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1.
Pan Afr Med J ; 47: 94, 2024.
Article in English | MEDLINE | ID: mdl-38799187

ABSTRACT

Introduction: epidemiological estimates from the 2021 Joint United Nations Program on HIV/AIDS (UNAIDS) emphasize the existing gender disparities, where women face a higher risk of HIV/AIDS exposure. In Mozambique, as of 2021, the HIV prevalence rate among the adult population stood at 12.5%, with an even more concerning rate of 15.4% among women of reproductive age. Methods: a cross-sectional study was carried out with secondary data from the Survey on National Indicators of Vaccination, Malaria, and HIV/AIDS (IMASIDA 2015), where we included married women, both civil marriage and common law marriage of reproductive age 15-49 years. Statistical analyses, including chi-squared tests and logistic regression models, accounting for survey design, were employed to assess associations. Results: the study findings showed that HIV prevalence was higher among married women aged 35-49 years (aOR=2.5; 95% CI: 1.3-4.6; p=0.005), those without formal education (aOR=7.7; 95% CI: 1.1-52.9; p=0.038) and those with primary education (aOR=9.8; 95% CI: 1.6-60.1; p=0.014), those who experienced domestic violence (aOR=1.8; 95% CI: 1.0-3.2; p=0.04), had an uncircumcised partner (aOR=1.9; 95% CI: 1.2-3.1; p=0.008), and had three or more lifetime sex partners (aOR=3.6; 95% CI: 2.9-7.3; p<0.001). Women who were in one lifelong union had a lower risk of HIV positivity (aOR=0.5; 96%CI: 0.3-0.8, p=0.005). Conclusion: the findings of this study highlight sociodemographic, behavioral, and violent factors associated with HIV prevalence among women. These findings underscore the importance of targeted interventions and education programs aimed at reducing HIV transmission among females and promoting safer sexual practices.


Subject(s)
Educational Status , HIV Infections , Marriage , Humans , Female , Mozambique/epidemiology , Adult , Cross-Sectional Studies , Young Adult , Adolescent , Prevalence , HIV Infections/epidemiology , Middle Aged , Marriage/statistics & numerical data , Risk Factors , Surveys and Questionnaires , Sexual Behavior/statistics & numerical data
2.
Pan Afr Med J ; 43: 162, 2022.
Article in English | MEDLINE | ID: mdl-36825120

ABSTRACT

In the past ten years, the prevalence of primary Human Immunodeficiency Virus (HIV) drug resistance has ranged from zero to 25%, with higher and increasing rates in countries with access to antiretroviral therapy (ART), a specific case in Mozambique. World Health Organization (WHO) recommended that countries implement and routinely evaluate representative HIV drug resistance (HIVDR) research to monitor the emergency and transmission of HIV drug resistance mutations. This study aimed to describe the functioning of the system and also to identify gaps in the sensitivity, representativeness and quality of the data using the WHO methodology for Pre-Treatment and Acquired Approaches. We conducted a descriptive evaluation of the information system for surveillance of HIVDR in Mozambique in 2017-2018, based on updated guidelines for evaluating of public health surveillance systems from the Center for Disease Control and Prevention (CDC). The evaluation was conducted in all provinces using secondary data extracted from a cross-sectional survey database on HIVDR, with HIV positive cases at the beginning of ART aged ≥15 years. The system was described through informal conversations with HIVDR stakeholders and the simplicity, data quality and representativeness attributes were evaluated. With 322 positive cases at the beginning of ART (mean age=32.5 years, SD±11.1), about 63.0% (203/322) cases were women and 37.6% (121/322) men. The system was implemented in 25 health facilities distributed across all 11 Mozambican provinces and was considered representative. The system used two data collection instruments, the ART book and the form accompanying samples sent to the reference laboratory. The ART form, with 27 variables, was sent offline at two levels (health facility and National Institute of Health (NHI)), accompanied by dried blood spot samples for viral load testing and genotyping in the NHI virology laboratory, and was considered simple according to the standardized criteria. The system´s data quality was considered regular at 79.9%, with about 59.8% (1156/1932) of variable fields completed and 100% (1932/1932) consistency. The system used a single national laboratory to measure the prevalence of resistance to HIV drugs and was considered simple, with regular quality and representative data. We recommended public health efforts such as conducting genotyping tests be expanded to the provincial level, and periodic monitoring of system´s data collection procedures using forms.


