A comparison of HIV outpatient care in primary and secondary healthcare-level settings in Zimbabwe.

SETTING: Decentralisation of HIV care to nurse-led primary care services is being implemented across low- and middle-income countries in sub-Saharan Africa. OBJECTIVE: To compare services offered to clients attending for HIV care at a physician-led and a nurse-led service in Harare, Zimbabwe. DESIGN: A cross-sectional study was performed at Harare Central Hospital (HCH) and Budiriro Primary Care Clinic (PCC) from June to August 2018. An interviewer-administered questionnaire was used to collect sociodemographics, HIV treatment and clinical history from clients attending for routine HIV care. The Mann-Whitney U-test was used to evaluate for differences between groups for continuous variables. For categorical variables, the χ2 test was used. RESULTS: The median age of the 404 participants recruited was 38 years (IQR 28-47); 69% were female. Viral suppression was comparable between sites (HCH, 70% vs. PCC, 80%; P = 0.07); however, screening for comorbidities such as cervical cancer screening (HCH, 61% vs. PCC, 41%; P = 0.001) and provision of referral services (HCH, 23% vs. PCC, 13%; P = 0.01) differed between sites. CONCLUSION: Efforts to improve service provision in primary care settings are needed to ensure equity for users of health services.

Factors influencing treatment failure in HIV positive adult patients on first line antiretroviral therapy.

BACKGROUND: Risk factors for treatment failure in HIV positive adults have not been studied extensively in Zimbabwe. AIM: To investigate socio-demographic, psychosocial and antiretroviral drug related factors as possible risk factors for treatment failure. OBJECTIVE: To compare the accuracy and reliability of CD4 count results in diagnosing treatment failure versus viral load results. DESIGN: A descriptive cross-sectional survey. SETTING: Harare Central Hospital adult opportunistic infections clinic. PARTICIPANTS: One hundred and eighteen (118) HIV positive participants on 1st line antiretroviral therapy (any 1 of stavudine, tenofovir or zidovudine combined with lamivudine and nevirapine or efavirenz) for at least 1 year. Participants were conveniently sampled. MAIN OUTCOME MEASURES: First line treatment failure as defined according to World Health Organisation (WHO) 2010 guidelines. RESULTS: Factors associated with higher odds of treatment failure were severe depression [OR 3.7; p-value 0.002; 95% CI 1.6-8.5] and discontinuing ART [OR 4.4; p-value 0.02; 95% CI 1.3-14.7]. Factors associated with lower odds of treatment failure were age = 42 [OR 0.3; p-value 0.007; 95% CI 0.1-0.7], taking ART on time [OR 0.2; p-value 0.02; 95% CI 0.05-0.8], time on ART > 4 years [OR 0.6; p-value 0.02; 95% CI 0.3-0.9] and female sex [OR 0.4; p-value 0.02; 95% CI 0.2-0.8]. There was statistically significant difference between CD4 count and viral load results in diagnosing treatment failure [OR 8.7; p-value 0.0005; 95% CI 3.6-21.2]. CONCLUSION: Severe depression and discontinuing ART predisposed to treatment failure. CD4 counts were not as reliable as viral load measurements in diagnosing treatment failure.

The epidemiology of respiratory disease in Zimbabwe

This review of the burden of respiratory diseases in children and adult Zimbabweans is based on limited available literature and highlights a need for more descriptive epidemio- logical studies. In children; the commonest reported causes of respiratory mortality were acute pyogenic pneumonia; Pneumocystis carinii pneumonia; and tuberculosis; with different patterns of diseases evident between HIV-positive and HIV-negative children. Asthma and other atopic conditions are common but under-reported due to a predomi- nance of publication on HIV-related subjects. In adults; exposure to indoor air pollution due to burning of biomass fuels is probably associated with acute respiratory infections; asthma; chronic obstructive pulmonary disease; lung cancer; and nasopharyngeal and laryngeal cancers in Zimbabwe as in other regions. These conditions also have other common risk factors including malnutrition and tobacco smoking but the prevalence rates of these conditions and their associations with risk factors are not known. In adults with chronic cough; tuberculosis is the most common diagnosis among HIV infected adults but lower respiratory tract infections and asthma were more common among HIV- negative patients. Factors associated with tobacco smoking in Zimbabwe are discussed

Iodine deficiency disorder (IDD) presenting as hypothyroidism with a large pericardial effusion.

Iodine deficiency in Zimbabwe is common, but resultant hypothyroidism is said to be rare. A case of goitrous hypothyroidism with a large pericardia effusion is presented.