Publications
262 results found
Crea TM, Reynolds AD, Sinha A, et al., 2015, Effects of cash transfers on Children's health and social protection in Sub-Saharan Africa: differences in outcomes based on orphan status and household assets, BMC Public Health, Vol: 15, ISSN: 1471-2458
BackgroundUnconditional and conditional cash transfer programmes (UCT and CCT) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS (OVC). We address the gap in current understanding about the extent to which household-based cash transfers differentially impact individual children’s outcomes, according to risk or protective factors such as orphan status and household assets.MethodsData were obtained from a cluster-randomised controlled trial in eastern Zimbabwe, with random assignment to three study arms – UCT, CCT or control. The sample included 5,331 children ages 6-17 from 1,697 households. Generalized linear mixed models were specified to predict OVC health vulnerability (child chronic illness and disability) and social protection (birth registration and 90% school attendance). Models included child-level risk factors (age, orphan status); household risk factors (adults with chronic illnesses and disabilities, greater household size); and household protective factors (including asset-holding). Interactions were systematically tested.ResultsOrphan status was associated with decreased likelihood for birth registration, and paternal orphans and children for whom both parents’ survival status was unknown were less likely to attend school. In the UCT arm, paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans. Effects of study arms on outcomes were not moderated by any other risk or protective factors. High household asset-holding was associated with decreased likelihood of child’s chronic illness and increased birth registration and school attendance, but household assets did not moderate the effects of cash transfers on risk or protective factors.ConclusionOrphaned children are at higher risk for poor social protection outcomes even when cared for in family-based settings. UCT and CCT each produced direct effects on children’s social protection
Gregson S, Hallett TB, 2015, Population Structure and Public Health Research on HIV Control in Sub-Saharan Africa, Population in the Human Sciences: Concepts, Models, Evidence, ISBN: 9780199688203
The Human Immunodeficiency Virus type 1 (HIV-1) has been a major public health disaster in sub-Saharan Africa since the late 1970s. Early projections of HIV epidemics in Africa and their likely demographic consequences were criticized for failing to account for population age structure. With hindsight, age structure per se had relatively little influence on the size of epidemics. However, other aspects of population structure- particularly heterogeneities in sexual behaviour-have been key determinants in the scale and temporal dynamics of HIV epidemics. This chapter explains how an understanding of the influence of population structure on the dynamics of HIV epidemics is important in understanding observed trends in national epidemics, in evaluating the effectiveness of national control programmes, and in prioritizing intervention efforts.
Zaba B, Reniers G, Slaymaker E, et al., 2015, Understanding why people participate in HIV surveillance, BULLETIN OF THE WORLD HEALTH ORGANIZATION, Vol: 93, Pages: 356-357, ISSN: 0042-9686
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- Citations: 3
Campbell C, Andersen L, Mutsikiwa A, et al., 2015, Factors shaping the HIV-competence of two primary schools in rural Zimbabwe, International Journal of Educational Development, Vol: 41, Pages: 226-236, ISSN: 0738-0593
We present multi-method case studies of two Zimbabwean primary schools – one rural and one small-town. The rural school scored higher than the small-town school on measures of child well-being and school attendance by HIV-affected children. The small-town school had superior facilities, more teachers with higher morale, more specialist HIV/AIDS activities, and an explicit religious ethos. The relatively impoverished rural school was located in a more cohesive community with a more critically conscious, dynamic and networking headmaster. The current emphasis on HIV/AIDS-related teacher training and specialist school-based activities should be supplemented with greater attention to impacts of school leadership and the nature of the school-community interface on the HIV-competence of schools.
