Objective: Age-disparate sexual relationships with older men may drive high rates of HIV acquisition in young women sub-Saharan Africa, but evidence is limited. We investigate the association between age-disparate and incidence Manicaland, Zimbabwe. Design: A general-population open-cohort study (six surveys) (1998–2013). Methods: total 3746 aged 15–24 years participated consecutive surveys were HIV-negative at beginning intersurvey periods. Last partner age difference [intergenerational...

An individual's HIV risk, and consequently their prevention needs, change over time. In this study we aimed to quantify these changes, examine which life-course events were associated with them, investigate the extent those acquisition. We used longitudinal data from eight rounds of a general population cohort in Manicaland province, eastern Zimbabwe, on sociodemographic risk behaviours, as well serostatus first seven rounds. visualised how comprised having multiple, concurrent, non-regular,...

Purpose The Manicaland cohort was established to provide robust scientific data on HIV prevalence and incidence, patterns of sexual risk behaviour the demographic impact in a sub-Saharan African population subject generalised epidemic. aims were later broadened include provision coverage effectiveness national control programmes including antiretroviral therapy (ART). Participants General open located 12 sites Manicaland, east Zimbabwe, representing 4 major socioeconomic strata (small towns,...

Abstract Background In sub-Saharan Africa, adolescent girls and young women (AGYW) are at high risk of acquiring HIV. A growing number African countries beginning to avail pre-exposure prophylaxis, or PrEP, but with limited success. Unpacking strategies overcome barriers the uptake PrEP is critical prevent HIV amongst AGYW. This article explores health professionals’ views recommendations on what required increase PrEP. Methods The study draws interview data from 12 providers prevention...

Abstract Background Perceiving a personal risk for HIV infection is considered important engaging in prevention behaviour and often targeted interventions. However, there limited evidence assumed causal relationships between perception the degree to which change attributable poorly understood. This study examines longitudinal changes condom use public health importance of changing perception. Methods Data on sexually active, HIV-negative adults (15–54 years) were taken from four surveys...

Abstract Background Pre-exposure prophylaxis, or PrEP, has been hailed for its promise to provide women with user-control. However, gender-specific challenges undermining PrEP use are beginning emerge. We explore the role of gender norms in shaping adolescent girls and young women’s (AGYW) engagement PrEP. Methods draw on qualitative data from 12 individual interviews three focus group discussions AGYW eastern Zimbabwe. Interviews were transcribed thematically coded NVivo 12. Emerging themes...

HIV-negative adolescent girls and young women (AGYW), male partners, have disproportionately high HIV incidence in many African countries. We used a new Prevention Cascade (HPC) approach to quantify levels of, barriers to, prevention method use guide interventions increase effective uptake of primary prevention. Data from the Manicaland HPC pilot study (2018-19; N=9803) Zimbabwe were measure sexual risk behaviour construct HPCs for condom, PrEP (females), VMMC (males) combination by...

<ns3:p>Background Gender norms against adolescent girls and young women (AGYW)’s having pre-marital sex using condoms in marriage are included as barriers to motivation use HIV prevention cascades. Representative data on gender needed test this assumption. Methods General-population survey participants Manicaland, Zimbabwe (ages≥15, N=9803) reported agreement/disagreement with statements norms. AGYW at risk of infection whether community views discouraged condom use. Multivariable logistic...

Risk perception for HIV infection is an important determinant engaging in prevention behaviour. We investigate the degree to which risk accurate, i.e. corresponds actual risks, a general-population open-cohort study Zimbabwe (2003–2013) including 7201 individuals over 31,326 person-years. future (no/yes) at beginning of periods between two surveys was associated with increased (Cox regression hazard ratio = 1.38 [1.07–1.79], adjusting socio-demographic characteristics, sexual behaviour, and...

HIV prevention cascades provide a systematic understanding of barriers to prevention. In this study we used mathematical modelling understand the consequences these and how cascade could be strengthened maximise epidemiological impact, providing potentially important insights for programmes.

Abstract Background HIV incidence in adolescent girls and young women remains high sub-Saharan Africa. Progress towards uptake of prevention methods low. Studies oral pre-exposure prophylaxis (PrEP) have shown that adherence may be low due to low-risk perception ambivalence around using antiretrovirals for prevention. No evidence exists on whether an interactive intervention aimed at adjusting risk addressing the uncertainty PrEP will improve uptake. This pilot research trial aims provide...