Subject(s)
Anti-HIV Agents , HIV Infections , HIV-1 , Male , Humans , Female , Adult , HIV-1/genetics , HIV Infections/drug therapy , HIV Infections/epidemiology , Mozambique/epidemiology , Cross-Sectional Studies , Drug Resistance, Viral/genetics , Anti-Retroviral Agents/therapeutic use , Viral Load , Prevalence , Anti-HIV Agents/pharmacology , Anti-HIV Agents/therapeutic use
3.
South Afr J HIV Med ; 22(1): 1237, 2021.
Article in English | MEDLINE | ID: mdl-34192070

ABSTRACT

BACKGROUND: The burden of HIV is especially concerning for Eastern and Southern Africa (ESA), as despite expansion of test-and-treat programmes, this region continues to experience significant challenges resulting from high rates of morbidity, mortality and new infections. Hard-won lessons from programmes on the ground in ESA should be shared. OBJECTIVES: This report summarises relevant evidence and regional experts' recommendations regarding challenges specific to ESA. METHOD: This commentary includes an in-depth review of relevant literature, progress against global goals and consensus opinion from experts. RESULTS: Recommendations include priorities for essential research (surveillance data collection, key and vulnerable population education and testing, in-country testing trials and evidence-based support services to improve retention in care) as well as research that can accelerate progress towards the prevention of new infections and achieving ambitious global goals in ESA. CONCLUSION: The elimination of HIV in ESA will require continued investment, commitment to evidence-based programmes and persistence. Local research is critical to ensuring that responses in ESA are targeted, efficient and evaluated.

4.
Arch Sex Behav ; 50(5): 2057-2065, 2021 07.
Article in English | MEDLINE | ID: mdl-33821377

ABSTRACT

Mozambique has one of the highest burdens of HIV in the world, where the prevalence is estimated at 13.2% among adults aged 15-49 years. Men who pay for sex (MPS) are considered a bridging population for HIV infection. However, the characteristics of MPS in Mozambique are poorly understood. The objective of this study was to estimate the prevalence of paid sex among men 15-49 years and investigate risk factors associated with paid sex. We analyzed data collected from 4724 men, aged 15-49 years, as part of the 2015 Mozambique AIDS Indicator Survey. Chi-squared tests and logistic regression models accounting for survey design were used to assess the associations between paying for sex and demographic characteristics and the number of lifetime and recent sex partners, condom use at last sex, and self-reported sexually transmitted infection symptoms. The prevalence of paid sex in the last 12 months was 10.4% (95% CI 9.0-12.1), with Cabo Delgado province having the highest prevalence (38.8%). MPS in the last 12 months were most frequently between the ages of 20-24 years (13.5%), not in a relationship (17.8%), had a primary education (11.9%), from poor households (14.0%), had more than three sexual partners excluding their spouse in the last 12 months (44.7%), and self-reported a STI in the past 12 months (44.2%). HIV prevalence was higher among men who ever paid for sex compared with men who did not (13.1% vs. 9.4%, p = .02). Men who reported 10+ lifetime partner (aOR 7.7; 95% CI 4.5-13.0; p < .001), from Cabo Delgado (aOR 4.0; 95% CI 2.2-7.4; p < .001), who reported STI symptoms in the past 12 months (aOR 2.7; 95% CI 1.7-4.2; p < .001), and HIV positive (aOR 1.6; 95% CI 1.0-3.7; p = .05) were more likely to have paid for sex in the last 12 months. These findings present the HIV prevalence among Mozambican MPS and highlight the need for a comprehensive behavioral, structural, and biomedical approach to interventions to reduce the risks of commercial and transactional sex.


