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Papers by Simukai Shamu

Research paper thumbnail of Associations between depressive symptoms, socio-economic factors, traumatic exposure and recent intimate partner violence experiences among women in Zimbabwe: a cross-sectional study

BMC Women's Health

Background Population-based research on the cumulative effects of socio-economic conditions and t... more Background Population-based research on the cumulative effects of socio-economic conditions and trauma exposures, particularly women’s experiences of intimate partner violence (IPV) on their mental health in Zimbabwe, has been limited. Aim Our study aimed to determine the associations between depressive symptoms and socio-economic factors, IPV, and traumatic exposures among a nationally representative sample of women from Zimbabwe. Methods Data was collected from 2905 women who volunteered to participate in a survey that had a multi-stage random sampling design. Depression was measured using the Centre for Epidemiologic Studies Depression Scale (CESD). Traumatic exposures included childhood trauma, life events, and experiences of IPV in the past year. We compared mean depression scores for different categories of variables, conducted linear regression modelling to investigate the bivariate and multivariate associations between variables and depressive symptoms’ outcomes, and applied...

Research paper thumbnail of Additional file 1 of Knowledge, attitudes and practices of young adults towards HIV prevention: an analysis of baseline data from a community-based HIV prevention intervention study in two high HIV burden districts, South Africa

Additional file 1. Knowledge, attitudes and practices data. This file contains data used for this... more Additional file 1. Knowledge, attitudes and practices data. This file contains data used for this manuscript.

Research paper thumbnail of Intimate Partner Violence Prior to and During COVID-19 Measures in 30 Countries: A Global Cross-Sectional Study From the I-SHARE Consortium

SSRN Electronic Journal, 2021

Research paper thumbnail of Pre-exposure prophylaxis (PrEP) awareness, attitudes and uptake willingness among young people: gender differences and associated factors in two South African districts

Global Health Action, 2021

Background: Pre-exposure prophylaxis (PrEP) for HIV prevention is safe and effective in reducing ... more Background: Pre-exposure prophylaxis (PrEP) for HIV prevention is safe and effective in reducing HIV incidence. However, more evidence of PrEP knowledge, willingness and distribution preferences is required for scale-up among young people at-risk. Objective: To understand young people PrEP awareness, willingness and roll-out preferences. Methods: Young people (18-24y) were selected through multi-stage sampling in a crosssectional household survey in low-income communities. Self-administered interviews collected participants' data about PrEP awareness, attitudes, willingness and HIV-risk practices. Data were descriptively analysed by gender. Regression models assessed factors associated with PrEP awareness and willingness by district. Results: Of the 1917 participants interviewed 44.6% (men = 39.4% vs women = 49%, p = 0.001) were PrEP aware, 49.0% were willing to use PrEP. Participants most preferred PrEP distribution channels were public clinics (51.2%) and hospitals (23.8%). More men than women preferred distribution through schools (11.9% vs7.8%; p = 0.002) and NGOs (8.5% vs5.4%; p = 0.008). The biggest barrier to PrEP willingness was inadequate PrEP knowledge (10.0%) but more men than women disliked taking pills daily (4.1%vs2.0%; p-value = 0.007). Gendered determinants to use PrEP were side effects (51%; men = 47% vs women = 55%; p = 0.001) and pill effectiveness (29.5%; men = 26.4% vs women = 32.6%; p = 0.003). In both districts PrEP knowledge was associated with being female and media use. The associations between PrEP awareness and having multiple sexual partnerships, HIV knowledge, HIV selftest willingness and belonging to social clubs differed by district. PrEP willingness was positively associated with having TB and PrEP knowledge in each district but district differences were observed in media and occupation factors. Conclusions: The study shows young people's low levels of PrEP awareness. It also shows relatively increased willingness, gendered PrEP awareness and distribution preferences. Promoting youth's PrEP awareness requires a multifarious media strategy.

Research paper thumbnail of A Qualitative Study on Experiences of HIVVaccine Trial Participants in a Phase I/IIDouble Blinded, Randomized Placebo Controlled Clinical Trial in Tanzania: Lessons for COVID-19 Vaccine Testing

Background: HIV remains a major public health problem in Sub-Saharan Africa. More than half (54.5... more Background: HIV remains a major public health problem in Sub-Saharan Africa. More than half (54.5%) of all people living with HIV live in Eastern and Southern Africa where 700,000 new infections were reported in 2019. There is no HIV vaccine or cure available yet despite ongoing research to develop one. Uptake of vaccines, when these become available, is critical for its successful introduction in the global society. It is imperative to describe the knowledge, expectations, perceptions and experiences of the vaccines trial participants, as these may be indicative of future vaccine uptake, and may give lessons for COVID-19 vaccine development. Methods: A phenomenological qualitative study was conducted to describe the experiences of volunteers who participated in the first HIV vaccine trial in Mbeya, Tanzania. A purposive sample of 20 of the 60 trial participants was interviewed. Interviews were audio-recorded, transcribed, translated, and subjected to thematic-content analysis.Resul...

Research paper thumbnail of The dynamics of intimate partner violence during pregnancy and linkages with HIV infection and disclosure in Zimbabwe

Introduction: The study assessed the linkages between HIV infection and intimate partner violence... more Introduction: The study assessed the linkages between HIV infection and intimate partner violence (IPV) during pregnancy and after HIV status disclosure in a context where HIV testing has become almost mandatory through the provider-initiated counselling and testing approach and non-disclosure of HIV status to sexual partners has been criminalised in many countries including Zimbabwe. The study also explored women’s experiences of and health workers’ perceptions of IPV during pregnancy. Methods: A mixed-methods study of IPV and HIV during pregnancy was conducted to determine the prevalence of and risk factors for IPV during pregnancy and after disclosing HIV status, to assess the relationship between HIV, pregnancy and IPV, to understand women’s perspectives of and midwives’ experiences of responding to IPV during pregnancy. A systematic review and meta-analysis of 19 African studies on IPV during pregnancy was first conducted to understand the rates of and risk factors for IPV incl...

Research paper thumbnail of A community-based HIV counselling and testing programme found a decreasing proportion of new HIV testers in South Africa

This article assesses the history of HIV testing among community-based HIV counselling and testin... more This article assesses the history of HIV testing among community-based HIV counselling and testing (CBCT) clients between 2014 and 2018 in 13 South African districts. Consenting clients were tested for HIV and interviewed to categorise as first-time testers or repeat testers. Of the 1 800 753 clients tested for HIV, 15.7% (95% CI [15.6–15.7]) were first-time testers. The rate of identifying first-time testers decreased by 10.7% in four years from 18.4% in year one to 7.7% in year four. A substantial proportion (5.5% [5.4–5.6]) of HIV-positive people not yet on antiretroviral treatment sought HIV re-test, of whom nearly half (48.4% [47.1–49.6]) did not disclose their HIV-positive status during pre-counselling and were re-tested. A decreasing proportion of first-time testers may signal positive progress towards universal HIV testing. This downward trend should be sustained to control the HIV epidemic.