Campbell C, Andersen L, Mutsikiwa A, et al., 2015, Re-thinking children's agency in extreme hardship: Zimbabwean children's draw-and-write about their HIV-affected peers, HEALTH & PLACE, Vol: 31, Pages: 54-64, ISSN: 1353-8292
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- Citations: 15
Ward H, Gregson S, Watts C, et al., 2014, Translational Epidemiology: Developing and Applying Theoretical Frameworks to Improve the Control of HIV and Other Sexually Transmitted Infections, JOURNAL OF INFECTIOUS DISEASES, Vol: 210, Pages: S547-S548, ISSN: 0022-1899
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- Citations: 2
Eaton JW, Takavarasha FR, Schumacher CM, et al., 2014, Trends in Concurrency, Polygyny, and Multiple Sex Partnerships During a Decade of Declining HIV Prevalence in Eastern Zimbabwe, JOURNAL OF INFECTIOUS DISEASES, Vol: 210, Pages: S562-S568, ISSN: 0022-1899
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- Citations: 14
Elmes J, Nhongo K, Ward H, et al., 2014, The Price of Sex: Condom Use and the Determinants of the Price of Sex Among Female Sex Workers in Eastern Zimbabwe, JOURNAL OF INFECTIOUS DISEASES, Vol: 210, Pages: S569-S578, ISSN: 0022-1899
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- Citations: 36
Scott K, Campbell C, Madanhire C, et al., 2014, In what ways do communities support optimal antiretroviral treatment in Zimbabwe?, HEALTH PROMOTION INTERNATIONAL, Vol: 29, Pages: 645-654, ISSN: 0957-4824
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- Citations: 9
Pufall EL, Nyamukapa C, Eaton JW, et al., 2014, HIV in Children in a General Population Sample in East Zimbabwe: Prevalence, Causes and Effects, PLOS One, Vol: 9, ISSN: 1932-6203
Background: There are an estimated half-million children living with HIV in sub-Saharan Africa. The predominant source ofinfection is presumed to be perinatal mother-to-child transmission, but general population data about paediatric HIV aresparse. We characterise the epidemiology of HIV in children in sub-Saharan Africa by describing the prevalence, possiblesource of infection, and effects of paediatric HIV in a southern African population.Methods: From 2009 to 2011, we conducted a household-based survey of 3389 children (aged 2–14 years) in Manicaland,eastern Zimbabwe (response rate: 73.5%). Data about socio-demographic correlates of HIV, risk factors for infection, andeffects on child health were analysed using multi-variable logistic regression. To assess the plausibility of mother-to-childtransmission, child HIV infection was linked to maternal survival and HIV status using data from a 12-year adult HIV cohort.Results: HIV prevalence was (2.2%, 95% CI: 1.6–2.8%) and did not differ significantly by sex, socio-economic status, location,religion, or child age. Infected children were more likely to be underweight (19.6% versus 10.0%, p = 0.03) or stunted (39.1%versus 30.6%, p = 0.04) but did not report poorer physical or psychological ill-health. Where maternal data were available,reported mothers of 61/62 HIV-positive children were deceased or HIV-positive. Risk factors for other sources of infectionwere not associated with child HIV infection, including blood transfusion, vaccinations, caring for a sick relative, and sexualabuse. The observed flat age-pattern of HIV prevalence was consistent with UNAIDS estimates which assumes perinatalmother-to-child transmission, although modelled prevalence was higher than observed prevalence. Only 19/73 HIV-positivechildren (26.0%) were diagnosed, but, of these, 17 were on antiretroviral therapy.Conclusions: Childhood HIV infection likely arises predominantly from mother-to-child transmission and is associated wit
Campbell C, Scott K, Mupambireyi Z, et al., 2014, Community resistance to a peer education programme in Zimbabwe, BMC HEALTH SERVICES RESEARCH, Vol: 14, ISSN: 1472-6963
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- Citations: 8
Reniers G, Slaymaker E, Nakiyingi-Miiro J, et al., 2014, Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA), AIDS, Vol: 28, Pages: S533-S542, ISSN: 0269-9370
Background: The rollout of antiretroviral therapy (ART) is one of the largest public health interventions in Eastern and Southern Africa of recent years. Its impact is well described in clinical cohort studies, but population-based evidence is rare.Methods: We use data from seven demographic surveillance sites that also conduct community-based HIV testing and collect information on the uptake of HIV services. We present crude death rates of adults (aged 15–64) for the period 2000–2011 by sex, HIV status, and treatment status. Parametric survival models are used to estimate age-adjusted trends in the mortality rates of people living with HIV (PLHIV) before and after the introduction of ART.Results: The pooled ALPHA Network dataset contains 2.4 million person-years of follow-up time, and 39114 deaths (6893 to PLHIV). The mortality rates of PLHIV have been relatively static before the availability of ART. Mortality declined rapidly thereafter, with typical declines between 10 and 20% per annum. Compared with the pre-ART era, the total decline in mortality rates of PLHIV exceeds 58% in all study sites with available data, and amounts to 84% for women in Masaka (Uganda). Mortality declines have been larger for women than for men; a result that is statistically significant in five sites. Apart from the early phase of treatment scale up, when the mortality of PLHIV on ART was often very high, mortality declines have been observed in PLHIV both on and off ART.Conclusion: The expansion of treatment has had a large and pervasive effect on adult mortality. Mortality declines have been more pronounced for women, a factor that is often attributed to women's greater engagement with HIV services. Improvements in the timing of ART initiation have contributed to mortality reductions in PLHIV on ART, but also among those who have not (yet) started treatment because they are increasingly selected for early stage disease.
