Publications
23 results found
Davis K, Pickles M, Gregson S, et al., 2023, The effect of universal testing and treatment for HIV on health-related quality of life – an analysis of data from the HPTN 071 (PopART) cluster randomised trial, SSM: Population Health, Vol: 23, Pages: 1-10, ISSN: 2352-8273
BackgroundHIV treatment has clear Health-Related Quality-of-Life (HRQoL) benefits. However, little is known about how Universal Testing and Treatment (UTT) for HIV affects HRQoL. This study aimed to examine the effect of a combination prevention intervention, including UTT, on HRQoL among People Living with HIV (PLHIV).MethodsData were from HPTN 071 (PopART), a three-arm cluster randomised controlled trial in 21 communities in Zambia and South Africa (2013–2018). Arm A received the full UTT intervention of door-to-door HIV testing plus access to antiretroviral therapy (ART) regardless of CD4 count, Arm B received the intervention but followed national treatment guidelines (universal ART from 2016), and Arm C received standard care. The intervention effect was measured in a cohort of randomly selected adults, over 36 months. HRQoL scores, and the prevalence of problems in five HRQoL dimensions (mobility, self-care, performing daily activities, pain/discomfort, anxiety/depression) were assessed among all participants using the EuroQol-5-dimensions-5-levels questionnaire (EQ-5D-5L). We compared HRQoL among PLHIV with laboratory confirmed HIV status between arms, using adjusted two-stage cluster-level analyses.ResultsAt baseline, 7,856 PLHIV provided HRQoL data. At 36 months, the mean HRQoL score was 0.892 (95% confidence interval: 0.887–0.898) in Arm A, 0.886 (0.877–0.894) in Arm B and 0.888 (0.884–0.892) in Arm C. There was no evidence of a difference in HRQoL scores between arms (A vs C, adjusted mean difference: 0.003, -0.001-0.006; B vs C: -0.004, -0.014-0.005). The prevalence of problems with pain/discomfort was lower in Arm A than C (adjusted prevalence ratio: 0.37, 0.14–0.97). There was no evidence of differences for other HRQoL dimensions.ConclusionsThe intervention did not change overall HRQoL, suggesting that raising HRQoL among PLHIV might require more than improved testing and treatment. However, PLHIV had fewer problems with p
Shamsuddin S, Davis K, Moorhouse L, et al., 2023, Relationship between psychological distress, health behaviours and future reports of hypertension among adults in East Zimbabwe: a cohort study, Open Heart, Vol: 10, Pages: 1-10, ISSN: 2053-3624
Introduction:Extensive cross-sectional evidence has demonstrated an association between psychological distress (PD) and hypertension. However, evidence on the temporal relationship is limited, especially in low- and middle-income countries. The role of health risk behaviours including smoking and alcohol consumption in this relationship is also largely unknown. The aim of this study was to investigate the association between PD and later development of hypertension, and how this association may have been influenced by health risk behaviours, among adults in east Zimbabwe.Methods:The analysis included 742 adults (aged 15-54 years) recruited by the Manicaland general population cohort study, who did not have hypertension at baseline in 2012-2013, and who were followed until 2018. In 2012-2013, PD was measured using the Shona Symptom Questionnaire, a screening tool validated for use in Shona speaking countries including Zimbabwe [cut-off point: 7]. Smoking, alcohol consumption, and use of drugs (health risk behaviours) were also self-reported. In 2018, participants reported if they had diagnosed with hypertension by a doctor or nurse. Logistic regression was used to assess the association between PD and hypertension.Results:In 2012, 10.4% of the participants had PD. The odds of new reports of hypertension were 2.04 times greater (95% confidence interval=1.16-3.59) among those with PD at baseline, after adjusting for sociodemographic and health risk behaviour variables. Female gender (adjusted odds ratio, AOR=5.57, 2.82-11.02), older age (AOR=2.72,1.66-4.45), and greater wealth (AOR=2.13, 1.06-4.29 more wealthy, 2.91, 1.26-6.72 most wealthy) were significant risk factors for hypertension. The odds ratio for the relationship between PD and hypertension did not differ substantially between models with and without health risk behaviours.Conclusion:PD was associated with an increased risk of later reports of hypertension in the Manicaland cohort. Integrating mental health a
Davis K, Moorhouse L, Maswera R, et al., 2023, Association between HIV status and payment for hypertension care in Manicaland, East Zimbabwe: a cross-sectional study, AIDSImpact 2023
Hall E, Davis K, Ohrnberger J, et al., 2023, PCR134 associations between HIV stigma and health-related quality of life among people living with HIV in Zambia and South Africa: a cross-sectional analysis of data from the HPTN 071 (POPART) study, ISPOR 2023, Publisher: Elsevier, Pages: S336-S337, ISSN: 1098-3015
Little is known about the relationship between HIV stigma and health-related quality of life (HRQoL) among people living with HIV (PLHIV). We aimed to explore associations between four HIV stigma outcomes and HRQoL among PLHIV and examined which HRQoL domains were most affected.
