Imperial College London

DrLouisaMoorhouse

Faculty of MedicineSchool of Public Health

Research Associate
 
 
 
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Contact

 

+44 (0)20 7594 3266l.moorhouse

 
 
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Location

 

Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
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26 results found

Thomas R, Galizzi MM, Moorhouse L, Nyamukapa C, Hallett TBet al., 2024, Do risk, time and prosocial preferences predict risky sexual behaviour of youths in a low-income, high-risk setting?, Journal of Health Economics, Vol: 93, Pages: 102845-102845, ISSN: 0167-6296

Young people in sub-Saharan Africa are particularly at high risk of sexually transmitted infections. Little is known about their preferences and even less about their association with risky sexual behaviour. We conducted incentivized economic experiments to measure risk, time and prosocial preferences in Zimbabwe. Preferences measured at baseline predict biomarker and self-reported measures of risky sexual behaviour gathered 12 months later. We find robust evidence that individuals more altruistic at baseline are more likely to be Herpes Simplex Virus Type-2 (HSV-2) positive 12 months later. Analysis by sex shows this association is driven by our sample of women. Having more sexual partners is associated with greater risk tolerance amongst men and greater impatience amongst women. Results highlight heterogeneity in the association between preferences and risky sexual behaviour.

Journal article

Pickles M, Gregson S, Moorhouse L, Dadirai T, Dzamatira F, Mandizvidza P, Maswera R, Museka T, Schaefer R, Skovdal M, Thomas R, Tsenesa B, Mugurungi O, Nyamukapa C, Hallett Tet al., 2023, Strengthening the HIV prevention cascade to maximise epidemiological impact in Eastern Zimbabwe: a modelling study, The Lancet Global Health, Vol: 11, Pages: e1105-e1113, ISSN: 2214-109X

Background HIV prevention cascades provide a systematic understanding of barriers to prevention. In this study we use mathematical modelling to understand the consequences of these barriers and how the cascade could be strengthened to maximise epidemiological impact, providing potentially important insights for programmes. Methods We use an individual-based model of HIV transmission (PopART-IBM), calibrated to cohort data from eastern Zimbabwe. HIV prevention cascade estimates from this cohort are used as probabilities for indicators in the model representing an individual’s ‘motivation’, ‘access’ and ‘capacity to use effectively’ pre-exposure prophylaxis, voluntary male medical circumcision and condom use. We examine how current barriers affect the number and distribution of HIV infections compared to a no-barrier scenario. Using assumptions about how interventions could strengthen the HIV prevention cascade, we estimate the reduction in HIV infections over a ten-year period through addressing different elements of the cascade.Findings 22,000 new potentially ‘avertable’ HIV infections will occur over the next ten years due to existing HIV prevention cascade barriers, 74·2% of the 28,000 new infections that would occur with existing barriers in a population of approximately 1·2 million adults. Removing these barriers would reduce HIV incidence below the benchmarks for epidemic elimination. Addressing all cascade steps in one priority population is much more impactful than addressing one step across all populations. Interpretation Interventions exists in eastern Zimbabwe to reduce HIV towards elimination, but barriers of motivation, access and effective use prevent their full effect being realised. Interventions need to be multi-layered, and address all steps along the HIV prevention cascade. Models incorporating the HIV prevention cascade can help identify the main barriers to greater impact.Funding

Journal article

Shamsuddin S, Davis K, Moorhouse L, Mandizvidza P, Maswera R, Dadirai T, Nyamukapa C, Gregson S, Chigogora Set 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

Journal article

Davis K, Moorhouse L, Maswera R, Mandizvidza P, Dadirai T, Moyo B, Nyamukapa C, Mugurungi O, Gregson Set al., 2023, Association between HIV status and payment for hypertension care in Manicaland, East Zimbabwe: a cross-sectional study, AIDSImpact 2023

Conference paper

Ansari A, Vincent JP, Moorhouse L, Shimakawa Y, Nayagam Set al., 2023, Risk of early horizontal transmission of hepatitis B virus in children of uninfected mothers in sub-Saharan Africa: a systematic review and meta-analysis, The Lancet Global Health, Vol: 11, Pages: e715-e728, ISSN: 2214-109X

