice
Transfusion Clinique et Biologique
Tropical Medicine and Infectious Disease
Sub-Saharan Africa carries the highest burden of HIV-1 and AIDS. About 39% of all new infections ... more Sub-Saharan Africa carries the highest burden of HIV-1 and AIDS. About 39% of all new infections in the world in 2020 were in this region. Oral PrEP was found to be very effective in reducing the risk of HIV-1 transmission. However, its effectiveness is highly dependent on users adhering to the drugs. The availability of long-acting injectable PrEP that eliminates the need for a daily pill may increase PrEP uptake and adherence in people who struggle to adhere to oral PrEP. The USA’s FDA approved long-acting cabotegravir (CAB-LA) for PrEP of HIV-1 in December 2021. In this review, we discussed the implementation challenges to the successful roll-out of CAB-LA in Africa and measures to address these implementation challenges. Some health system-level challenges include the cost of the drug, its refrigeration requirement, and the shortage of healthcare providers trained to administer parenteral medicines. In contrast, client challenges include lack of knowledge, accessibility of the d...
Public Health in Practice
Southern African Journal of Infectious Diseases