Research paper thumbnail of High frequency intimate partner violence during pregnancy, post natal depression and suicidal tendencies in Harare, Zimbabwe

General Hospital Psychiatry, 2015

Introduction: Intimate partner violence (IPV) is a common form of violence experienced by pregnan... more Introduction: Intimate partner violence (IPV) is a common form of violence experienced by pregnant women and is believed to have adverse mental health effects postnatally. This study investigated the association of postnatal depression (PND) and suicidal ideation with emotional, physical and sexual IPV experienced by women during pregnancy. Methods: Data were collected from 842 women interviewed postnatally in six postnatal clinics in Harare, Zimbabwe. We used the World Health Organization versions of IPV and Centre for Epidemiological Studies-Depression Scale measures to assess IPV and PND respectively. We derived a violence severity variable and combined forms of IPV variables from IPV questions. Logistic regression was used to analyse data whilst controlling for past mental health and IPV experiences. Results: One in five women [21.4% (95% CI 18.6-24.2)] met the diagnostic criteria for PND symptomatology whilst 21.6% (95% CI 18.8-24.4) reported postpartum suicide thoughts and 4% (95% CI 2.7-5.4) reported suicide attempts. Two thirds (65.4%) reported any form of IPV. Although individual forms of severe IPV were associated with PND, stronger associations were found between PND and severe emotional IPV or severe combined forms of IPV. Suicidal ideation was associated with emotional IPV. Other forms of IPV, except when combined with emotional IPV, were not individually associated with suicidal ideation. Conclusion: Emotional IPV during pregnancy negatively affects women's mental health in the postnatal period. Clinicians and researchers should include it in their conceptualisation of violence and health. Further research must look at possible indirect relationships between sexual and physical IPV on mental health.

Research paper thumbnail of The International Sexual Health And Reproductive Health Survey (I-SHARE-1): A Cross-Sectional Multi-Country Analysis of Adults from 30 Countries Prior to and During the Initial COVID-19 Wave

Background: To better understand sexual and reproductive health (SRH) during the initial COVID-19... more Background: To better understand sexual and reproductive health (SRH) during the initial COVID-19 wave, we organized a multi-country cross-sectional survey. Methods: Consortium research teams conducted online surveys in 30 countries. Primary outcomes included sexual behaviors, partner violence, and SRH service utilization, and we compared three months prior to and three months after policy measures to mitigate COVID-19. We used established indicators and analyses pre-specified in our protocol. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods. Findings: Descriptive analyses included 22,724 individuals in 25 countries. Five additional countries with sample sizes <200 were included in descriptive meta-analyses. Respondents were mean age 34 years; most identified as women (15160; 66.7%), cis-gender (19432; 86.6%) and heterosexual (16592; 77.9%). Among 4546 respondents with casual partners, condom use stayed steady for 337...

Research paper thumbnail of Knowledge, attitudes and practices of young adults towards HIV prevention: an analysis of baseline data from a community-based HIV prevention intervention study in two high HIV burden districts, South Africa

BMC Public Health

Background With an HIV incidence of 1.00 skewed against women (1.51), adolescents in South Africa... more Background With an HIV incidence of 1.00 skewed against women (1.51), adolescents in South Africa are at high HIV risk. This paper assesses young adults’ (18–24 years) knowledge, attitudes and practices regarding HIV prevention in Nkangala and OR Tambo districts. Methods A cross-sectional household survey was conducted in two districts in 2017/8. Participants completed computer-assisted self-interviews on HIV knowledge, attitudes, behaviour practices, use of social media and condom use at last sex (proxy for high-risk sex). HIV knowledge was assessed using the South African-adapted UNAIDS scale. Descriptive analyses were conducted and logistic regression models were built to assess factors associated with being knowledgeable of HIV and condom use at last sex. Results One thousand nine hundred fifty-five participants were interviewed (90% response rate). Less than half (44.7%) had correct knowledge of HIV prevention and 73% used a condom at last sex. Social media use predicted high H...

Research paper thumbnail of Social franchising of community-based HIV counselling and testing services to increase HIV testing and linkage to care in Tshwane, South Africa: study protocol for a non-randomised implementation trial

BMC Public Health

Background Meeting the ambitious UN 90–90-90 HIV testing, treatment and viral load suppression ta... more Background Meeting the ambitious UN 90–90-90 HIV testing, treatment and viral load suppression targets requires innovative strategies and approaches in Sub-Saharan Africa. To date no known interventions have been tested with community health workers (counsellors) as social franchisees or owner-managed businesses in Community-based HIV counselling and testing (CBCT) work. The aim of this methods paper is to describe a Social franchise (SF) CBCT implementation trial to increase HIV testing and linkage to care for individuals at community levels in comparison with an existing CBCT programme methods. Methods/design This is a two arm non-randomised community implementation trial with a once off round of post-test follow-up per HIV positive participant to assess linkage to care in low income communities. The intervention arm is a social franchise CBCT in which unemployed, self-employed or employed community members are recruited, contracted and incentivised to test at least 100 people per...

Research paper thumbnail of Social franchising of community-based HIV testing and linkage to HIV care and treatment services: an evaluation of a pilot study in Tshwane, South Africa

Journal of the International AIDS Society

Research paper thumbnail of Debating medicalization of Female Genital Mutilation/Cutting (FGM/C): learning from (policy) experiences across countries