BackgroundSub-Saharan Africa is highly endemic for hepatitis B virus (HBV); historically, most people were exposed during childhood through vertical or horizontal transmission. Although all African countries now provide a three-dose infant hepatitis B vaccination starting at age 6–8 weeks, only a third of African countries have introduced birth dose (HepB-BD) vaccine. Adding HepB-BD is fundamental to prevent vertical transmission, but its effectiveness in preventing horizontal transmission, compared with the three-dose infant vaccination alone, is unknown. We aimed to estimate the risk of early horizontal transmission in children of hepatitis B surface antigen (HBsAg)-negative mothers in sub-Saharan Africa stratified according to the vaccination schedule.MethodsIn this systematic review and meta-analysis we searched MEDLINE, Global Health, Embase, African Index Medicus and African Journals Online from their inception to Oct 24, 2022, for studies reporting HBsAg or HBV DNA, or both, in children (aged 0–5 years) of HBsAg-negative mothers. We excluded studies if children were only tested at birth. Two reviewers independently screened the titles and abstracts of all articles and data were extracted using a standardised pre-piloted data extraction sheet, and authors were contacted if any important information was missing. The primary outcome was the risk of HBV infection in children of HBsAg-negative mothers, stratified by vaccination schedule (no vaccination, first dose at 6–8 weeks, or first dose at birth). We pooled the child risks of HBsAg or HBV DNA-positivity from the age of 0 years to 5 years via a random-effect meta-analysis using a generalised linear mixed model. The study was registered on PROSPERO, CRD42021236203.FindingsOf 8856 articles identified, 27 studies evaluating 10 003 children of HBsAg-negative mothers were included. The pooled risks of infection were 6·16% (95% CI 3·05–12·04; 155/1407) in the no vaccinati

Journal article

Davis K, Moorhouse L, Maswera R, Mandizvidza P, Dadirai T, Dzamatira F, Nyamukapa C, Pickles M, Gregson Set al., 2023, Association between symptoms of depression and sexual risk behaviours among young people in Manicaland, East Zimbabwe: a cohort study, AIDSImpact

Conference paper

Davis K, Moorhouse L, Maswera R, Mandizvidza P, Dadirai T, Museka T, Nyamukapa C, Smit M, Gregson Set 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.

Journal article

Rao A, Moorhouse L, Maswera R, Dadirai T, Mandizvidza P, Nyamukapa C, Nayagam S, Gregson Set al., 2022, Status of the HIV epidemic in Manicaland, east Zimbabwe prior to the outbreak of the COVID-19 pandemic, PLoS One, Vol: 17, Pages: 1-19, ISSN: 1932-6203

BackgroundManicaland province in eastern Zimbabwe has a high incidence of HIV. Completion of the seventh round of the Manicaland Survey in 2018–2019 provided the opportunity to assess the state of the epidemic prior to the start of the COVID-19 pandemic. The study aims were to: a) estimate HIV seroprevalence and assess whether prevalence has declined since the last round of the survey (2012–2013), b) describe and analyse the socio-demographic and behavioural risk factors for HIV infection and c) describe the HIV treatment cascade.MethodsParticipants were administered individual questionnaires collecting data on socio-demographic characteristics, sexual relationships, HIV prevention methods and treatment access, and were tested for HIV. Descriptive analyses were followed by univariate and multivariate analyses of risk factors for HIV seropositvity using logistic regression modelling based on the proximate-determinants framework.ResultsHIV prevalence was 11.3% [95% CI; 10.6–12.0] and was higher in females than males up to 45–49 years. Since 2012–2013 HIV prevalence has significantly declined in 30–44 year-olds in males, and 20–44 year-olds in females. The HIV epidemic has aged since 2012–2013, with an increase in the mean age of HIV positive persons from 38 to 41 years. Socio-demographic determinants of HIV prevalence were church denomination in males, site-type, wealth-status, employment sector and alcohol use in females, and age and marital status in both sexes. Behavioural determinants associated with increased odds of HIV were a higher number of regular sexual partners (lifetime), non-regular sexual partners (lifetime) and condom use in both sexes, and early sexual debut and concomitant STIs in females; medical circumcision was protective in males. HIV status awareness among participants testing positive in our study was low at 66.2%. ART coverage amongst all participants testing positive for HIV in our study was 65.

