Albert Takaruza | Midlands State University, Zimbabwe (original) (raw)

Papers by Albert Takaruza

This data is an accompaniment to the journal article 'Might ART Adherence Estimates Be Improv... more This data is an accompaniment to the journal article 'Might ART Adherence Estimates Be Improved by Combining Biomarker and Self-Report Data?' (Rhead et al. 2016) Abstract: As we endeavour to examine rates of viral suppression in PLHIV, reliable data on ART adherence are needed to distinguish between the respective contributions of poor adherence and treatment failure on high viral load. Self-reported data are susceptible to response bias and although biomarker data on drug presence and concentration can provide a superior, alternative method of measurement, complications due to drug-drug interactions and genetic variations can cause some inaccuracies. We investigate the feasibility of combining both biomarker and self-report data to produce a potentially more accurate measure of ART adherence. Data were taken from a large general-population survey in the Manicaland province, Zimbabwe, conducted in 2009-2011. HIV-infected adults who had initiated ART (N=560) provided self-report data on adherence and dried blood spot samples that were analysed for traces of ART medication. Using this data, new three-category measure of ART adherence was constructed, based on biomarker data but using self-report data to adjust for cases with abnormally low and high drug concentrations due to possible drug-drug interactions and genetic factors, and was assessed for plausibility using survey data on socio-demographic correlates. The Manicaland Centre is a major collaborative scientific HIV/STD Prevention research initiative that has been underway in rural areas of eastern Zimbabwe since the early 1990s. The principal collaborating institutions in the project are the Biomedical Research and Training Institute in Harare and Imperial College London. We also have joint research projects with people from the London School of Hygiene and Tropical Medicine and the University of Copenhagen. The Manicaland Project has one of the largest prospective population-based surveys in Africa. This has allowed us to uniquely track trends in the [...]

Journal of the International AIDS Society, 2015

Background: It remains unclear whether poverty or in fact wealth correlates with HIV risk, and to... more Background: It remains unclear whether poverty or in fact wealth correlates with HIV risk, and to what extent. We analyse associations and trends between wealth and HIV infection rates while accounting for demographic factors using data over several rounds of a large population-based cohort study in Manicaland, Zimbabwe, over the period 1998 to 2011. Methods: Household-based wealth was estimated from summed asset ownership scores for 'sellable', 'nonsellable' and all assets combined. Multivariate logistic random-effects models were used to analyse associations between absolute wealth group and HIV infection risk after accounting for age, sex, education, marital and occupational status. Results were compared over several study rounds to investigate trends and dynamics. Results: Mean asset scores remained similar at around 0.37 up to 2007 but decreased to levels below 0.35 thereafter. Highest scores were observed in towns but the gap to other locations reduced over time, especially for sellable assets. Concurrently, adult HIV prevalence dropped steadily from 22.3% to 14.3%. Prevalence was significantly higher in women than men across absolute wealth groups, except in least poor women, and variation between groups narrowed over the years. We found no significant associations between wealth and HIV prevalence in men but lower prevalence in the wealthiest women at the beginning of the study. However, this trend became less and less important with each study round. Conclusions: Wealth appears to be associated with HIV infection risk at macro-level only. Individual-level trends were inconsistent or lacking which suggests that the epidemic is widely spread throughout wealth groups.

BMJ Open, Feb 1, 2018

Objective Globally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment co... more Objective Globally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is suboptimal. To improve uptake of HIV services by FSWs, it is important to identify potential inequalities in access and use of care and their determinants. Our aim is to investigate HIV treatment cascades for FSWs and non-sex workers (NSWs) in Manicaland province, Zimbabwe, and to examine the socio-demographic characteristics and intermediate determinants that might explain differences in service uptake. Methods Data from a household survey conducted in 2009-2011 and a parallel snowball sample survey of FSWs were matched using probability methods to reduce under-reporting of FSWs. HIV treatment cascades were constructed and compared for FSWs (n=174) and NSWs (n=2555). Determinants of service uptake were identified a priori in a theoretical framework and tested using logistic regression. results HIV prevalence was higher in FSWs than in NSWs (52.6% vs 19.8%; age-adjusted OR (AOR) 4.0; 95% CI 2.9 to 5.5). In HIV-positive women, FSWs were more likely to have been diagnosed (58.2% vs 42.6%; AOR 1.62; 1.02-2.59) and HIV-diagnosed FSWs were more likely to initiate ART (84.9% vs 64.0%; AOR 2.33; 1.03-5.28). No difference was found for antiretroviral treatment (ART) adherence (91.1% vs 90.5%; P=0.9). FSWs' greater uptake of HIV treatment services became non-significant after adjusting for intermediate factors including HIV knowledge and risk perception, travel time to services, physical and mental health, and recent pregnancy. Conclusion FSWs are more likely to take up testing and treatment services and were closer to achieving optimal outcomes along the cascade compared with NSWs. However, ART coverage was low in all women at the time of the survey. FSWs' need for, knowledge of and proximity to HIV testing and treatment facilities appear to increase uptake.