Reproductive Health

Background: Although Female Genital Mutilation/Cutting (FGM/C) is internationally considered a ha... more Background: Although Female Genital Mutilation/Cutting (FGM/C) is internationally considered a harmful practice, it is increasingly being medicalized allegedly to reduce its negative health effects, and is thus suggested as a harm reduction strategy in response to these perceived health risks. In many countries where FGM/C is traditionally practiced, the prevalence rates of medicalization are increasing, and in countries of migration, such as the United Kingdom, the United States of America or Sweden, court cases or the repeated issuing of statements in favor of presumed minimal forms of FGM/C to replace more invasive forms, has raised the debate between the medical harm reduction arguments and the human rights approach. Main body: The purpose of this paper is to discuss the arguments associated with the medicalization of FGM/C, a trend that could undermine the achievement of Sustainable Development Goal 5.3. The paper uses four country case studies, Egypt, Indonesia, Kenya and UK, to discuss the reasons for engaging in medicalized forms of FGM/C, or not, and explores the ongoing public discourse in those countries concerning harm reduction versus human rights, and the contradiction between medical ethics, national criminal justice systems and international conventions. The discussion is structured around four key hotly contested ethical dilemmas. Firstly, that the WHO definition of medicalized FGM/C is too narrow allowing medicalized FGM to be justified by many healthcare professionals as a form of harm reduction which contradicts the medical oath of do no harm. Secondly, that medicalized FGM/C is a human rights abuse with lifelong consequences, no matter who performs it. Thirdly, that health care professionals who perform medicalized FGM/C are sustaining cultural norms that they themselves support and are also gaining financially. Fourthly, the contradiction between protecting traditional cultural rights in legal constitutions versus human rights legislation, which criminalizes FGM/C. Conclusion: More research needs to be done in order to understand the complexities that are facilitating the medicalization of FGM/C as well as how policy strategies can be strengthened to have a greater de-medicalization impact. Tackling medicalization of FGM/C will accelerate the achievement of the Sustainable Development Goal of ending FGM by 2030.

Research paper thumbnail of RCT evaluation of Skhokho: A holistic school intervention to prevent gender-based violence among South African Grade 8s

PLOS ONE

We evaluated the effectiveness of the Skhokho interventions (enhanced teaching materials and a pa... more We evaluated the effectiveness of the Skhokho interventions (enhanced teaching materials and a parenting programme) in reducing dating and sexual violence. This pragmatic, threearm cluster randomised controlled trial was conducted in 24 State schools in Grade 8 classes, with all learners invited to participate. The interventions were: i) a schools' package: A Life Orientation (LO) curriculum workbook for the Grade 8 national curriculum and teacher training; ii) a workshop for caregivers and teenagers, supported by clubs in the second year. Arms were: a no intervention control, the schools' package, and the combined schools' and families' package. Learners were followed up for 18 months. The primary outcomes were the incidence of physical and/or sexual IPV, severe IPV and non-partner rape. At baseline, 3756 (61.8% of total) learners (aged 12-15) were interviewed and 3411 (90.8%) provided end line data. A third of caregivers and learners attended all four families' intervention workshop sessions. At baseline, 47% of girls and 29% boys were dating and 18% of boys and 2% of girls had had sex. Differences in the primary outcomes between study arms were not statistically significant, however all effects were in the direction of protection from violence and several secondary outcomes were significantly changed. For girls, the incidence of any IPV experience was aIRR 0.84 (95%CI 0.66, 1.07 p = 0.159) for the school's arm and the incidence of non-partner rape was aIRR 0.84 (95%CI 0.62, 1.14 p = 0.255) for the combined schools and families arm v. control arm. This under-powered pragmatic study's findings suggest a generally beneficial impact of the Skhokho interventions on a number of outcome measures, when viewed by both adolescents, caregivers and their teachers. These include measures of adolescents' exposure to violence, improved sexual health and reductions in several IPV risk factors. The intervention warrants further research. Trial registration ClinicalTrials.gov NCT02349321.

Research paper thumbnail of Comparison of community-based HIV counselling and testing (CBCT) through index client tracing and other modalities: Outcomes in 13 South African high HIV prevalence districts by gender and age

PLOS ONE

Date of test D D M M Y Y Y Y Rise member: Y N Name of club/ school Card No I Hereby give signed c... more Date of test D D M M Y Y Y Y Rise member: Y N Name of club/ school Card No I Hereby give signed consent to: (Tick Yes or No) Yes No Be tested for HIV including CD4 A home visit by a Health Care Worker who will provide HCT to my family Allow FPD to verify that i have reached the referral facility Be contacted telephonically from FPD's call centre on any of the numbers supplied below.

Research paper thumbnail of Does a history of sexual and physical childhood abuse contribute to HIV infection risk in adulthood? A study among post-natal women in Harare, Zimbabwe

BackgroundSexual and physical abuse in childhood creates a great health burden including on menta... more BackgroundSexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women.MethodsA cross sectional survey was conducted among 2042 postnatal women (mean age=26y) attending six public primary health care clinics in Harare, Zimbabwe within 6 weeks post-delivery. Clinic records were reviewed for mother’s antenatal HIV status. Participants were interviewed about childhood abuse including physical or sexual abuse before 15 years of age, forced first sex before 16, HIV risk factors such as age difference at first sex before age 16. Multivariate analyses assessed the associations between mother’s HIV status and child physical and sexual abuse while controlling for confounding variables.ResultsMore than one in four (26.6%) re...

Research paper thumbnail of Feasibility of community-based HIV self-screening in South Africa: a demonstration project

BMC Public Health

Background: HIV diagnosis is a critical step in linking HIV-infected individuals to care and trea... more Background: HIV diagnosis is a critical step in linking HIV-infected individuals to care and treatment and linking HIV-uninfected persons to prevention services. However, the uptake of HIV testing remains low in many countries. HIV self-screening (HIVSS) is acceptable to adults, but there is limited data on HIVSS feasibility in community programmes. This study aimed to evaluate the feasibility of HIVSS in South Africa. Methods: We conducted a prospective study that enrolled participants through mobile site, homebased, workplace and sex worker programmes in two townships from May to November 2017. Following an information session on HIVSS, interested participants were offered one of three methods of HIVSS testing: supervised, semi-supervised, and unsupervised. Participants who opted for unsupervised testing and those who tested HIV positive after semi-or supervised HIVSS were followed up telephonically or with a home visit one week after receipt of the test kit to confirm results and linkages to care. Follow-up visits were concluded when the participant indicated that they had used the kit or had accessed a confirmatory HIV test. Results: Of the 2061 people approached, 88.2% (1818/2061) received HIV testing information. Of this group, 89% (1618/1818) were enrolled in the study and 70.0% (1133/1618) were tested for HIV with the kit. The median age was 28 (IQR:23-33) years with an even gender distribution. Of those enrolled, 43.0% (696/1618) were identified through homebased outreach, 42.5% (687/1618) through mobile sites, 7.3% (118/1618) at their workplace and 7.2% (117/1618) from sex worker programmes. A total of 68.7% (1110/1616) selected unsupervised HIVSS, whereas 6.3% (101/1616) opted for semi-supervised and 25.0% ((405/1616) chose supervised HIVSS. Overall, the HIV prevalence using the HIVSS test was 8.2% (93/1129). Of those newly diagnosed with HIV, 16% (12/75) were initiated on ART. Almost half (48.0%; 543/1131) of those tested were linked to a primary HIV test as follows: supervised (85.2%; 336/394); semi-supervised (93.8%; 91/97) and unsupervised (18.1%; 116/640). Conclusion: Unsupervised HIVSS was by far the most selected and utilised HIVSS method. Linkages to primary and confirmatory testing for the unsupervised HIVSS and further care were low, despite home visits and telephonic reminders.