Subject(s)
Acquired Immunodeficiency Syndrome , HIV Infections , Sexually Transmitted Diseases , Adolescent , Adult , Cross-Sectional Studies , HIV Infections/epidemiology , Humans , Male , Middle Aged , Mozambique/epidemiology , Prevalence , Risk Factors , Sexual Behavior , Sexual Partners , Young Adult
5.
BMC Public Health ; 21(1): 91, 2021 01 07.
Article in English | MEDLINE | ID: mdl-33413261

ABSTRACT

High quality, representative data from HIV surveillance systems that have country ownership and commitment are critical for guiding national HIV responses, especially among key and priority populations given their disproportionate role in the transmission of the virus. Between 2011 to 2013, the Mozambique Ministry of Health has conducted five Biobehavioral Surveillance Surveys among key populations (female sex workers, men who has sex with men and people who inject drugs) and priority populations (long distance truck drives and miners) as part of the national HIV surveillance system. We describe the experience of strengthening the HIV surveillance system among those populations through the implementation of these surveys in Mozambique. We document the lessons learned through the impact on coordination and collaboration; workforce development and institutional capacity building; data use and dissemination; advocacy and policy impact; financial sustainability and community impact. Key lessons learned include the importance of multisectoral collaboration, vital role of data to support key populations visibility and advocacy efforts, and institutional capacity building of government agencies and key populations organizations. Given that traditional surveillance methodologies from routine data often do not capture these hidden populations, it will be important to ensure that Biobehavioral Surveillance Surveys are an integral part of ongoing HIV surveillance activities in Mozambique.


Subject(s)
HIV Infections , Sex Workers , Capacity Building , Female , HIV Infections/diagnosis , HIV Infections/epidemiology , Humans , Male , Mozambique/epidemiology , Organizations
6.
BMC public health (Online) ; (21:91): 2-9, Jan. 7, 2021. tab
Article in English | RSDM | ID: biblio-1357637

ABSTRACT

High quality, representative data from HIV surveillance systems that have country ownership and commitment are critical for guiding national HIV responses, especially among key and priority populations given their disproportionate role in the transmission of the virus. Between 2011 to 2013, the Mozambique Ministry of Health has conducted five Biobehavioral Surveillance Surveys among key populations (female sex workers, men who has sex with men and people who inject drugs) and priority populations (long distance truck drives and miners) as part of the national HIV surveillance system. We describe the experience of strengthening the HIV surveillance system among those populations through the implementation of these surveys in Mozambique. We document the lessons learned through the impact on coordination and collaboration; workforce development and institutional capacity building; data use and dissemination; advocacy and policy impact; financial sustainability and community impact. Key lessons learned include the importance of multisectoral collaboration, vital role of data to support key populations visibility and advocacy efforts, and institutional capacity building of government agencies and key populations organizations. Given that traditional surveillance methodologies from routine data often do not capture these hidden populations, it will be important to ensure that Biobehavioral Surveillance Surveys are an integral part of ongoing HIV surveillance activities in Mozambique.


Subject(s)
Humans , Male , Female , Adolescent , Middle Aged , Population , Women , HIV , Sex Workers , Transgender Persons , Men , Unsafe Sex , Drug Users , Epidemiological Monitoring , Miners , Sexual and Gender Minorities , Mozambique
7.
Rev. moçamb. ciênc. saúde ; 6(1): 26-30, Out. 2020. tab
Article in Portuguese | AIM (Africa), RSDM | ID: biblio-1380921

ABSTRACT

A 30 de Janeiro de 2020, o Director-geral da Organização Mundial de Saúde determinou que a COVID-19 constitui uma preocupação de saúde pública de emergência internacional. Objectivo: Identificar as barreiras e facilitadores para o cumprimento da quarentena e do isolamento obrigatório em pessoas expostas e diagnosticadas com COVID-19 em Maputo. Material e Métodos: Foram realizadas entrevistas em profundidade durante os meses de Maio a Julho de 2020 com 30 pessoas expostas e diagnosticadas com COVID-19. Os participantes foram selecionados usando uma amostragem aleatória sistemática. Resultados: A maioria dos participantes mencionaram a redução de salário mensal/horas extras, a interdição de bens e serviços e, o apoio familiar e dos profissionais de saúde como factores condicionantes para o cumprimento adequado da quarentena e isolamento. Conclusão: As condições sócio-económicas jogam um papel fundamental para que as pessoas cumpram a quarentena ou isolamento.