Dringus S, Davis K, Simms V, et al., 2023, Delivery of index-linked HIV testing for children: learnings from a qualitative process evaluation of the B-GAP study in Zimbabwe, BMC Infectious Diseases, Vol: 23, Pages: 1-10, ISSN: 1471-2334
BackgroundIndex-linked HIV testing for children, whereby HIV testing is offered to children of individuals living with HIV, has the potential to identify children living with undiagnosed HIV. The “Bridging the Gap in HIV Testing and Care for Children in Zimbabwe” (B-GAP) study implemented and evaluated the provision of index-linked HIV testing for children aged 2–18 years in Zimbabwe. We conducted a process evaluation to understand the considerations for programmatic delivery and scale-up of this strategy.MethodsWe used implementation documentation to explore experiences of the field teams and project manager who delivered the index-linked testing program, and to describe barriers and facilitators to index-linked testing from their perspectives. Qualitative data were drawn from weekly logs maintained by the field teams, monthly project meeting minutes, the project coordinator’s incident reports and WhatsApp group chats between the study team and the coordinator. Data from each of the sources was analysed thematically and synthesised to inform the scale-up of this intervention.ResultsFive main themes were identified related to the implementation of the intervention: (1) there was reduced clinic attendance of potentially eligible indexes due to community-based differentiated HIV care delivery and collection of HIV treatment by proxy individuals; (2) some indexes reported that they did not live in the same household as their children, reflecting the high levels of community mobility; (3) there were also thought to be some instances of ‘soft refusal’; (4) further, delivery of HIV testing was limited by difficulties faced by indexes in attending health facilities with their children for clinic-based testing, stigma around community-based testing, and the lack of familiarity of indexes with caregiver provided oral HIV testing; (5) and finally, test kit stockouts and inadequate staffing also constrained delivery of index-linked HIV testi
Davis K, Moorhouse L, Maswera R, et al., 2023, Association between symptoms of depression and sexual risk behaviours among young people in Manicaland, East Zimbabwe: a cohort study, AIDSImpact
Davis K, Moorhouse L, Maswera R, et al., 2023, Associations between HIV status and self-reported hypertension in a high HIV prevalence sub-Saharan African population: a cross-sectional study, BMJ Open, Vol: 13, ISSN: 2044-6055
Objectives: This study examined whether HIV status and antiretroviral therapy (ART)-exposure were associated with self-reported hypertension in Zimbabwe. Design: Study data were taken from a cross-sectional, general population survey, which included HIV testing (July 2018 – December 2019). Setting: The data were collected in Manicaland Province, Zimbabwe.Participants: 9,780 people aged 15 years and above were included. Outcome measure: Self-reported hypertension was the outcome measure. This was defined as reporting a previous diagnosis of hypertension by a doctor or nurse. After weighting of survey responses by age and sex using household census data, chi-squared tests and logistic regression were used to explore whether HIV status and ART-exposure were associated with self-reported hypertension.Results: The weighted prevalence of self-reported hypertension was 13.6% (95% Confidence Interval: 12.9%-14.2%) and the weighted prevalence of HIV was 11.1% (10.4%-11.7%). In univariable analyses, there was no evidence of a difference in the weighted prevalence of self-reported hypertension between people living with HIV (PLHIV) and HIV-negative people (14.1%, 11.9%-16.3% vs 13.3%, 12.6%-14.0%; p=0.503) or between ART-exposed and ART-naive PLHIV (14.8%, 12.0%-17.7% vs 12.8%, 9.1%-16.4%, p=0.388). Adjusting for socio-demographic variables in logistic regression did not alter this finding (odds ratios: HIV status: 0.88, 0.70-1.10, p=0.261; ART-exposure: 0.83, 0.53-1.30, p=0.411). Conclusions: Approximately one in seven PLHIV self-reported having hypertension, highlighting an important burden of disease. However, no associations were found between HIV status or ART-exposure and self-reported hypertension, suggesting that it will be valuable to focus on managing other risk factors for hypertension in this population. These findings should be fully accounted for as Zimbabwe re-orients its health system towards non-communicable disease control and management.