Journal article

Davis K, Pickles M, Gregson S, Hargreaves J, Ayles H, Bock P, Pliakas T, Thomas R, Ohrnberger J, Bwalya J, Bell-Mandla N, Shanaube K, Probert W, Hoddinott G, Bond V, Hayes R, Fidler S, Hauck Ket 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

Conference paper

Gregson S, Dadirai T, Maswera R, Moorhouse L, Museka T, Mandizvidza P, Dzamatira F, Tsenesa B, Nyamukapa C, Skovdel Met al., 2022, Survey measurements of community norms on adolescent girls and young women's (AGYW) sexual behaviour and use of condoms for HIV prevention in Manicaland, East Zimbabwe, 24th International AIDS Conference, Publisher: International AIDS Society, Pages: 88-88, ISSN: 1758-2652

Background: Qualitative data suggest pre-marital sex stigma presents a major obstacle to AGYW's use of HIV prevention methods. Lack of social acceptability therefore is included as a barrier to motivation to use condoms in HIV prevention cascades. Representative survey data on community norms are rare but necessary to test the validity of this assumption and measure their contributions to gaps in prevention cascades. Methods: General-population survey participants in Manicaland (ages≥15,N = 9803) were asked if they agreed/disagreed with statements on social norms. AGYW were asked whether community views are an obstacle to their using condoms. Proportions agreeing/disagreeing with these statements were calculated, variations in community members’ views were investigated in multivariable logistic-regression models, and the association between AGYW's perceiving negative community norms and condom use was measured.Results: 93.5%(95%CI,93%-94%) of respondents agreed that ‘Many young women have sex before marriage these days’. 57%(56%-59%) of men and 70%(69%-71%) of women disagreed that ‘If I have a teenage daughter and she has sex before marriage, I would be ok with this’; and 41%(40%-43%) of men and 57%(56%-59%) of women disagreed that ‘If I have a teenage daughter, I would tell her about condoms’. Fathers but not mothers were more likely to disagree with their daughters having sex before marriage (Figure). Similar proportions of parents and other community members were against telling daughters about condoms. 68%(61%-75%) of sexually-active unmarried AGYW said negative community views were unimportant in decisions to use condoms. Condom use didn't differ between those who agreed/disagreed that negative community views are important (46.9% vs. 50.0%; AOR = 0.88, 95%CI, 0.48–1.62; N = 202).Conclusions: Community resistance to condom promotion based on pre-marital sex stigma may be weakening as a barrier to AGYW's motivat

Conference paper

Shamsuddin S, Davis K, Moorhouse L, Mandizvida P, Dadirai T, Maswera R, Nyamukapa C, Gregson S, Chigogora Set 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

Conference paper

Shamsuddin S, Davis K, Moorhouse L, Mandizvidza P, Dadirai T, Nyamukapa C, Gregson S, Chigogora Set al., 2022, ASSOCIATION BETWEEN PSYCHOLOGICAL DISTRESS AND LATER REPORTS OF HYPERTENSION AMONG ADULTS IN EAST ZIMBABWE, 31st Annual Scientific Meeting of the European-Society-of-Hypertension (ESH) on Hypertension and Cardiovascular Protection, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E213-E213, ISSN: 0263-6352

Conference paper

Shamsuddin S, Davis K, Moorhouse L, Mandizvidza P, Dadirai T, Nyamukapa C, Gregson S, Chigogora Set al., 2022, ASSOCIATION BETWEEN PSYCHOLOGICAL DISTRESS AND LATER REPORTS OF HYPERTENSION AMONG ADULTS IN EAST ZIMBABWE, 31st Annual Scientific Meeting of the European-Society-of-Hypertension (ESH) on Hypertension and Cardiovascular Protection, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E213-E213, ISSN: 0263-6352