Introduction: On January 30, 2020, the Director-General of the World Health Organization determined that COVID-19 is an international emergency public health concern. Objective: To identify barriers and facilitators for non-compliance with quarantine and mandatory isolation in people exposed and diagnosed with COVID-19 in Maputo. Material and Methods: In-depth interviews were conducted from May to July 2020 with 30 people exposed and diagnosed with COVID-19. Participants were selected using systematic random sampling. Results: Most participants mentioned the reduction of monthly wages/extra hours, the ban on goods and services and the support of family and health professionals as conditioning factors for the proper compliance with quarantine and isolation. Conclusion: Socio-economic conditions play a fundamental role for people to comply with quarantine or isolation.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Patient Isolation/methods , Diagnosis , SARS-CoV-2/isolation & purification , COVID-19/drug therapy , COVID-19/transmission , Socioeconomic Factors , Quarantine/methods , Sampling Studies , Mozambique
8.
Rev. moçamb. ciênc. saúde ; 6(1): 9-14, Out. 2020. tab, map
Article in Portuguese | AIM (Africa), RSDM | ID: biblio-1380981

ABSTRACT

Objectivo: Mapear o potencial risco de transmissão do novo coronavírus em Moçambique de modo a identificar os distritos cujas características sociodemográficas favorecem a propagação do vírus. Métodos: Usou-se a modelação espacial para determinar o risco relativo de propagação da COVID-19 num distrito em relação ao outro com base nos seguintes factores sociodemográficos: densidade populacional, tamanho médio de agregado familiar, percentagem da população jovem de 15-34 anos e percentagem da população que vive num raio de 2 km de uma estrada classificada. Primeiro, para cada factor foi estimado um risco relativo dividindo os distritos em quintis, e, em segundo lugar, os riscos individuais de cada factor foram somados com igual peso para estimar o risco agregado de transmissão da COVID-19 por distrito. Resultados: Dezanove distritos localizados sobretudo nos principais centros urbanos e no corredor da Beira apresentam alto risco de propagação da COVID-19 em função das suas características sociodemográficas; 24 distritos mostram risco médio-alto e distribuem-se pelas regiões centro e sul do país; 60 distritos localizados nas regiões centro e sul e no interior da região norte apresentam risco médio e; 58 distritos mostram risco médio-baixo ou baixo de transmissão da COVID-19 e encontram-se no litoral centro-norte do país. Conclusão: Os distritos cujo perfil sociodemográfico é favorável à rápida propagação do novo coronavírus são os das grandes cidades e os localizados nas principais rotas de transporte. No entanto, este padrão de risco é susceptível de alterações em função da celeridade, abrangência e níveis de observância das medidas de prevenção e/ou de mitigação da COVID-19. Assim, recomenda-se que as medidas de prevenção e mitigação tenham em conta o risco potencial em cada distrito em função das suas características sociodemográficas.


Objective: To map the potential risk of COVID-19 transmission in Mozambique in order to identify districts with sociodemographic characteristics that favour the spread of coronavirus. Methods: Spatial modelling was used to determine the relative risk of COVID-19 transmission in a certain district in relation to other districts based on the following sociodemographic factors: population density, mean number of household members, the percentage of the young population aged 15-34 and the proportion of a district's population living within two kilometres of a classified road. First, a relative risk due to each factor was estimated grouping the districts into quintiles and, second, the individual risks were added with equal weight to estimate the aggregate relative risk of COVID-19 transmission per district. Results: Nineteen districts located in the main urban centres and along the Beira corridor were found to be at a high relative risk of COVID-19 transmission; 24 districts located mainly in central and southern regions display a medium-high risk category; 60 districts located in the central and southern regions and in the hinterland of the northern region show a medium risk category and; 58 districts exhibit a medium-low or low risk category of COVID-19 transmission and are mainly located at the eastern part of the central-north region. Conclusion: The districts with sociodemographic profile favouring the spread of the new coronavirus are those in the big cities and those located along the main transportation routes. However, the pattern of risk is subject to changes due to the speed, coverage and level of compliance with COVID-19 prevention and mitigation measures. It is recommended that COVID-19 prevention and mitigation measures should take into account the potential risk of each district.