Research paper thumbnail of Factors associated with past year physical and sexual intimate partner violence against women in Zimbabwe: results from a national cluster-based cross-sectional survey

Global Health Action

Background: Intimate partner violence (IPV) against women continues to be a public health burden ... more Background: Intimate partner violence (IPV) against women continues to be a public health burden globally. Objectives: To assess prevalence and factors associated with women's experiences of past 12 months physical/sexual IPV Methods: A two-stage cluster-based national cross-sectional survey in which women were randomly selected for participation was conducted among 5295 women aged 15-49 years. IPV in the last 12 months was assessed using the WHO interviewer-administered questionnaire for measuring violence against women. Participants' wife beating attitudes, partner controlling behaviours, household decision-making, STI history, HIV status and demographic characteristics were assessed. Multivariate logistic regression was conducted to assess factors associated with IPV. Results: Of the 5292 women interviewed, mean age was 31.5 years and 84.7% were married. Over one-fifth of the women (20.2: 95%CI 19.1-21.3) were physically/sexually abused in the last 12 months. IPV was associated with gender inequitable norms and practices which include lacking household decision-making power (aOR 2.05, 1.71-2.47), experiencing low (aOR 2.05; 1.71-2.47) or high (aOR 4.5; 3.62-5.60) partner controlling behaviours (vs none) and endorsing low (aOR 1.29) or high (aOR 1.36) wife beating attitudes (vs none), having sexual self-efficacy (aOR 1.19; 1.10-1.41), experiencing emotional abuse (aOR 4.50; 3.62-5.60) and having a sexually transmitted infection (STI) (aOR 1.36, 1.04-1.77). IPV was also associated with women's empowerment factors including possessing household assets (aOR 1.26, 1.03-1.54) and reporting current media usage (aOR 1.29; 1.04-1.61). Demographic factors associated with IPV were age and number of children. Conclusions: This study provides evidence that IPV is a significant public health and societal problem as one in five women were abused in the past year. Younger women, less empowered women, women in inequitable intimate relationships and women endorsing traditional gender norms were at increased risk of abuse. IPV prevention programmes must prioritise transforming traditional gender norms and women's economic empowerment.

Research paper thumbnail of Relationship power and HIV sero-status: an analysis of their relationship among low-income urban Zimbabwean postpartum women

BMC Public Health

Background: HIV disproportionately infects women in many regions. Zimbabwe is one of the countrie... more Background: HIV disproportionately infects women in many regions. Zimbabwe is one of the countries, most heavily affected. Unequal gender power relations between men and women can increase women's vulnerability to HIV. The aim of this paper was to determine the relationship between gender power and HIV sero-status among postpartum women in Zimbabwe. Methodology: A cross-sectional survey was conducted among 2042 women aged 15-49 years, attending postnatal-care at six public primary health care clinics in low-income urban communities of Harare in 2011. Women were asked about relationship power factors using an interviewer-administered questionnaire. The questionnaire included adapted WHO multi-country study items, which measure partner violence perpetrated against women. HIV status data were based on rapid HIV diagnostic tests done during earlier antenatal visits. The analysis was restricted to women with known HIV test results (n = 1951). Multivariable logistic regression analyses were performed to assess the predictors of HIV and relationship power factors. Results: HIV prevalence was 15.3% (n = 299/1951). Three quarters of the women (76.9%, n = 1438/1871) reported some level of relationship control in their current/most recent intimate relationship. HIV positive women reported higher levels of control by the male partner in their intimate relationships. In adjusted models, the study found a significant association between relationship-control by the male partner and women's HIV status (AOR 1.11, 95% CI 1.01-1.22), and the decision-making dimensions of relationship power. Although there were indications of high male partner control in participants' intimate relationships, some women still had agency, as they were able to make independent decisions to fall pregnant. These women were less likely to be HIV positive (AOR 0.54, 95% CI 0.29-1.00). Having a partner who ever refused use of a family planning method was associated with increased odds of having a positive HIV status among the postpartum women (AOR 1.88, 95% CI 1.20-2.90). Conclusion: Unequal gender power relations continue to be a risk factor for heterosexual transmission of HIV. This suggests that prevention efforts have not successfully resulted in gender equality. HIV prevention interventions should address gender power dynamics to help curb the disproportionate HIV burden among women.

Research paper thumbnail of Study on knowledge about associated factors of Tuberculosis (TB) and TB/HIV co-infection among young adults in two districts of South Africa

PLOS ONE

South Africa ranks third among 22 high burden countries in the world. TB which remains a leading ... more South Africa ranks third among 22 high burden countries in the world. TB which remains a leading cause of death causes one in five adult deaths in South Africa. An in-depth understanding of knowledge, attitudes and practices of young people towards TB is required to implement meaningful interventions. We analysed young men and women (18-24 years)'s TB knowledge including TB/HIV coinfections, testing rates and factors associated with them. A cross sectional cluster-based household survey was conducted in two provinces. Participants completed computer-assisted self-interviews on TB knowledge, testing history and TB/HIV coinfections. A participant was regarded as knowledgeable of TB if s/he correctly answered the WHO-adopted TB knowledge questions. We built three multivariate regression models in Stata 13.0 to assess factors associated with knowing TB alone, testing alone and both knowing and testing for TB. 1955 participants were interviewed (89.9% response rate). Their median age was 20 years (IQR19-22). Sixteen percent (16.2%) of the participants were social grant recipients, 55% were enrolled in a school/college and 5% lived in substandard houses. A total of 72% had knowledge of TB, 21% underwent screening tests for TB and 14.7% knew and tested for TB. Factors associated with TB knowledge were being female, younger, a student, social grant recipient, not transacting sex and having positive attitudes towards people living with HIV (PLWH). Factors associated with TB testing were being a student, receiving a social grant, living in OR Tambo district, HIV knowledge and having a family member with TB history. Factors associated with both TB knowledge and testing were being female, a student, using the print media, living in OR Tambo district and having a family member with a TB history. The study demonstrates the importance of demographic factors (gender, economic status, family TB history, and location) and HIV factors in explaining TB knowledge and testing. We recommend extending community TB testing services to increase testing.