Conference paper

Moorhouse L, Schaefer R, Eaton JW, Dadirai T, Maswera R, Museka T, Mandizvidza P, Dzamatira F, Tsenesa B, Hallett TB, Nyamukapa C, Gregson Set al., 2022, Male partners' influence on adolescent girls and young women's use of combination HIV prevention: insights from analysis of HIV-prevention cascade data collected in a general-population survey in Manicaland, Zimbabwe, AIDS 2022

Conference paper

Goodwin T, Gregson S, Maswera R, Moorhouse L, Nyamukapa Cet al., 2021, Understanding the determinants and consequences of HIV status disclosure in Manicaland, Zimbabwe: cross-sectional and prospective analyses, AIDS Care: psychological and socio-medical aspects of AIDS-HIV, Vol: 33, Pages: 1577-1594, ISSN: 0954-0121

Few longitudinal studies have measured trends and effects of disclosure over ART scale-up in general-population samples. We investigated levels, determinants and outcomes of disclosure to relatives and partners in a large general-population cohort in Zimbabwe. Trends in disclosure levels from 2003-2013 were analysed, and multivariable logistic regression was used to identify determinants. Longitudinal analyses were conducted testing associations between disclosure and prevention/treatment-related outcomes. Disclosure to anyone increased from 79% to 100% in men and from 63% to 98% in women from 2003-2008; but declined to 89% in both sexes in 2012-2013. More women than men disclosed to relatives (67.8% versus 44.4%; p<0.001) but fewer women disclosed to partners (85.3% versus 95.0%; p<0.001). In 2012-13, younger age, secondary/higher education, being single, and experience of stigma were associated with disclosure to relatives in both sexes. Partner characteristics and HIV-group attendance were associated with disclosure to partners for women. Reactions to disclosure were generally supportive but less so for females than males disclosing to partners (92.0% versus 97.4%). Partner disclosure was associated with greater social support and treatment adherence in females. To conclude, this study shows disclosure is vital to HIV prevention and treatment, and programmes to facilitate disclosure should be re-invigorated.

Journal article

Chang A, Maswera R, Moorhouse L, Nyamukapa C, Skovdal M, Gregson Set al., 2021, The determinants and impacts of age-disparate relationships on women in Zimbabwe: A life course perspective, Social Science and Medicine – Population Health, Vol: 16, Pages: 1-9, ISSN: 2352-8273

Age-disparate relationships (ADR) with older men have been studied mostly in the context of HIV and found to be associated with increased HIV prevalence among young women in sub-Saharan Africa. Less is known about the impact of ADR on the broader life course of women. The objectives of this study are to identify the factors associated with being in ADR and estimate the association between ADR and a set of life outcomes in Manicaland, Zimbabwe. We used data from a general population open-cohort survey from 1998 to 2013 in Manicaland. We applied binary logistic regression models to estimate the odds ratios for association between socio-demographic determinants and ADR and multinomial logistic regression models to estimate the association between ADR and women's life outcomes. We found that women with less education, younger age at first sex and first marriage were more likely to be in ADR, and women in ADR have male partners with less education and less skilled employment. In terms of life and relationship outcomes, women in ADR had mostly negative life outcomes compared to women not in ADR. Future policies and research on ADR in women should reflect these complexities and study a wider range of life outcomes, beyond the commonly studied narrower topics such as HIV.