Subject(s)
Humans , Male , Adolescent , Risk , Coronavirus/immunology , COVID-19/diagnosis , Viruses , Disease Transmission, Infectious , Disease Transmission, Infectious/prevention & control , Foraminifera/growth & development , Sociodemographic Factors , Disaster Mitigation , Crystalluria , Mozambique
9.
BMC Infect Dis ; 20(1): 636, 2020 Aug 27.
Article in English | MEDLINE | ID: mdl-32854638

ABSTRACT

BACKGROUND: Key populations - men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID) - are at high risk for sexually transmitted infections (STI) given their sexual risk behaviours along with social, legal and structural barriers to prevention, care and treatment services. The purpose of this secondary analysis is to assess the prevalence of self-reported STIs and to describe associated risk factors among participations of the first Biological Behavioural Surveillance (BBS) in Mozambique. METHODS: Responses from the first BBS surveys conducted in 2011-2014 were aggregated across survey-cities to produce pooled estimates for each population. Aggregate weighted estimates were computed to analyse self-reported STI prevalence. Unweighted pooled estimates were used in multivariable logistic regression to identify risk factors associated with self-reported STI. RESULTS: The prevalence of self-reported STI was 11.9% (95% CI, 7.8-16.0), 33.6% (95% CI, 29.0-41.3), and 22.0% (95% CI, 17.0-27.0) among MSM, FSW and PWID, respectively. MSM who were circumcised, had HIV, reported drug use, reported receptive anal sex, and non-condom use with their last male partner had greater odds of STI self-report. STI-self report among FSW was associated with living in Beira, being married, employment aside from sex work, physical violence, sexual violence, drug use, access to comprehensive HIV prevention services, non-condom use with last client, and sexual relationship with a non-client romantic partner. Among PWID, risk factors for self-reported STI included living in Nampula/Nacala, access to HIV prevention services, and sex work. CONCLUSION: The high-burden of STIs among survey participants requires integrated HIV and STI prevention, treatment, and harm reduction services that address overlapping risk behaviours, especially injection drug use and sex work. A robust public health response requires the creation of a national STI surveillance system for better screening and diagnostic procedures within these vulnerable populations.


Subject(s)
Sexually Transmitted Diseases/epidemiology , Adolescent , Adult , Female , Homosexuality, Male/statistics & numerical data , Humans , Male , Mozambique/epidemiology , Prevalence , Risk Factors , Risk-Taking , Self Report , Sex Work , Sex Workers/statistics & numerical data , Sexual Partners , Sexual and Gender Minorities , Surveys and Questionnaires , Young Adult
10.
BMC Public Health ; 20(1): 975, 2020 Jun 22.
Article in English | MEDLINE | ID: mdl-32571365

ABSTRACT

BACKGROUND: Prior to 2014, data about health seeking behaviors or service uptake for People who inject drugs (PWID) in Mozambique did not exist. We present the results from the formative assessment component of the Biological and Behavioral Survey (BBS). METHODS: Standardized interview guides were used during key informant interviews (KII) and focus group discussions (FGD) in Maputo and Nampula/Nacala to discuss issues related to risk behaviors and access to and utilization of health and social services by PWID. The target sample size was not defined a priori, but instead KII and FGD were conducted until responses reached saturation. Data analysis was based on the principles of grounded theory related to qualitative research. RESULTS: Eighty-eight respondents, ages 15 to 60, participated in KIIs and FGDs. Participants were majority male from diverse income and education levels and included current and former PWID, non-injection drug users, health and social service providers, peer educators, and community health workers. Respondents reported that PWID engage in high-risk behaviors such as needle and syringe sharing, exchange of sex for drugs or money, and low condom use. According to participants, PWID would rather rent, share or borrow injection equipment at shooting galleries than purchase them due to stigma, fear of criminalization, transportation and purchase costs, restricted pharmacy hours, personal preference for needle sharing, and immediacy of drug need. Barriers to access and utilization of health and social services include distance, the limited availability of programs for PWID, lack of knowledge of the few programs that exist, concerns about the quality of care provided by health providers, lack of readiness as a result of addiction and perceived stigma related to the use of mental health services offering treatment to PWID. CONCLUSIONS: Mozambique urgently needs to establish specialized harm reduction programs for PWID and improve awareness of available resources. Services should be located in hot spot areas to address issues related to distance, transportation and the planning required for safe injection. Specific attention should go to the creation of PWID-focused health and social services outside of state-sponsored psychiatric treatment centers.