Research paper thumbnail of Associations between depressive symptoms, socio-economic factors, traumatic exposure and recent intimate partner violence experiences among women in Zimbabwe: a cross-sectional study

BMC Women's Health

Background Population-based research on the cumulative effects of socio-economic conditions and t... more Background Population-based research on the cumulative effects of socio-economic conditions and trauma exposures, particularly women’s experiences of intimate partner violence (IPV) on their mental health in Zimbabwe, has been limited. Aim Our study aimed to determine the associations between depressive symptoms and socio-economic factors, IPV, and traumatic exposures among a nationally representative sample of women from Zimbabwe. Methods Data was collected from 2905 women who volunteered to participate in a survey that had a multi-stage random sampling design. Depression was measured using the Centre for Epidemiologic Studies Depression Scale (CESD). Traumatic exposures included childhood trauma, life events, and experiences of IPV in the past year. We compared mean depression scores for different categories of variables, conducted linear regression modelling to investigate the bivariate and multivariate associations between variables and depressive symptoms’ outcomes, and applied...

Research paper thumbnail of Additional file 1 of Knowledge, attitudes and practices of young adults towards HIV prevention: an analysis of baseline data from a community-based HIV prevention intervention study in two high HIV burden districts, South Africa

Additional file 1. Knowledge, attitudes and practices data. This file contains data used for this... more Additional file 1. Knowledge, attitudes and practices data. This file contains data used for this manuscript.

Research paper thumbnail of Intimate Partner Violence Prior to and During COVID-19 Measures in 30 Countries: A Global Cross-Sectional Study From the I-SHARE Consortium

SSRN Electronic Journal, 2021

Research paper thumbnail of Pre-exposure prophylaxis (PrEP) awareness, attitudes and uptake willingness among young people: gender differences and associated factors in two South African districts

Global Health Action, 2021

Background: Pre-exposure prophylaxis (PrEP) for HIV prevention is safe and effective in reducing ... more Background: Pre-exposure prophylaxis (PrEP) for HIV prevention is safe and effective in reducing HIV incidence. However, more evidence of PrEP knowledge, willingness and distribution preferences is required for scale-up among young people at-risk. Objective: To understand young people PrEP awareness, willingness and roll-out preferences. Methods: Young people (18-24y) were selected through multi-stage sampling in a crosssectional household survey in low-income communities. Self-administered interviews collected participants' data about PrEP awareness, attitudes, willingness and HIV-risk practices. Data were descriptively analysed by gender. Regression models assessed factors associated with PrEP awareness and willingness by district. Results: Of the 1917 participants interviewed 44.6% (men = 39.4% vs women = 49%, p = 0.001) were PrEP aware, 49.0% were willing to use PrEP. Participants most preferred PrEP distribution channels were public clinics (51.2%) and hospitals (23.8%). More men than women preferred distribution through schools (11.9% vs7.8%; p = 0.002) and NGOs (8.5% vs5.4%; p = 0.008). The biggest barrier to PrEP willingness was inadequate PrEP knowledge (10.0%) but more men than women disliked taking pills daily (4.1%vs2.0%; p-value = 0.007). Gendered determinants to use PrEP were side effects (51%; men = 47% vs women = 55%; p = 0.001) and pill effectiveness (29.5%; men = 26.4% vs women = 32.6%; p = 0.003). In both districts PrEP knowledge was associated with being female and media use. The associations between PrEP awareness and having multiple sexual partnerships, HIV knowledge, HIV selftest willingness and belonging to social clubs differed by district. PrEP willingness was positively associated with having TB and PrEP knowledge in each district but district differences were observed in media and occupation factors. Conclusions: The study shows young people's low levels of PrEP awareness. It also shows relatively increased willingness, gendered PrEP awareness and distribution preferences. Promoting youth's PrEP awareness requires a multifarious media strategy.

Research paper thumbnail of A Qualitative Study on Experiences of HIVVaccine Trial Participants in a Phase I/IIDouble Blinded, Randomized Placebo Controlled Clinical Trial in Tanzania: Lessons for COVID-19 Vaccine Testing

Background: HIV remains a major public health problem in Sub-Saharan Africa. More than half (54.5... more Background: HIV remains a major public health problem in Sub-Saharan Africa. More than half (54.5%) of all people living with HIV live in Eastern and Southern Africa where 700,000 new infections were reported in 2019. There is no HIV vaccine or cure available yet despite ongoing research to develop one. Uptake of vaccines, when these become available, is critical for its successful introduction in the global society. It is imperative to describe the knowledge, expectations, perceptions and experiences of the vaccines trial participants, as these may be indicative of future vaccine uptake, and may give lessons for COVID-19 vaccine development. Methods: A phenomenological qualitative study was conducted to describe the experiences of volunteers who participated in the first HIV vaccine trial in Mbeya, Tanzania. A purposive sample of 20 of the 60 trial participants was interviewed. Interviews were audio-recorded, transcribed, translated, and subjected to thematic-content analysis.Resul...

Research paper thumbnail of The dynamics of intimate partner violence during pregnancy and linkages with HIV infection and disclosure in Zimbabwe

Introduction: The study assessed the linkages between HIV infection and intimate partner violence... more Introduction: The study assessed the linkages between HIV infection and intimate partner violence (IPV) during pregnancy and after HIV status disclosure in a context where HIV testing has become almost mandatory through the provider-initiated counselling and testing approach and non-disclosure of HIV status to sexual partners has been criminalised in many countries including Zimbabwe. The study also explored women’s experiences of and health workers’ perceptions of IPV during pregnancy. Methods: A mixed-methods study of IPV and HIV during pregnancy was conducted to determine the prevalence of and risk factors for IPV during pregnancy and after disclosing HIV status, to assess the relationship between HIV, pregnancy and IPV, to understand women’s perspectives of and midwives’ experiences of responding to IPV during pregnancy. A systematic review and meta-analysis of 19 African studies on IPV during pregnancy was first conducted to understand the rates of and risk factors for IPV incl...

Research paper thumbnail of A community-based HIV counselling and testing programme found a decreasing proportion of new HIV testers in South Africa

This article assesses the history of HIV testing among community-based HIV counselling and testin... more This article assesses the history of HIV testing among community-based HIV counselling and testing (CBCT) clients between 2014 and 2018 in 13 South African districts. Consenting clients were tested for HIV and interviewed to categorise as first-time testers or repeat testers. Of the 1 800 753 clients tested for HIV, 15.7% (95% CI [15.6–15.7]) were first-time testers. The rate of identifying first-time testers decreased by 10.7% in four years from 18.4% in year one to 7.7% in year four. A substantial proportion (5.5% [5.4–5.6]) of HIV-positive people not yet on antiretroviral treatment sought HIV re-test, of whom nearly half (48.4% [47.1–49.6]) did not disclose their HIV-positive status during pre-counselling and were re-tested. A decreasing proportion of first-time testers may signal positive progress towards universal HIV testing. This downward trend should be sustained to control the HIV epidemic.