Tang R, Bharani T, Ding J, et al., 2022, When internships disappoint., Science, Vol: 378, Pages: 22-24, ISSN: 0036-8075
Davis K, Pickles M, Gregson S, et al., 2022, The effect of universal testing and treatment for HIV on health-related quality of life - data from the HPTN 071 (PopART) cluster randomised trial in Zambia and South Africa, AIDS 2022, Publisher: International AIDS Society, ISSN: 1758-2652
Shamsuddin S, Davis K, Moorhouse L, et al., 2022, Association between psychological distress and later reports of hypertension amongst adults in East Zimbabwe, 31st European Meeting on Hypertension and Cardiovascular Protection (ESH 2022), Publisher: Lippincott, Williams & Wilkins, Pages: e213-e213, ISSN: 0263-6352
Objective: Little is known about the temporal relationship between psychological distress (PD) and hypertension, especially in low-income countries. We assessed the association between PD and later development of hypertension among Zimbabwean adults, and the role of smoking, alcohol consumption and recreational drug use in this relationship.Design and method: Data were taken from the Manicaland Study, an open cohort study in east Zimbabwe. Participants aged 15–54 were surveyed in 2012/2013 and followed-up in 2018/19. At baseline, PD was assessed using the Shona Symptom Questionnaire, a screening tool developed and validated in Shona-speaking countries. Participants self-reported whether they were currently: smokers; took drugs for pleasure; or regularly visited bars and/or consumed over three alcoholic drinks per sitting. At baseline and follow-up, participants reported whether they had ever been diagnosed with hypertension by a doctor/nurse. We selected individuals who did not report hypertension at baseline and used logistic regression to examine associations between baseline PD and hypertension at follow-up, controlling for sociodemographic and economic confounders. We also explored the effect of including binary variables capturing smoking status, drug use and alcohol consumption in the model.Results: 742 participants who completed baseline and follow-up surveys, were not hypertensive at baseline, and had full covariate data, were included. At baseline, 10.4% of these had PD, and at follow-up 17.5% (overall) had developed hypertension. The odds of developing hypertension were 2.01 (95% Confidence Interval = 1.14–3.54) times higher among those with PD at baseline, after adjustment for sociodemographic and economic confounders (Table 1). Introducing smoking status, drug use and alcohol consumption into the model had little effect on our findings (adjusted Odds Ratio, aOR:2.04, 1.16–3.59) and we had little evidence that these behaviours were indep
Hall E, Davis K, Ohrnberger J, et al., 2022, Associations between HIV stigma and health-related quality of life among people living with HIV in Zambia and South Africa: Cross-sectional analysis of data from the HPTN071 (PopART) study, AIDS 2022
Chen JS, Huang CY, Lanke S, et al., 2022, Rules all PIs should follow., Science, Vol: 376, Pages: 24-26, ISSN: 0036-8075
Davis K, Moorhouse L, Maswera R, et al., 2021, Associations between HIV status and hypertension status in a high HIV prevalence population in Manicaland: a cross-sectional study of adults, 23rd International Workshop on Long-term Complications of HIV and SARS-CoV-2, Publisher: SAGE Publications, Pages: 35-36, ISSN: 1359-6535
Stapley J, Davis K, Dadirai T, et al., 2021, Impact of community-level ART coverage on HIV-related stigmatising attitude within a general population cohort in Manicaland, east Zimbabwe; a longitudinal study, 12th Annual International Conference on Stigma
Strachan S, Newson L, Nwokolo N, et al., 2021, “We are still here”: co-developing a guide to the menopause for women living with HIV, Dignified Menopause Summit
Davis K, Perez-Guzman P, Hoyer A, et al., 2021, Correction to: Association between HIV infection and hypertension: a global systematic review and meta-analysis of cross-sectional studies., BMC Medicine, Vol: 19, Pages: 228-228, ISSN: 1741-7015
Davis K, Muzariri K, Mangenah C, et al., 2021, Modelling the interaction between depression and HIV incidence in Manicaland, East Zimbabwe, Fast Track Cities 2021
Shibemba M, Chibowa T, Gordon C, et al., 2021, O16.5 Young women rising: connecting young women living with HIV in the UK, STi & HIV 2021 World Congress, Publisher: BMJ Publishing Group, Pages: A45-A45, ISSN: 1368-4973
Davis K, Perez Guzman P, Hoyer A, et al., 2021, Association between HIV infection and hypertension: a global systematic review and meta-analysis of cross-sectional studies, BMC Medicine, Vol: 19, ISSN: 1741-7015