Subject(s)
Health Services Accessibility/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Social Work/statistics & numerical data , Substance Abuse, Intravenous/epidemiology , Adolescent , Adult , Female , Focus Groups , Harm Reduction , Health Behavior , Humans , Interviews as Topic , Male , Mental Health Services/organization & administration , Middle Aged , Mozambique/epidemiology , Needle Sharing , Pharmacies/organization & administration , Qualitative Research , Social Stigma , Young Adult
11.
PLoS One ; 15(4): e0231303, 2020.
Article in English | MEDLINE | ID: mdl-32267866

ABSTRACT

BACKGROUND: As part of ongoing efforts to generate evidence needed on HIV and tuberculosis (TB) to inform policies and programs aimed to improve the health outcomes of migrants and communities affected by migration and mining, a preliminary investigation was conducted through a biological and behavioral (BBS) approach related to HIV and TB in two communities of origin of migrant mineworkers in Gaza Province. The main objective was to determine the prevalence of HIV and the rates of asymptomatic infection by TB, and the social and behavioral risk factors associated. METHODS: A cross-sectional survey was conducted from May to June 2017 using a simple random sampling methodology. Eligible participants were individuals who were living in the community at the time the survey was conducted, which included adult mine workers and members of their families aged 18 and above. A socio-behavioral questionnaire was administered, blood specimens were collected for HIV testing (Determine/Unigold) and sputum for TB (GeneXpert MTB/RIF) was collected. The statistical analysis was performed using the R studio software to produce means, proportion and odds ratio at 95% confidence intervals. RESULTS: A total of 1012 participants were enrolled, 75.2% were females, with a median age of 34. The overall prevalence of HIV found in the two communities was 24.2% (CI: 21.6-27.0) and was higher in the rural community (31.6%; 95% CI: 27.0-35.3). The prevalence of active TB was found to be 0.3% (n = 3) while 7.5% of the participants self-reported to have been previously diagnosed with TB at some point in their life. Only 2.8% of participants had knowledge of the basic principles of TB transmission. Condom use at last sexual intercourse with a regular partner was low among both sexes (17.3% male and 12.6% female). A considerable proportion of participants had not been aware of their HIV positive serostatus(31.1% female and 25.0% male). About 1/3 of the participants had had a history of STIs. CONCLUSION: The results of this survey confirm a high prevalence of HIV in communities of origin of migrant miners in Gaza province. Findings also demonstrated low levels of awareness/ knowledge and prevention of TB and HIV. It is important to strengthen strategies that encourage regular HIV testing and TB screening. Appropriate communication interventions on methods of transmission and prevention of HIV and TB in these communities must be intensified, as well as ensuring ongoing linkage to TB and HIV social and healthcare services.


Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/psychology , Awareness , Knowledge , Latent Tuberculosis/epidemiology , Latent Tuberculosis/psychology , Miners/psychology , Transients and Migrants/psychology , AIDS-Related Opportunistic Infections/transmission , AIDS-Related Opportunistic Infections/virology , Adolescent , Adult , Cross-Sectional Studies , Female , HIV , Humans , Latent Tuberculosis/microbiology , Latent Tuberculosis/transmission , Male , Mass Screening , Middle Aged , Mozambique/epidemiology , Mycobacterium tuberculosis , Prevalence , Risk Factors , Rural Population , Sexual Behavior , Surveys and Questionnaires , Young Adult
12.
PLos ONE ; 15(4): 1-14, Apr., 2020. Fig
Article in English | RSDM | ID: biblio-1400218