Journal article

, 2021, Abstracts, Antiviral Therapy, Vol: 26, Pages: 1-51, ISSN: 1359-6535

Journal article

Davis K, Moorhouse L, Maswera R, Mandizvidza P, Dadirai T, Museka T, Nyamukapa C, Smit M, Gregson Set 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

Conference paper

Stapley J, Davis K, Dadirai T, Moorhouse L, Eaton J, Maswera R, Nyamukapa C, Gregson Set 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

Conference paper

Risher K, Cori A, Reniers G, Marston M, Calvert C, Crampin A, Dadirai T, Dube A, Gregson S, Herbst K, Lutalo T, Moorhouse L, Mtenga B, Nabukalu D, Newton R, Price AJ, Tlhajoane M, Todd J, Tomlin K, Urassa M, Vandormael A, Fraser C, Slaymaker E, Eaton Jet al., 2021, Age patterns of HIV incidence in eastern and southern Africa: a collaborative analysis of observational general population cohort studies, The Lancet HIV, Vol: 8, Pages: e429-e439, ISSN: 2405-4704

Background: As the HIV epidemic in sub-Saharan Africa matures, evidence about the age distribution of new HIV infections and how this has changed over the epidemic is needed to guide HIV prevention. We assessed trends in age-specific HIV incidence in six population-based cohort studies in eastern and southern Africa, reporting changes in average age at infection, age distribution of new infections, and birth cohort cumulative incidence. Methods: We used a Bayesian model to reconstruct age-specific HIV incidence from repeated observations of individuals’ HIV serostatus and survival collected among population HIV cohorts in rural Malawi, South Africa, Tanzania, Uganda, and Zimbabwe. The HIV incidence rate by age, time and sex was modelled using smooth splines functions. Incidence trends were estimated separately by sex and study. Estimated incidence and prevalence results for 2000-2017, standardised to study population distribution, were used to estimate average age at infection and proportion of new infections by age. Findings: Age-specific incidence declined at all ages, though the timing and pattern of decline varied by study. The average age at infection was higher in men (cohort means: 27·8-34·6 years) than women (cohort means: 24·8-29·6 years). Between 2000 and 2017, the average age at infection increased slightly: cohort means 0·5-2·8 years among men and -0·2-2·5 years among women. Across studies, between 38-63%(cohort means)of women’s infections were among 15-24-year-olds and between 30-63% of men’s infections were in 20-29-year-olds. Lifetime risk of HIV declined for successive birth cohorts. Interpretation: HIV incidence declined in all age groups and shifted slightly, but not dramatically, to older ages. Disproportionate new HIV infections occur among 15-24-year-old 4women and20-29-year-oldmen, supporting focused prevention in these groups. But 40-60% of infections were outside these

Journal article

Gregson S, Moorhouse L, Dadirai T, Sheppard H, Mayini J, Beckmann N, Skovdal M, Dzangare J, Moyo B, Maswera R, Pinsky B, Mharakurwa S, Francis I, Mugurungi O, Nyamukapa Cet al., 2021, Comprehensive investigation of sources of misclassification errors in routine HIV testing in Zimbabwe, Journal of the International AIDS Society, Vol: 24, ISSN: 1758-2652

IntroductionMisclassification errors have been reported in rapid diagnostic HIV tests (RDTs) in sub‐Saharan African countries. These errors 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) and wasted resources. Few national estimates or systematic quantifications of sources of errors have been produced. We conducted a comprehensive assessment of possible sources of misclassification errors in routine HIV testing in Zimbabwe.MethodsRDT‐based HIV test results were extracted from routine PMTCT programme records at 62 sites during national antenatal HIV surveillance in 2017. Positive‐ (PPA) and negative‐percent agreement (NPA) for HIV RDT results and the false‐HIV‐positivity rate for people with previous HIV‐positive results (“known‐positives”) were calculated using results from external quality assurance testing done for HIV surveillance purposes. Data on indicators of quality management systems, RDT kit performance under local climatic conditions and user/clerical errors were collected using HIV surveillance forms, data‐loggers and a Smartphone camera application (7 sites). Proportions of cases with errors were compared for tests done in the presence/absence of potential sources of errors.ResultsNPA was 99.9% for both pregnant women (N = 17224) and male partners (N = 2173). PPA was 90.0% (N = 1187) and 93.4% (N = 136) for women and men respectively. 3.5% (N = 1921) of known‐positive individuals on ART were HIV negative. Humidity and temperature exceeding manufacturers’ recommendations, particularly in storerooms (88.6% and 97.3% respectively), and premature readings of RDT output (56.0%) were common. False‐HIV‐negative cases, including interpretation errors, occurred despite staff training and good algorithm compliance, and were not reduced by existing external or internal quality assurance procedures. PPA was l