Research paper thumbnail of High frequency intimate partner violence during pregnancy, post natal depression and suicidal tendencies in Harare, Zimbabwe

General Hospital Psychiatry, 2015

Introduction: Intimate partner violence (IPV) is a common form of violence experienced by pregnan... more Introduction: Intimate partner violence (IPV) is a common form of violence experienced by pregnant women and is believed to have adverse mental health effects postnatally. This study investigated the association of postnatal depression (PND) and suicidal ideation with emotional, physical and sexual IPV experienced by women during pregnancy. Methods: Data were collected from 842 women interviewed postnatally in six postnatal clinics in Harare, Zimbabwe. We used the World Health Organization versions of IPV and Centre for Epidemiological Studies-Depression Scale measures to assess IPV and PND respectively. We derived a violence severity variable and combined forms of IPV variables from IPV questions. Logistic regression was used to analyse data whilst controlling for past mental health and IPV experiences. Results: One in five women [21.4% (95% CI 18.6-24.2)] met the diagnostic criteria for PND symptomatology whilst 21.6% (95% CI 18.8-24.4) reported postpartum suicide thoughts and 4% (95% CI 2.7-5.4) reported suicide attempts. Two thirds (65.4%) reported any form of IPV. Although individual forms of severe IPV were associated with PND, stronger associations were found between PND and severe emotional IPV or severe combined forms of IPV. Suicidal ideation was associated with emotional IPV. Other forms of IPV, except when combined with emotional IPV, were not individually associated with suicidal ideation. Conclusion: Emotional IPV during pregnancy negatively affects women's mental health in the postnatal period. Clinicians and researchers should include it in their conceptualisation of violence and health. Further research must look at possible indirect relationships between sexual and physical IPV on mental health.

Research paper thumbnail of The International Sexual Health And Reproductive Health Survey (I-SHARE-1): A Cross-Sectional Multi-Country Analysis of Adults from 30 Countries Prior to and During the Initial COVID-19 Wave

Background: To better understand sexual and reproductive health (SRH) during the initial COVID-19... more Background: To better understand sexual and reproductive health (SRH) during the initial COVID-19 wave, we organized a multi-country cross-sectional survey. Methods: Consortium research teams conducted online surveys in 30 countries. Primary outcomes included sexual behaviors, partner violence, and SRH service utilization, and we compared three months prior to and three months after policy measures to mitigate COVID-19. We used established indicators and analyses pre-specified in our protocol. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods. Findings: Descriptive analyses included 22,724 individuals in 25 countries. Five additional countries with sample sizes <200 were included in descriptive meta-analyses. Respondents were mean age 34 years; most identified as women (15160; 66.7%), cis-gender (19432; 86.6%) and heterosexual (16592; 77.9%). Among 4546 respondents with casual partners, condom use stayed steady for 337...

Research paper thumbnail of Knowledge, attitudes and practices of young adults towards HIV prevention: an analysis of baseline data from a community-based HIV prevention intervention study in two high HIV burden districts, South Africa

BMC Public Health

Background With an HIV incidence of 1.00 skewed against women (1.51), adolescents in South Africa... more Background With an HIV incidence of 1.00 skewed against women (1.51), adolescents in South Africa are at high HIV risk. This paper assesses young adults’ (18–24 years) knowledge, attitudes and practices regarding HIV prevention in Nkangala and OR Tambo districts. Methods A cross-sectional household survey was conducted in two districts in 2017/8. Participants completed computer-assisted self-interviews on HIV knowledge, attitudes, behaviour practices, use of social media and condom use at last sex (proxy for high-risk sex). HIV knowledge was assessed using the South African-adapted UNAIDS scale. Descriptive analyses were conducted and logistic regression models were built to assess factors associated with being knowledgeable of HIV and condom use at last sex. Results One thousand nine hundred fifty-five participants were interviewed (90% response rate). Less than half (44.7%) had correct knowledge of HIV prevention and 73% used a condom at last sex. Social media use predicted high H...

Research paper thumbnail of Social franchising of community-based HIV counselling and testing services to increase HIV testing and linkage to care in Tshwane, South Africa: study protocol for a non-randomised implementation trial

BMC Public Health

Background Meeting the ambitious UN 90–90-90 HIV testing, treatment and viral load suppression ta... more Background Meeting the ambitious UN 90–90-90 HIV testing, treatment and viral load suppression targets requires innovative strategies and approaches in Sub-Saharan Africa. To date no known interventions have been tested with community health workers (counsellors) as social franchisees or owner-managed businesses in Community-based HIV counselling and testing (CBCT) work. The aim of this methods paper is to describe a Social franchise (SF) CBCT implementation trial to increase HIV testing and linkage to care for individuals at community levels in comparison with an existing CBCT programme methods. Methods/design This is a two arm non-randomised community implementation trial with a once off round of post-test follow-up per HIV positive participant to assess linkage to care in low income communities. The intervention arm is a social franchise CBCT in which unemployed, self-employed or employed community members are recruited, contracted and incentivised to test at least 100 people per...

Research paper thumbnail of Social franchising of community-based HIV testing and linkage to HIV care and treatment services: an evaluation of a pilot study in Tshwane, South Africa

Journal of the International AIDS Society

Research paper thumbnail of Debating medicalization of Female Genital Mutilation/Cutting (FGM/C): learning from (policy) experiences across countries