Background:Improved access to effective antiretroviral therapy has meant that people living with HIV (PLHIV) are surviving to older ages. However, PLHIV may be ageing differently to HIV-negative individuals, with dissimilar burdens of non-communicable diseases, such as hypertension. While some observational studies have reported a higher risk of prevalent hypertension among PLHIV compared to HIV-negative individuals, others have found a reduced burden. To clarify the relationship between HIV and hypertension, we identified observational studies and pooled their results to assess whether there is a difference in hypertension risk by HIV status.Methods:We performed a global systematic review and meta-analysis of published cross-sectional studies that examined hypertension risk by HIV status among adults aged > 15 (PROSPERO: CRD42019151359). We searched MEDLINE, EMBASE, Global Health and Cochrane CENTRAL to August 23, 2020, and checked reference lists of included articles. Our main outcome was the risk ratio for prevalent hypertension in PLHIV compared to HIV-negative individuals. Summary estimates were pooled with a random effects model and meta-regression explored whether any difference was associated with study-level factors.Results:Of 21,527 identified studies, 59 were eligible (11,101,581 participants). Crude global hypertension risk was lower among PLHIV than HIV-negative individuals (risk ratio 0.90, 95% CI 0.85–0.96), although heterogeneity between studies was high (I2 = 97%, p < 0.0001). The relationship varied by continent, with risk higher among PLHIV in North America (1.12, 1.02–1.23) and lower among PLHIV in Africa (0.75, 0.68–0.83) and Asia (0.77, 0.63–0.95). Meta-regression revealed strong evidence of a difference in risk ratios when comparing North American and European studies to African ones (North America 1.45, 1.21–1.74; Europe 1.20, 1.03–1.40).Conclusions:Our findings suggest that the r
Davis K, Guzman PP, Gregson S, et al., 2020, Comparing the prevalence of hypertension by HIV status in sub-Saharan African adults: a systematic review and meta-analyses of cross-sectional studies, HIV Glasgow, Publisher: JOHN WILEY & SONS LTD, Pages: 70-70
Background: Some evidence from high-income countries (HICs) suggests that PLHIV experience a higher hypertension prevalence thanHIV-negative individuals. It is unclear whether this is the case in subSaharan Africa (SSA), where large-scale integration of hypertensionservices into HIV programmes is being considered. We examined thehypothesis that living with HIV is associated with higher hypertensionprevalence among adults in SSA.Materials and methods: A systematic review of MEDLINE, EMBASE,Global Health, Cochrane Database of Systematic Reviews, CochraneCentral Register of Controlled Trials and African Journals Online wasperformed, following PRISMA guidelines, to identify cross-sectionalstudies assessing hypertension prevalence in PLHIV and HIV-negativeindividuals >15 years, in SSA. Only studies defining hypertension as“study-ascertained blood pressure ≥140/90 mmHg”, or as “studyascertained blood pressure ≥140/90 mmHg and/or history of antihypertensive medication usage”, were included. Risk of bias assessmentsaddressed adequacy of sample sizes, participant selection and HIV andhypertension status measurement. Random effects models were usedto pool odds ratios (ORs) for prevalent hypertension.Results: We identified 1431 unique studies, of which 12 wereselected for quantitative analysis, providing data on 107 425 participants (49.4% to 69.6% female). The 12 studies collected data between2003 and 2015, in South Africa, Tanzania and Uganda. Risk of biaswas low to moderate, with participant selection a key source of bias.Hypertension prevalence ranged from 5.3% to 51.7% among PLHIVand 8.2% to 65.4% in HIV-negative individuals. Overall, hypertensionprevalence was 41% lower among PLHIV than HIV-negative individuals when using the ≥140/90 mmHg definition (n = 5, OR 0.59, 95%CI 0.55 to 0.64) and 34% lower when using the definition thatincluded medication (n = 7, OR 0.66, 95% CI 0.47 to 0.99).Conclusions: Robust studies comparing hypertension
Davis K, Moorhouse L, Maswera R, et al., 2020, Examining associations between HIV status and high blood pressure (hypertension) in a high HIV prevalence population in Manicaland, east Zimbabwe: a cross-sectional study of adults, HIV Glasgow, Publisher: JOHN WILEY & SONS LTD, Pages: 69-69
