Evaluating the effectiveness of a multi-component intervention on early childhood development in paediatric HIV care and treatment programmes: a randomised controlled trial.

BACKGROUND: HIV infection in a family may affect optimum child development. Our hypothesis is that child development outcomes among HIV-exposed infants will be improved through a complex early childhood stimulation (ECS) programme, and income and loans saving programme for HIV positive parents. METHODS: The study was a cluster-randomized controlled trial in 30 clinic sites in two districts in Zimbabwe. Clinics were randomised in a 1:1 allocation ratio to the Child Health Intervention for Development Outcomes (CHIDO) intervention or Ministry of Health standard care. The CHIDO intervention comprises three elements: a group ECS parenting programme, an internal savings and lending scheme (ISALS) and case-management home visits by village health workers. The intervention was aimed at caregiver-child dyads (child aged 0-24 months) where the infant was HIV exposed or infected. The primary outcomes were cognitive development (assessed by the Mullen Scales of Early Learning) and retention of the child in HIV care, at 12 months after enrolment. A comprehensive process evaluation was conducted. DISCUSSION: The results of this cluster-randomised trial will provide important information regarding the effects of multi-component interventions in mitigating developmental delays in HIV-exposed infants living in resource-limited environments. TRIAL REGISTRATION: This trial is registered with the Pan African Clinical Trials Registry ( www.pactr.org ), registration number PACTR201701001387209; the trial was registered on 16th January 2017 (retrospectively registered).

'Here, we cannot practice what is preached': early qualitative learning from community perspectives on Zimbabwe's response to COVID-19

The ramifications of the COVID-19 pandemic extend beyond the direct health consequences to negative social, economic and wider health impacts. Integrating community engagement should be an integral pillar of national responses to strengthen countries' ability to mitigate these negative consequences. We present lessons from rapid qualitative research early in the COVID-19 pandemic in Zimbabwe, aimed at understanding community and health worker perspectives on COVID-19 and policy responses. We conducted phone interviews with community-based organisations (n=4) and healthcare workers (n=16), and collected information from social media and news outlets related to COVID-19. We conducted thematic analysis and present results around four themes. 1) Individuals are overloaded with information, but lack trusted sources, with consequences of widespread fear and unanswered questions. 2) Policies of social distancing are disconnected to communities' ability to follow such measures, without access at home to water, long-term food supplies, or a daily income. 3) Healthcare workers perceived themselves to be vulnerable, due to a shortage of personal protective equipment, contributing to ongoing strikes. 4) Health implications beyond COVID-19 are expected to be wide-reaching and severe, as resources are redirected. Our research emphasises the importance of listening to community perspectives and accounting for context-specific realities to design locally appropriate and effective responses to COVID-19. Communities require support with basic needs and reliable information to enable them to follow prevention measures. Healthcare workers urgently need personal 3 protective equipment. Lastly, continued provision of essential services and medication is essential in reducing excess mortality and morbidity from conditions other than COVID-19