Journal article

Davis K, Moorhouse L, Maswera R, Nyamukapa C, Smit M, Gregson Set 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

Conference paper

Thomas R, Skovdal M, Gallizzi M, Schaefer R, Moorhouse L, Nyamukapa C, Maswera R, Mandizvidza P, Hallett T, Gregson Set al., 2020, Improving risk perception and uptake of voluntary medical male circumcision with peer-education sessions and incentives, in Manicaland, East Zimbabwe: study protocol for a pilot randomised trial, Trials, Vol: 21, ISSN: 1745-6215

BackgroundVoluntary 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 is limited evidence on how a combination of social learning from peer education by a role model with different behavioural incentives influences demand for VMMC in such settings.Methods/DesignThis matched-cluster randomised controlled trial with 1740 participants will compare two behavioural incentives against a control with no intervention. In the intervention clusters, participants will participate in an education session delivered by a circumcised young male (“role model”) on the risks of HIV infection and the benefits from medical male circumcision. All participants will receive contributions towards transport costs to access medical male circumcision at participating clinics. Via blocked randomisation, in the intervention clusters participants will be randomly assigned to receive one of two types of incentives – fixed cash payment or lottery payment – both conditional on undergoing surgical VMMC. In two sites, a community-led intervention will also be implemented to address social obstacles and to increase support from peers, families and social structures. Baseline measures of endpoints will be gathered in surveys. Follow-up assessment at 6 months will include self-reported uptake of VMMC triangulated with clinic data.DiscussionThis is the first trial to pilot-test social learning to improve risk perception and self-efficacy and to address the fear of pain associated with VMMC and possible present-biased preferences with front-loaded compensations as well as fixed or lottery-based cash payments. This study will generate important knowledge to inform HIV-prevention policies about the effectiveness of behavioural interventions and incentives, which could be easily scaled-up.Trial registrationThis tria

Journal article

Thomas R, Skovdal M, Galizzi MM, Schaefer R, Moorhouse L, Nyamukapa C, Maswera R, Mandizvidza P, Hallett T, Gregson Set al., 2019, Improving risk perception and uptake of pre-exposure prophylaxis (PrEP) through interactive feedback-based counselling with and without community engagement in young women in Manicaland, East Zimbabwe: study protocol for a pilot randomized trial, Trials, Vol: 20, ISSN: 1745-6215

BackgroundHIV incidence in adolescent girls and young women remains high in sub-Saharan Africa. Progresstowards uptake of HIV prevention methods remains low. Studies of oral PrEP have shown that uptakeand adherence may be low due to low risk perception and ambivalence around using antiretroviralsfor prevention. No evidence exists on whether an interactive intervention aimed at adjusting riskperception and addressing the uncertainty around PrEP will improve uptake. This pilot research trialaims to provide an initial evaluation of the impact of an interactive digital tablet-based counsellingsession, correcting risk perception and addressing ambiguity around availability, usability andeffectiveness of PrEP.Methods/DesignThis is a matched-cluster randomised controlled trial which will compare an interactive tablet-basededucation intervention against a control with no intervention. The study will be implemented in eightsites. In each site, two matched clusters of villages will be created. One cluster will be randomlyallocated to intervention. In two sites a community engagement intervention will also be implementedto address social obstacles and to increase support from peers, families and social structures. 1,200HIV-negative young women 18-24 years, not on PrEP at baseline will be eligible. Baseline measures ofendpoints will be gathered in surveys. Follow-up assessment at six months will include bio-markers ofPrEP uptake and surveys.DiscussionThis will be the first randomized controlled trial to determine whether interactive feedbackcounselling leads to uptake of HIV prevention methods such as PrEP and reduces risky sexualbehaviour. If successful, policymakers could consider such an intervention in school-based educationcampaigns or as post- HIV-testing counselling for young people.Trial RegistrationThis trial has been registered on clinicaltrials.gov on 21/06/2018 (identifier: NCT03565575).https://clinicaltrials.gov/ct2/show/NCT03565575