Stover J, Andreev K, Slaymaker E, et al., 2014, Updates to the Spectrum model to estimate key HIV indicators for adults and children, AIDS, Vol: 28, Pages: S427-S434, ISSN: 0269-9370
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- Citations: 56
Hallett TB, Zaba B, Stover J, et al., 2014, Embracing different approaches to estimating HIV incidence, prevalence and mortality, AIDS, Vol: 28, Pages: S523-S532, ISSN: 0269-9370
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- Citations: 12
Case KK, Hallett TB, Gregson S, et al., 2014, Development and future directions for the Joint United Nations Programme on HIV/AIDS estimates, AIDS, Vol: 28, Pages: S411-S414, ISSN: 0269-9370
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- Citations: 6
Haney E, Singh K, Nyamukapa C, et al., 2014, One size does not fit all: Psychometric properties of the Shona Symptom Questionnaire (SSQ) among adolescents and young adults in Zimbabwe, JOURNAL OF AFFECTIVE DISORDERS, Vol: 167, Pages: 358-367, ISSN: 0165-0327
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- Citations: 7
Skovdal M, Robertson L, Mushati P, et al., 2014, Acceptability of conditions in a community-led cash transfer programme for orphaned and vulnerable children in Zimbabwe, HEALTH POLICY AND PLANNING, Vol: 29, Pages: 809-817, ISSN: 0268-1080
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- Citations: 3
Pufall EL, Gregson S, Eaton JW, et al., 2014, The contribution of schools to supporting the well being of children affected by HIV in eastern Zimbabwe, AIDS, Vol: 28, Pages: S379-S387, ISSN: 0269-9370
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- Citations: 12
Campbell C, Andersen L, Mutsikiwa A, et al., 2014, Children's representations of school support for HIV-affected peers in rural Zimbabwe, BMC PUBLIC HEALTH, Vol: 14
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- Citations: 6
Pufall EL, Nyamukapa C, Eaton JW, et al., 2014, The impact of HIV on children's education in eastern Zimbabwe, AIDS Care, Vol: 26, Pages: 1136-1143, ISSN: 0954-0121
Little is known about how HIV impacts directly and indirectly on receiving, or particularly succeeding in, education in sub-Saharan Africa. To address this gap, we used multivariable logistic regression to determine the correlation between education outcomes in youth (aged 15–24) (being in the correct grade-for-age, primary school completion and having at least five “O” level passes) and being HIV-positive; having an HIV-positive parent; being a young carer; or being a maternal, paternal or double orphan, in five rounds (1998–2011) of a general population survey from eastern Zimbabwe. The fifth survey round (2009–2011) included data on children aged 6–17, which were analysed for the impacts of the above risk factors on regular attendance in primary and secondary schools and being in the correct grade-for-age. For data pooled over all rounds, being HIV-positive had no association with primary school completion, “O” level passes, or being in the correct grade-for-age in adolescents aged 16–17 years. Additionally, HIV status had no significant association with any education outcomes in children aged 6–17 surveyed in 2009–2011. In 2009–2011, being a young carer was associated with lower attendance in secondary school (69% vs. 85%, AOR: 0.44; p=0.02), whilst being a maternal (75% vs. 83%, AOR: 0.67; p<0.01), paternal (76% vs. 83%, AOR: 0.67; p=0.02) or double (75% vs. 83%, AOR: 0.68; p=0.02) orphan was associated with decreased odds of being in the correct grade-for-age. All forms of orphanhood also significantly decreased the odds of primary school completion in youths surveyed from 1998 to 2011 (all p<0.01). We found no evidence that HIV status affects education but further evidence that orphans do experience worse education outcomes than other children. Combination approaches that provide incentives for children to attend school and equip schools with tools to support vulnerable children may