Reproductive Health

Background: Although Female Genital Mutilation/Cutting (FGM/C) is internationally considered a ha... more Background: Although Female Genital Mutilation/Cutting (FGM/C) is internationally considered a harmful practice, it is increasingly being medicalized allegedly to reduce its negative health effects, and is thus suggested as a harm reduction strategy in response to these perceived health risks. In many countries where FGM/C is traditionally practiced, the prevalence rates of medicalization are increasing, and in countries of migration, such as the United Kingdom, the United States of America or Sweden, court cases or the repeated issuing of statements in favor of presumed minimal forms of FGM/C to replace more invasive forms, has raised the debate between the medical harm reduction arguments and the human rights approach. Main body: The purpose of this paper is to discuss the arguments associated with the medicalization of FGM/C, a trend that could undermine the achievement of Sustainable Development Goal 5.3. The paper uses four country case studies, Egypt, Indonesia, Kenya and UK, to discuss the reasons for engaging in medicalized forms of FGM/C, or not, and explores the ongoing public discourse in those countries concerning harm reduction versus human rights, and the contradiction between medical ethics, national criminal justice systems and international conventions. The discussion is structured around four key hotly contested ethical dilemmas. Firstly, that the WHO definition of medicalized FGM/C is too narrow allowing medicalized FGM to be justified by many healthcare professionals as a form of harm reduction which contradicts the medical oath of do no harm. Secondly, that medicalized FGM/C is a human rights abuse with lifelong consequences, no matter who performs it. Thirdly, that health care professionals who perform medicalized FGM/C are sustaining cultural norms that they themselves support and are also gaining financially. Fourthly, the contradiction between protecting traditional cultural rights in legal constitutions versus human rights legislation, which criminalizes FGM/C. Conclusion: More research needs to be done in order to understand the complexities that are facilitating the medicalization of FGM/C as well as how policy strategies can be strengthened to have a greater de-medicalization impact. Tackling medicalization of FGM/C will accelerate the achievement of the Sustainable Development Goal of ending FGM by 2030.

Research paper thumbnail of RCT evaluation of Skhokho: A holistic school intervention to prevent gender-based violence among South African Grade 8s

PLOS ONE

We evaluated the effectiveness of the Skhokho interventions (enhanced teaching materials and a pa... more We evaluated the effectiveness of the Skhokho interventions (enhanced teaching materials and a parenting programme) in reducing dating and sexual violence. This pragmatic, threearm cluster randomised controlled trial was conducted in 24 State schools in Grade 8 classes, with all learners invited to participate. The interventions were: i) a schools' package: A Life Orientation (LO) curriculum workbook for the Grade 8 national curriculum and teacher training; ii) a workshop for caregivers and teenagers, supported by clubs in the second year. Arms were: a no intervention control, the schools' package, and the combined schools' and families' package. Learners were followed up for 18 months. The primary outcomes were the incidence of physical and/or sexual IPV, severe IPV and non-partner rape. At baseline, 3756 (61.8% of total) learners (aged 12-15) were interviewed and 3411 (90.8%) provided end line data. A third of caregivers and learners attended all four families' intervention workshop sessions. At baseline, 47% of girls and 29% boys were dating and 18% of boys and 2% of girls had had sex. Differences in the primary outcomes between study arms were not statistically significant, however all effects were in the direction of protection from violence and several secondary outcomes were significantly changed. For girls, the incidence of any IPV experience was aIRR 0.84 (95%CI 0.66, 1.07 p = 0.159) for the school's arm and the incidence of non-partner rape was aIRR 0.84 (95%CI 0.62, 1.14 p = 0.255) for the combined schools and families arm v. control arm. This under-powered pragmatic study's findings suggest a generally beneficial impact of the Skhokho interventions on a number of outcome measures, when viewed by both adolescents, caregivers and their teachers. These include measures of adolescents' exposure to violence, improved sexual health and reductions in several IPV risk factors. The intervention warrants further research. Trial registration ClinicalTrials.gov NCT02349321.

Research paper thumbnail of Comparison of community-based HIV counselling and testing (CBCT) through index client tracing and other modalities: Outcomes in 13 South African high HIV prevalence districts by gender and age

PLOS ONE

Date of test D D M M Y Y Y Y Rise member: Y N Name of club/ school Card No I Hereby give signed c... more Date of test D D M M Y Y Y Y Rise member: Y N Name of club/ school Card No I Hereby give signed consent to: (Tick Yes or No) Yes No Be tested for HIV including CD4 A home visit by a Health Care Worker who will provide HCT to my family Allow FPD to verify that i have reached the referral facility Be contacted telephonically from FPD's call centre on any of the numbers supplied below.

Research paper thumbnail of Does a history of sexual and physical childhood abuse contribute to HIV infection risk in adulthood? A study among post-natal women in Harare, Zimbabwe

BackgroundSexual and physical abuse in childhood creates a great health burden including on menta... more BackgroundSexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women.MethodsA cross sectional survey was conducted among 2042 postnatal women (mean age=26y) attending six public primary health care clinics in Harare, Zimbabwe within 6 weeks post-delivery. Clinic records were reviewed for mother’s antenatal HIV status. Participants were interviewed about childhood abuse including physical or sexual abuse before 15 years of age, forced first sex before 16, HIV risk factors such as age difference at first sex before age 16. Multivariate analyses assessed the associations between mother’s HIV status and child physical and sexual abuse while controlling for confounding variables.ResultsMore than one in four (26.6%) re...

Research paper thumbnail of Feasibility of community-based HIV self-screening in South Africa: a demonstration project

BMC Public Health

Background: HIV diagnosis is a critical step in linking HIV-infected individuals to care and trea... more Background: HIV diagnosis is a critical step in linking HIV-infected individuals to care and treatment and linking HIV-uninfected persons to prevention services. However, the uptake of HIV testing remains low in many countries. HIV self-screening (HIVSS) is acceptable to adults, but there is limited data on HIVSS feasibility in community programmes. This study aimed to evaluate the feasibility of HIVSS in South Africa. Methods: We conducted a prospective study that enrolled participants through mobile site, homebased, workplace and sex worker programmes in two townships from May to November 2017. Following an information session on HIVSS, interested participants were offered one of three methods of HIVSS testing: supervised, semi-supervised, and unsupervised. Participants who opted for unsupervised testing and those who tested HIV positive after semi-or supervised HIVSS were followed up telephonically or with a home visit one week after receipt of the test kit to confirm results and linkages to care. Follow-up visits were concluded when the participant indicated that they had used the kit or had accessed a confirmatory HIV test. Results: Of the 2061 people approached, 88.2% (1818/2061) received HIV testing information. Of this group, 89% (1618/1818) were enrolled in the study and 70.0% (1133/1618) were tested for HIV with the kit. The median age was 28 (IQR:23-33) years with an even gender distribution. Of those enrolled, 43.0% (696/1618) were identified through homebased outreach, 42.5% (687/1618) through mobile sites, 7.3% (118/1618) at their workplace and 7.2% (117/1618) from sex worker programmes. A total of 68.7% (1110/1616) selected unsupervised HIVSS, whereas 6.3% (101/1616) opted for semi-supervised and 25.0% ((405/1616) chose supervised HIVSS. Overall, the HIV prevalence using the HIVSS test was 8.2% (93/1129). Of those newly diagnosed with HIV, 16% (12/75) were initiated on ART. Almost half (48.0%; 543/1131) of those tested were linked to a primary HIV test as follows: supervised (85.2%; 336/394); semi-supervised (93.8%; 91/97) and unsupervised (18.1%; 116/640). Conclusion: Unsupervised HIVSS was by far the most selected and utilised HIVSS method. Linkages to primary and confirmatory testing for the unsupervised HIVSS and further care were low, despite home visits and telephonic reminders.