AIDS, Jun 19, 2017

Objective: Age-disparate sexual relationships with older men may drive high rates of HIV acquisit... more Objective: Age-disparate sexual relationships with older men may drive high rates of HIV acquisition in young women in sub-Saharan Africa, but evidence is limited. We investigate the association between age-disparate relationships and HIV incidence in Manicaland, Zimbabwe. Design: A general-population open-cohort study (six surveys) (1998-2013). Methods: A total of 3746 young women aged 15-24 years participated in consecutive surveys and were HIV-negative at the beginning of intersurvey periods. Last sexual partner age difference and age-disparate relationships [intergenerational (10 years age difference) and intragenerational (5-9 years) versus age-homogeneous (0-4 years)] were tested for associations with HIV incidence in Cox regressions. A proximate determinants framework was used to explore factors possibly explaining variations in the contribution of age-disparate relationships to HIV incidence between populations and over time. Results: About 126 HIV infections occurred over 8777 person-years (1.43 per 100 person-years; 95% confidence interval ¼ 1.17-1.68). Sixty-five percent of women reported partner age differences of at least 5 years. Increasing partner age differences were associated with higher HIV incidence [adjusted hazard ratio (aHR) ¼ 1.05 (1.01-1.09)]. Intergenerational relationships tended to increase HIV incidence [aHR ¼ 1.78 (0.96-3.29)] but not intragenerational relationships [aHR ¼ 0.91 (0.47-1.76)]. Secondary education was associated with reductions in intergenerational relationships [adjusted odds ratio (aOR) ¼ 0.49 (0.36-0.68)]. Intergenerational relationships were associated with partners having concurrent relationships [aOR ¼ 2.59 (1.81-3.70)], which tended to increase HIV incidence [aHR ¼ 1.74 (0.96-3.17)]. Associations between age disparity and HIV incidence did not change over time. Conclusion: Sexual relationships with older men expose young women to increased risk of HIV acquisition in Manicaland, which did not change over time, even with introduction of antiretroviral therapy.

Diabetic Medicine, 2008

Aims To determine the prevalence of psychological distress in young adults with Type 1 diabetes ... more Aims To determine the prevalence of psychological distress in young adults with Type 1 diabetes and to explore associated factors.Methods Ninety‐two participants with Type 1 diabetes (46 male, 46 female) attending a young adult clinic completed two psychological self‐report assessments; the Centre for Epidemiological Studies–Depression Scale (CES‐D) and Adult Self‐Report Scale (ASR). The mean age was 21.6 ± 2.8 years (sd) and mean duration of diabetes was 9.3 ± 5.4 years. A questionnaire identified the method of insulin delivery, the frequency of blood glucose monitoring and hypoglycaemia requiring third‐party assistance. HbA1c was measured.Results Of the participants, 35.2% reported depressive symptoms (CES‐D ≥ 16), 23.1% indicating severe depressive symptoms (CES‐D ≥ 24), and 32.2, 40.4 and 35.5% of participants reported significant distress (ASR ≥ 60) on the ASR total problem scales, ASR internalizing and ASR externalizing scores, respectively. Mean HbA1c levels were higher in...

The LTE eNodeB base station software is composed of various interconnected components, which hand... more The LTE eNodeB base station software is composed of various interconnected components, which handle different functionalities. Integration testing is used to test the interfaces and interactions between the components when they are combined together. In agile software development new software component builds are created frequently, which leads to a need for a quick and automated testing environment. This thesis focuses on improving the level of automation in the LTE User Plane software integration testing continuous integration environment. Two different subjects, interface specification adaptation and test scenario configuration, are addressed in this study. An automated system triggered by the continuous integration platform is implemented to update the testing environment so that it complies with the latest interface specification. In addition, a new software tool is developed as a proof of concept for an alternative method for test script writing and test case creation. The too...

We study the tuning of U(1) gauge fields in F-theory models on a base of general dimension. We co... more We study the tuning of U(1) gauge fields in F-theory models on a base of general dimension. We construct a formula that computes the change in Weierstrass moduli when such a U(1) is tuned, based on the Morrison-Park form of a Weierstrass model with an additional rational section. Using this formula, we propose the form of "minimal tuning" on any base, which corresponds to the case where the decrease in the number of Weierstrass moduli is minimal. Applying this result, we discover some universal features of bases with non-Higgsable U(1)s. Mathematically, a generic elliptic fibration over such a base has additional rational sections. Physically, this condition implies the existence of U(1) gauge group in the low-energy supergravity theory after compactification that cannot be Higgsed away. In particular, we show that the elliptic Calabi-Yau manifold over such a base has a small number of complex structure moduli. We also suggest that non-Higgsable U(1)s can never appear on any toric bases. Finally, we construct the first example of a threefold base with non-Higgsable U(1)s. Contents 1 Introduction 1 2 Minimal tuning of U(1) on a general base 2 2.1 The Morrison-Park form for an additonal rational section 2 2.2 Counting independent variables 4 2.3 Minimal tuning of U(1) 8 2.4 Example: P 2 11 2.5 Example: F 12 12 2.6 Example: F 3 15 3 Constraints on bases with a non-Higgsable U(1) 17 4 Semi-toric generalized Schoen constructions 23 5 A 3D base with non-Higgsable U(1)s 30 6 Conclusion 35