Journal article

Moorhouse L, Schaefer R, Thomas R, Nyamukapa C, Skovdal M, Hallett T, Gregson Set al., 2019, Application of the HIV prevention cascade to identify, develop,and evaluate interventions to improve use of prevention methods:Examples from a study in east Zimbabwe, Journal of the International AIDS Society, Vol: 22, Pages: 86-92, ISSN: 1758-2652

Introduction: The HIV prevention cascade could be used in developing interventions to strengthen implementation of efficacious HIV prevention methods but its practical utility needs to be demonstrated. We propose a standardised approach to using the cascade to guide identification and evaluation of interventions and demonstrate its feasibility through a project to develop interventions to improve use of HIV prevention methods by adolescent girls and young women (AGYW) and potential male partners in east Zimbabwe.Discussion: We propose a six-step approach to using a published generic HIV prevention cascade formulation to develop interventions to increase motivation to use, access to and effective use of an HIV prevention method. The six steps are: (1) measure the HIV prevention cascade for the chosen population and method; (2) identify gaps in the cascade; (3) identify explanatory factors (barriers) contributing to observed gaps; (4) review literature to identify relevant theoretical frameworks and interventions; (5) tailor interventions to the local context; and (6) implement and evaluate the interventions using the cascade steps and explanatory factors as outcome indicators in the evaluation design. In the Zimbabwe example, steps 1-5 aided development of four interventions to overcome barriers to effective use of PrEP in AGYW (15-24 years) and VMMC in male partners (15-29). For young men, prevention cascade analyses identified gaps in motivation and access (due to transport costs/lost income) as barriers to VMMC uptake, so an intervention was designed including financial incentives and an education session. For AGYW, gaps in motivation (particularly lack of risk perception) and access were identified as barriers to PrEP uptake: an interactive counselling game was developed addressing these barriers. A text messaging intervention was developed to improve adherence to PrEP among AGYW, addressing reasons underlying lack of effective PrEP use through improving the capa

Journal article

McGuinness LA, Warren-Gash C, Moorhouse LR, Thomas SLet al., 2019, The validity of dementia diagnoses in routinely collected electronic health records in the United Kingdom: A systematic review., Pharmacoepidemiol Drug Saf, Vol: 28, Pages: 244-255

PURPOSE: The purpose of the study is to assess the validity of codes or algorithms used to identify dementia in UK electronic health record (EHR) primary care and hospitalisation databases. METHODS: Relevant studies were identified by searching the MEDLINE/EMBASE databases from inception to June 2018, hand-searching reference lists, and consulting experts. The search strategy included synonyms for "Dementia", "Europe", and "EHR". Studies were included if they validated dementia diagnoses in UK primary care or hospitalisation databases, irrespective of validation method used. The Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess risk of bias. RESULTS: From 1469 unique records, 14 relevant studies were included. Thirteen validated individual diagnoses against a reference standard, reporting high estimates of validity. Most reported only the positive predictive value (PPV), with estimates ranging between 0.09 and 1.0 and 0.62 and 0.85 in primary care and hospitalisation databases, respectively. One study performed a rate comparison, indicating good generalisability of dementia diagnoses in The Health Improvement Network (THIN) database to the UK population. Studies were of low methodological quality. As studies were not comparable, no summary validity estimates were produced. CONCLUSION: While heterogenous across studies, reported validity estimates were generally high. However, the credibility of these estimates is limited by the methodological quality of studies, primarily resulting from insufficient blinding of researchers interpreting the reference test. Inadequate reporting, particularly of the specific codes validated, hindered comparison of estimates across studies. Future validation studies should make use of more robust reference tests, follow established reporting guidelines, and calculate all measures of validity.

Journal article

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