Background: Evidence from high‐income countries indicates that PLHIV experience a higher hypertension prevalence than HIV‐negative individuals. However, it is unclear whether this applies in sub‐Saharan Africa, where behaviour and healthcare access differ. It is also unclear whether reported differences in hypertension prevalence result from socio‐demographic differences between PLHIV and HIV‐negative individuals or from HIV infection and treatment. We analysed data from Manicaland, Zimbabwe, to test the hypothesis that PLHIV had a higher hypertension prevalence than HIV‐negative individuals and assess whether controlling for socio‐demographic factors affected this relationship.Materials and methods: A cross‐sectional study, including interviews and HIV testing, was performed at two urban sites, a town and a roadside trading area (07/2018 to 03/2019). All young women (15 to 24 years) and men (15 to 29 years), and a random sample of 2/3 of older adults were eligible. Individuals were considered hypertensive if they reported ever being diagnosed with hypertension by a doctor/nurse. Logistic regression was used to estimate odds ratios (ORs) for prevalent hypertension, controlling for socio‐demographic confounders. Weights were used in all analyses to compensate for unequal selection probabilities.Results: Among 3404 participants (2169 men; 1235 women), the weighted HIV prevalence was 10.8% (95% CI 9.7 to 11.9%). There were more women among PLHIV (PLHIV: 62.5%, 57.2 to 67.8%; HIV‐negative: 53.2%, 52.2% to 54.2%) and PLHIV were older (>45 years: PLHIV: 40%, 31.8% to 48.2%; HIV‐negative: 25.3%, 23.9% to 26.6%). Hypertension prevalence was higher among PLHIV (20.6%, 16.3% to 25.0%) than HIV‐negative individuals (16.4%, 15.1% to 17.6%; OR 1.33, 1.01 to 1.76, p = 0.048). However, hypertension prevalence was higher in older individuals and women, so after adjusting for age and gender the difference in hypertension between PLHIV and HIV‐negative individuals was non‐signific
Davis K, Perez-Guzman P, Hoyer A, et al., 2020, Comparing the prevalence of hypertension between HIV-positive and HIV-negative adults: a global systematic review and meta-analysis of cross-sectional studies, 22nd International Workshop on Co-morbidities and Adverse Drug Reactions in HIV, Publisher: SAGE PUBLICATIONS LTD, Pages: 45-46, ISSN: 1359-6535
Davis K, Lewis J, Liva-Pye K, et al., 2019, P462 Re-testing for chlamydia in the national chlamydia screening programme in Bristol, England: an analysis of surveillance data, Abstracts for the STI & HIV World Congress (Joint Meeting of the 23rd ISSTDR and 20th IUSTI), July 14–17, 2019, Vancouver, Canada, Publisher: BMJ Publishing Group, Pages: A215-A216, ISSN: 1368-4973
Background England’s National Chlamydia Screening Programme (NCSP) recommends that sexually active people <25 years test for Chlamydia trachomatis annually and on change of sexual partner. Since 2013, NCSP has also recommended re-testing three months after testing positive. We used a detailed dataset to investigate characteristics associated with repeated chlamydia testing.Methods We used surveillance data of community-based chlamydia testing (excluding online testing and specialist sexual health services) among men and women aged 15–24 years in the Bristol area, January 2011-December 2017. Repeat-testing was defined as returning for further testing within the Bristol area, at least 42 days after initially testing. Initial tests <3 months from December 2017 were excluded. We used logistic regression to compare odds of repeat-testing by initial test result, testing service, residence, initial test result and sexual risk behaviour, adjusted for age and whether the 2013 guidance was operating.Results 14.11% (n=76,758) of women and 7.81% (n=28,038) of men repeat-tested within the study period. Of those with a positive result, 31.21% (n=5,104) of women and 14.88% (n=2,386) of men repeat-tested. Repeat-testing was associated with positive initial tests (Females: Adjusted Odds Ratio 1.90, 95% Confidence Interval 1.76–2.05; Males: 1.98, 1.71–2.27), having ≥2 sexual partners in the last year (1.17, 1.11–1.23; 1.15, 1.02–1.31), having a new sexual partner in the last 3 months (1.31, 1.24–1.38; 1.55, 1.36–1.77), living in the city of Bristol (1.68, 1.57–1.80; 1.43, 1.25–1.65) and testing through Contraception and Sexual Health clinics, which can treat uncomplicated infections, rather than other settings (1.34, 1.28–1.41; 1.37, 1.23–1.53).Conclusion It was encouraging that initial positive tests and riskier sexual behaviour, which mean individuals are more likely to be infected, were associated wit
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.