Smith J, Nyamukapa C, Gregson S, et al., 2014, The Distribution of Sex Acts and Condom Use within Partnerships in a Rural Sub-Saharan African Population, PLOS ONE, Vol: 9, ISSN: 1932-6203
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- Citations: 8
Nhamo-Murire M, Campbell C, Gregson S, 2014, Community Group Membership and Stigmatising Attitudes Towards People Living with HIV in Eastern Zimbabwe, JOURNAL OF COMMUNITY HEALTH, Vol: 39, Pages: 72-82, ISSN: 0094-5145
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- Citations: 10
Robertson L, Mushati P, Skovdal M, et al., 2014, Involving Communities in the Targeting of Cash Transfer Programs for Vulnerable Children: Opportunities and Challenges, WORLD DEVELOPMENT, Vol: 54, Pages: 325-337, ISSN: 0305-750X
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- Citations: 13
Manzou R, Schumacher C, Gregson S, 2014, Temporal Dynamics of Religion as a Determinant of HIV Infection in East Zimbabwe: A Serial Cross-Sectional Analysis, PLOS ONE, Vol: 9, ISSN: 1932-6203
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- Citations: 15
Marston M, Newell ML, Crampin A, et al., 2013, Is the Risk of HIV Acquisition Increased during and Immediately after Pregnancy? A Secondary Analysis of Pooled HIV Community-Based Studies from the ALPHA Network, PLOS ONE, Vol: 8, ISSN: 1932-6203
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- Citations: 26
Byass P, Calvert C, Miiro-Nakiyingi J, et al., 2013, InterVA-4 as a public health tool for measuring HIV/AIDS mortality: a validation study from five African countries, Global Health Action, Vol: 6, ISSN: 1654-9880
Background: Reliable population-based data on HIV infection and AIDS mortality in sub-Saharan Africa are scanty, even though that is the region where most of the world’s AIDS deaths occur. There is therefore a great need for reliable and valid public health tools for assessing AIDS mortality.Objective: The aim of this article is to validate the InterVA-4 verbal autopsy (VA) interpretative model within African populations where HIV sero-status is recorded on a prospective basis, and examine the distribution of cause-specific mortality among HIV-positive and HIV-negative people.Design: Data from six sites of the Alpha Network, including HIV sero-status and VA interviews, were pooled. VA data according to the 2012 WHO format were extracted, and processed using the InterVA-4 model into likely causes of death. The model was blinded to the sero-status data. Cases with known pre-mortem HIV infection status were used to determine the specificity with which InterVA-4 could attribute HIV/AIDS as a cause of death. Cause-specific mortality fractions by HIV infection status were calculated, and a person-time model was built to analyse adjusted cause-specific mortality rate ratios.Results: The InterVA-4 model identified HIV/AIDS-related deaths with a specificity of 90.1% (95% CI 88.7–91.4%). Overall sensitivity could not be calculated, because HIV-positive people die from a range of causes. In a person-time model including 1,739 deaths in 1,161,688 HIV-negative person-years observed and 2,890 deaths in 75,110 HIV-positive person-years observed, the mortality ratio HIV-positive:negative was 29.0 (95% CI 27.1–31.0), after adjustment for age, sex, and study site. Cause-specific HIV-positive:negative mortality ratios for acute respiratory infections, HIV/AIDS-related deaths, meningitis, tuberculosis, and malnutrition were higher than the all-cause ratio; all causes had HIV-positive:negative mortality ratios significantly higher than unity.Conclusions: These results
Scott K, Campbell C, Skovdal M, et al., 2013, What can companies do to support HIV-positive workers? Recommendations for medium- and large-sized African workplaces, International Journal of Workplace Health Management, Vol: 6, Pages: 174-188, ISSN: 1753-8351