Research paper thumbnail of Factors associated with past year physical and sexual intimate partner violence against women in Zimbabwe: results from a national cluster-based cross-sectional survey

Global Health Action

Background: Intimate partner violence (IPV) against women continues to be a public health burden ... more Background: Intimate partner violence (IPV) against women continues to be a public health burden globally. Objectives: To assess prevalence and factors associated with women's experiences of past 12 months physical/sexual IPV Methods: A two-stage cluster-based national cross-sectional survey in which women were randomly selected for participation was conducted among 5295 women aged 15-49 years. IPV in the last 12 months was assessed using the WHO interviewer-administered questionnaire for measuring violence against women. Participants' wife beating attitudes, partner controlling behaviours, household decision-making, STI history, HIV status and demographic characteristics were assessed. Multivariate logistic regression was conducted to assess factors associated with IPV. Results: Of the 5292 women interviewed, mean age was 31.5 years and 84.7% were married. Over one-fifth of the women (20.2: 95%CI 19.1-21.3) were physically/sexually abused in the last 12 months. IPV was associated with gender inequitable norms and practices which include lacking household decision-making power (aOR 2.05, 1.71-2.47), experiencing low (aOR 2.05; 1.71-2.47) or high (aOR 4.5; 3.62-5.60) partner controlling behaviours (vs none) and endorsing low (aOR 1.29) or high (aOR 1.36) wife beating attitudes (vs none), having sexual self-efficacy (aOR 1.19; 1.10-1.41), experiencing emotional abuse (aOR 4.50; 3.62-5.60) and having a sexually transmitted infection (STI) (aOR 1.36, 1.04-1.77). IPV was also associated with women's empowerment factors including possessing household assets (aOR 1.26, 1.03-1.54) and reporting current media usage (aOR 1.29; 1.04-1.61). Demographic factors associated with IPV were age and number of children. Conclusions: This study provides evidence that IPV is a significant public health and societal problem as one in five women were abused in the past year. Younger women, less empowered women, women in inequitable intimate relationships and women endorsing traditional gender norms were at increased risk of abuse. IPV prevention programmes must prioritise transforming traditional gender norms and women's economic empowerment.

Research paper thumbnail of Relationship power and HIV sero-status: an analysis of their relationship among low-income urban Zimbabwean postpartum women

BMC Public Health

Background: HIV disproportionately infects women in many regions. Zimbabwe is one of the countrie... more Background: HIV disproportionately infects women in many regions. Zimbabwe is one of the countries, most heavily affected. Unequal gender power relations between men and women can increase women's vulnerability to HIV. The aim of this paper was to determine the relationship between gender power and HIV sero-status among postpartum women in Zimbabwe. Methodology: A cross-sectional survey was conducted among 2042 women aged 15-49 years, attending postnatal-care at six public primary health care clinics in low-income urban communities of Harare in 2011. Women were asked about relationship power factors using an interviewer-administered questionnaire. The questionnaire included adapted WHO multi-country study items, which measure partner violence perpetrated against women. HIV status data were based on rapid HIV diagnostic tests done during earlier antenatal visits. The analysis was restricted to women with known HIV test results (n = 1951). Multivariable logistic regression analyses were performed to assess the predictors of HIV and relationship power factors. Results: HIV prevalence was 15.3% (n = 299/1951). Three quarters of the women (76.9%, n = 1438/1871) reported some level of relationship control in their current/most recent intimate relationship. HIV positive women reported higher levels of control by the male partner in their intimate relationships. In adjusted models, the study found a significant association between relationship-control by the male partner and women's HIV status (AOR 1.11, 95% CI 1.01-1.22), and the decision-making dimensions of relationship power. Although there were indications of high male partner control in participants' intimate relationships, some women still had agency, as they were able to make independent decisions to fall pregnant. These women were less likely to be HIV positive (AOR 0.54, 95% CI 0.29-1.00). Having a partner who ever refused use of a family planning method was associated with increased odds of having a positive HIV status among the postpartum women (AOR 1.88, 95% CI 1.20-2.90). Conclusion: Unequal gender power relations continue to be a risk factor for heterosexual transmission of HIV. This suggests that prevention efforts have not successfully resulted in gender equality. HIV prevention interventions should address gender power dynamics to help curb the disproportionate HIV burden among women.

Research paper thumbnail of Study on knowledge about associated factors of Tuberculosis (TB) and TB/HIV co-infection among young adults in two districts of South Africa

PLOS ONE

South Africa ranks third among 22 high burden countries in the world. TB which remains a leading ... more South Africa ranks third among 22 high burden countries in the world. TB which remains a leading cause of death causes one in five adult deaths in South Africa. An in-depth understanding of knowledge, attitudes and practices of young people towards TB is required to implement meaningful interventions. We analysed young men and women (18-24 years)'s TB knowledge including TB/HIV coinfections, testing rates and factors associated with them. A cross sectional cluster-based household survey was conducted in two provinces. Participants completed computer-assisted self-interviews on TB knowledge, testing history and TB/HIV coinfections. A participant was regarded as knowledgeable of TB if s/he correctly answered the WHO-adopted TB knowledge questions. We built three multivariate regression models in Stata 13.0 to assess factors associated with knowing TB alone, testing alone and both knowing and testing for TB. 1955 participants were interviewed (89.9% response rate). Their median age was 20 years (IQR19-22). Sixteen percent (16.2%) of the participants were social grant recipients, 55% were enrolled in a school/college and 5% lived in substandard houses. A total of 72% had knowledge of TB, 21% underwent screening tests for TB and 14.7% knew and tested for TB. Factors associated with TB knowledge were being female, younger, a student, social grant recipient, not transacting sex and having positive attitudes towards people living with HIV (PLWH). Factors associated with TB testing were being a student, receiving a social grant, living in OR Tambo district, HIV knowledge and having a family member with TB history. Factors associated with both TB knowledge and testing were being female, a student, using the print media, living in OR Tambo district and having a family member with a TB history. The study demonstrates the importance of demographic factors (gender, economic status, family TB history, and location) and HIV factors in explaining TB knowledge and testing. We recommend extending community TB testing services to increase testing.