JAMA Network Open, 2019

IMPORTANCE HIV self-testing is a promising approach for increasing awareness of HIV status in sub... more IMPORTANCE HIV self-testing is a promising approach for increasing awareness of HIV status in sub-Saharan Africa, particularly in Zimbabwe, where HIV prevalence is 13%. Evidence is lacking, however, on the optimal pricing policies and delivery strategies for maximizing the effect of HIV selftesting. OBJECTIVE To assess demand for HIV self-testing among adults and priority-population subgroups under alternative pricing and distribution strategies. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial recruited study participants between February 15, 2018, and April 25, 2018, in urban and rural communities in Zimbabwe. A factorial design was used to randomize participants to a combination of self-test price, distribution site, and promotional message. Individuals and their household members had to be at least 16 years old to be eligible for participation. This intention-to-treat population comprised 3996 participants. INTERVENTIONS Participants were given a voucher that could be redeemed for an HIV self-test within 1 month at varying prices (US 0−0-0−3) and distribution sites (clinics or pharmacies in urban areas, and retail stores or community health workers in rural areas). Vouchers included randomly assigned promotional messages that emphasized the benefits of HIV testing. MAIN OUTCOMES AND MEASURES Proportion of participants who obtained self-tests in each trial arm, measured by distributor records. RESULTS Among the 4000 individuals enrolled, 3996 participants were included. In total, the mean (SD) age was 35 (14.7) years, and most participants (2841 [71.1%]) were female. Self-testing demand was highly price sensitive; 260 participants (32.5%) who were offered free self-tests redeemed their vouchers, compared with 55 participants (6.9%) who were offered self-tests for US $0.50 (odds ratio [OR], 0.14; 95% CI, 0.10-0.19), a reduction in demand of more than 25 percentage points. Demand

HIV incidence by age and pre- and post-treatment time period.</p

Percentage of People Living with HIV 15–54 years who are aged 45–54, by sex and survey r... more Percentage of People Living with HIV 15–54 years who are aged 45–54, by sex and survey round.</p

New measure of adherence combining drug presence and NVP concentration while accounting ... more New measure of adherence combining drug presence and NVP concentration while accounting for interaction with TB medication.</p

Patterns of association between socio-demographic characteristics and a combined measure... more Patterns of association between socio-demographic characteristics and a combined measure of ART adherence (multinomial multivariate logistic regression).</p

Journal of the International AIDS Society

AIDS, 2018

Background: Research and intervention studies suggest that men face challenges in using HIV servi... more Background: Research and intervention studies suggest that men face challenges in using HIV services in sub-Saharan Africa. To address these challenges, quantitative measurements are needed to establish the individual-level determinants of masculine norms and their implications for HIV prevention and treatment programmes. Methods: Survey questions for four masculine norms identified in qualitative research were included in a general-population survey of 3116 men in east Zimbabwe, 2012-2013. Two sets of regression analyses were conducted in an structural equation modelling framework to examine: which sociodemographic characteristics were associated with high scores on each masculinity factor; and how high scores on these masculinity factors differed in their associations with sexual risk behaviour and use of HIV services. Findings: Sociodemographic characteristics associated with high factor scores differed between masculine norms. In HIV-negative men, more men with scores exceeding one standard deviation above the mean (high scorers) for antifemininity than men with scores under one standard deviation below the mean (low scorers) took steps to avoid infection (61 versus 54%, P < 0.01). Fewer high than low scorers on social status reported a recent HIV test (69 versus 74%, P ¼ 0.04). In HIV-positive men, more high scorers on sex drive had been diagnosed (85 versus 61%, P ¼ 0.02), were on antiretroviral treatment (91 versus 62%, P ¼ 0.04), and were in AIDS groups (77 versus 46% P ¼ 0.03). Conclusion: HIV treatment, prevention programmes looking to engage men must consider the multidimensionality of masculine norms. The scale developed in this study is robust and can be used by other large multipurpose surveys to examine masculine social norms.

BMJ open, Feb 28, 2018

Globally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is ... more Globally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is suboptimal. To improve uptake of HIV services by FSWs, it is important to identify potential inequalities in access and use of care and their determinants. Our aim is to investigate HIV treatment cascades for FSWs and non-sex workers (NSWs) in Manicaland province, Zimbabwe, and to examine the socio-demographic characteristics and intermediate determinants that might explain differences in service uptake. Data from a household survey conducted in 2009-2011 and a parallel snowball sample survey of FSWs were matched using probability methods to reduce under-reporting of FSWs. HIV treatment cascades were constructed and compared for FSWs (n=174) and NSWs (n=2555). Determinants of service uptake were identified a priori in a theoretical framework and tested using logistic regression. HIV prevalence was higher in FSWs than in NSWs (52.6% vs 19.8%; age-adjusted OR (AOR) 4.0; 95% CI 2.9 to 5.5)....