Purpose - The purpose of the paper is to provide recommendations for medium- and large-sized workplaces on how to support HIV-positive employees. Supporting HIV-positive workers is an issue of social responsibility and an economic necessity for employers. HIV-positive workers can remain productive and healthy for many years if able to access appropriate HIV management support. Design/methodology/approach - Recent (2000-2010) academic and grey literature on HIV workplace management was reviewed and a qualitative study of nine workers receiving antiretroviral treatment (ART) in Zimbabwe was conducted by the authors. Results from both the literature review and qualitative study were used to develop recommendations. Findings - Carefully considered organizational support is of primary importance in the following areas: workplace HIV policy, voluntary testing and counselling, HIV management, HIV treatment uptake and adherence, day-to-day assistance, peer education, nutrition support, opportunistic infection (OI) monitoring and support to temporary/contract workers. Confidentiality is a key element in achieving positive outcomes in all areas of organizational support for HIV-positive workers. Practical implications - The paper provides a source of information and concrete advice for workplaces seeking to implement or augment HIV management and support services for their employees. The paper offers vital insight into workplace intervention strategies shown work best for workplaces and employees. Originality/value - The paper fills a need for comprehensive documentation of strategies for effective HIV management at medium- and large-sized workplaces. Copyright © 2013 Emerald Group Publishing Limited. All rights reserved.
Gregson S, Hallett TB, Stover J, et al., 2013, Putting the burden of HIV in context, AIDS, Vol: 27, Pages: 2161-+, ISSN: 0269-9370
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- Citations: 1
Eaton JW, Garnett GP, Takavarasha FR, et al., 2013, Increasing Adolescent HIV Prevalence in Eastern Zimbabwe - Evidence of Long-Term Survivors of Mother-to-Child Transmission?, PLOS One, Vol: 8, ISSN: 1932-6203
Recent data from the Manicaland HIV/STD Prevention Project, a general-population open HIV cohort study, suggested thatbetween 2004 and 2007 HIV prevalence amongst males aged 15–17 years in eastern Zimbabwe increased from 1.20% to2.23%, and in females remained unchanged at 2.23% to 2.39%, while prevalence continued to decline in the rest of theadult population. We assess whether the more likely source of the increase in adolescent HIV prevalence is recent sexual HIVacquisition, or the aging of long-term survivors of perinatal HIV acquisition that occurred during the early growth of theepidemic. Using data collected between August 2006 and November 2008, we investigated associations betweenadolescent HIV and (1) maternal orphanhood and maternal HIV status, (2) reported sexual behaviour, and (3) reportingrecurring sickness or chronic illness, suggesting infected adolescents might be in a late stage of HIV infection. HIV-infectedadolescent males were more likely to be maternal orphans (RR = 2.97, p,0.001) and both HIV-infected adolescent males andfemales were more likely to be maternal orphans or have an HIV-infected mother (male RR = 1.83, p,0.001; female RR = 16.6,p,0.001). None of 22 HIV-infected adolescent males and only three of 23 HIV-infected females reported ever having hadsex. HIV-infected adolescents were 60% more likely to report illness than HIV-infected young adults. Taken together, allthree hypotheses suggest that recent increases in adolescent HIV prevalence in eastern Zimbabwe are more likelyattributable to long-term survival of mother-to-child transmission rather than increases in risky sexual behaviour. HIVprevalence in adolescents and young adults cannot be used as a surrogate for recent HIV incidence, and health systemsshould prepare for increasing numbers of long-term infected adolescents.
Elmes J, Nhongo K, Hallett T, et al., 2013, THE PRICE OF SEX: INSIGHTS INTO THE DETERMINANTS OF THE PRICE OF COMMERCIAL SEX AMONG FEMALE SEX WORKERS IN RURAL ZIMBABWE, SEXUALLY TRANSMITTED INFECTIONS, Vol: 89, Pages: A39-A39, ISSN: 1368-4973
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