Abstract Introduction Misclassification errors have been reported in rapid diagnostic HIV tests (RDTs) sub‐Saharan African countries. These can lead to missed opportunities for prevention‐of‐mother‐to‐child‐transmission (PMTCT), early infant diagnosis and adult HIV‐prevention, unnecessary lifelong antiretroviral treatment (ART) wasted resources. Few national estimates or systematic quantifications of sources produced. We conducted a comprehensive assessment possible misclassification routine...

This study examined whether HIV status and antiretroviral therapy (ART) exposure were associated with self-reported hypertension in Zimbabwe. Study data taken from a cross-sectional, general population survey, which included testing (July 2018-December 2019). The collected Manicaland Province, 9780 people aged 15 years above included. Self-reported was the outcome measure. defined as reporting previous diagnosis of by doctor or nurse. After weighting survey responses age sex using household...

This article examines how parental obligations of care intersect with HIV treatment-seeking behaviours and retention. It draws on qualitative data from eastern Zimbabwe, produced 65 interviews. Drawing theories practice ethics, our analysis revealed that norms obligation acted as key motivators for ongoing engagement services treatment. Parents’ attentiveness to the future needs their children ( caring about), sense taking of) improved ability caregiving) following treatment initiation,...

Background In the early phase of coronavirus disease 2019 (COVID-19) pandemic, health services were disrupted worldwide, including HIV prevention services. While some studies have begun to document effects COVID-19 on prevention, little has been done qualitatively examine how lockdown measures experienced and perceived affect access methods in sub-Saharan Africa.Objectives To explore pandemic was eastern Zimbabwe.Method This article draws qualitative data from first three collection points...

Disconcerting levels of misdiagnosis are common in point-of-care rapid HIV testing programmes sub-Saharan Africa. To investigate potential pathways to misdiagnosis, we interviewed 28 testers Zimbabwe and conducted weeklong observations at four facilities. Approaching adherence national algorithms as a social scripted practice, dependent on the integration certain competences, materials meanings, our thematic analysis revealed three underlying causes misdiagnosis: One, lack confidence using...

Intimate partner violence (IPV) is widespread in the WHO African region with generalised HIV epidemics and may contribute to ongoing transmission through its associations behaviours associated acquisition risk low use of prevention methods particularly marital relationships.

Voluntary medical male circumcision (VMMC) is a key component of combination HIV-prevention programmes. Several high-HIV-prevalence countries in sub-Saharan Africa, including Zimbabwe, are looking to scale up VMMC activities. There limited evidence on how social learning from peer education by role model with different behavioural incentives influences demand for such settings.

Research and intervention studies suggest that men face challenges in using HIV services sub-Saharan Africa. To address these challenges, quantitative measurements are needed to establish the individual-level determinants of masculine norms their implications for prevention treatment programmes.Survey questions four identified qualitative research were included a general-population survey 3116 east Zimbabwe, 2012-2013. Two sets regression analyses conducted an structural equation modelling...

Despite calls for "rapid adoption" of global health policies and treatment guidelines; there is little understanding the factors that help accelerate their adoption implementation. Drawing on in-depth interviews with sixteen Zimbabwean policymakers, we unpack how different factors, rhythmic experiences epochal practices come together to shape speeding up slowing down test-and-treat implementation in Zimbabwe. We present an empirically derived framework temporal analysis policy argue such can...

A growing number of studies highlight high levels misdiagnosis in the scale-up HIV rapid testing programmes, which often remain invisible to individual testers. Drawing on interviews with testers and observations four health facilities Zimbabwe, we show that navigated translation standardised, dis-embodied norms laboratory-based into body work point-of-care through ritualisation laboratory-practices their daily clinical work. Yet, this was interrupted challenging conditions face. They...

Few longitudinal studies have measured trends and effects of disclosure over ART scale-up in general-population samples. We investigated levels, determinants outcomes to relatives partners a large cohort Zimbabwe. Trends levels from 2003 2013 were analysed, multivariable logistic regression was used identify determinants. Longitudinal analyses conducted testing associations between prevention/treatment-related outcomes. Disclosure anyone increased 79% 100% men 63% 98% women 2008; but...