ABSTRACT

As part of ongoing efforts to generate evidence needed on HIV and tuberculosis (TB) to inform policies and programs aimed to improve the health outcomes of migrants and communities affected by migration and mining, a preliminary investigation was conducted through a biological and behavioral (BBS) approach related to HIV and TB in two communities of origin of migrant mineworkers in Gaza Province. The main objective was to determine the prevalence of HIV and the rates of asymptomatic infection by TB, and the social and behavioral risk factors associated. Methods A cross-sectional survey was conducted from May to June 2017 using a simple random sampling methodology. Eligible participants were individuals who were living in the community at the time the survey was conducted, which included adult mine workers and members of their families aged 18 and above. A socio-behavioral questionnaire was administered, blood specimens were collected for HIV testing (Determine/Unigold) and sputum for TB (GeneXpert MTB/RIF) was collected. The statistical analysis was performed using the R studio software to produce means, proportion and odds ratio at 95% confidence intervals. Results A total of 1012 participants were enrolled, 75.2% were females, with a median age of 34. The overall prevalence of HIV found in the two communities was 24.2% (CI: 21.6­27.0) and was higher in the rural community (31.6%; 95% CI: 27.0­35.3). The prevalence of active TB was found to be 0.3% (n = 3) while 7.5% of the participants self-reported to have been previously diagnosed with TB at some point in their life. Only 2.8% of participants had knowledge of the basic principles of TB transmission. Condom use at last sexual intercourse with a regular partner was low among both sexes (17.3% male and 12.6% female). A considerable proportion of participants had not been aware of their HIV positive serostatus(31.1% female and 25.0% male). About 1/3 of the participants had had a history of STIs. Conclusion The results of this survey confirm a high prevalence of HIV in communities of origin of migrant miners in Gaza province. Findings also demonstrated low levels of awareness/ knowledge and prevention of TB and HIV. It is important to strengthen strategies that encourage regular HIV testing and TB screening. Appropriate communication interventions on methods of transmission and prevention of HIV and TB in these communities must be intensified, as well as ensuring ongoing linkage to TB and HIV social and healthcare services.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Transients and Migrants/psychology , AIDS-Related Opportunistic Infections/psychology , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/virology , Knowledge , Latent Tuberculosis/epidemiology , Miners/psychology , Rural Population , Sexual Behavior , Awareness , Mass Screening , Prevalence , Surveys and Questionnaires , Risk Factors , AIDS-Related Opportunistic Infections/drug therapy , Latent Tuberculosis/microbiology , Latent Tuberculosis/psychology , Latent Tuberculosis/transmission , Mozambique , Mycobacterium tuberculosis
13.
BMC public health (Online) ; 20(975): [1-9], 2020. Tab.
Article in English | RSDM | ID: biblio-1353072

ABSTRACT

Background: Prior to 2014, data about health seeking behaviors or service uptake for People who inject drugs (PWID) in Mozambique did not exist. We present the results from the formative assessment component of the Biological and Behavioral Survey (BBS). Methods: Standardized interview guides were used during key informant interviews (KII) and focus group discussions (FGD) in Maputo and Nampula/Nacala to discuss issues related to risk behaviors and access to and utilization of health and social services by PWID. The target sample size was not defined a priori,butinsteadKIIandFGDwereconducteduntilresponses reached saturation. Data analysis was based on the principles of grounded theory related to qualitative research. Results: Eighty-eight respondents, ages 15 to 60, participated in KIIs and FGDs. Participants were majority male from diverse income and education levels and included current and former PWID, non-injection drug users, health and social service providers, peer educators, and community health workers. Respondents reported that PWID engage in high-risk behaviors such as needle and syringe sharing, exchange of sex for drugs or money, and low condom use. According to participants, PWID would rather rent, share or borrow injection equipment at shooting galleries than purchase them due to stigma, fear of criminalization, transportation and purchase costs, restricted pharmacy hours, personal preference for needle sharing, and immediacy of drug need. Barriers to access and utilization of health and social services include distance, the limited availability of programs for PWID, lack of knowledge of the few programs that exist, concerns about the quality of care provided by health providers, lack of readiness as a result of addiction and perceived stigma related to the use of mental health services offering treatment to PWID. (Continued on next page) (Continued from previous page) Page 2 of 9 Conclusions: Mozambique urgently needs to establish specialized harm reduction programs for PWID and improve awareness of available resources. Services should be located in hot spot areas to address issues related to distance, transportation and the planning required for safe injection. Specific attention should go to the creation of PWIDfocused health and social services outside of state-sponsored psychiatric treatment centers.


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Social Work/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Substance Abuse, Intravenous/epidemiology , Health Services Accessibility/statistics & numerical data , Pharmacies/organization & administration , Health Behavior , Interviews as Topic , Adolescent , Needle Sharing , Focus Groups , Harm Reduction , Qualitative Research , Social Stigma , Mental Health Services/organization & administration , Middle Aged , Mozambique/epidemiology
14.
BMC Infect Dis ; 19(1): 1022, 2019 Dec 02.
Article in English | MEDLINE | ID: mdl-31791273

ABSTRACT

BACKGROUND: Few countries in sub-Saharan Africa know the magnitude of their HIV epidemic among people who inject drugs (PWID). This was the first study in Mozambique to measure prevalence of HIV, HBV, and HCV, and to assess demographic characteristics and risk behaviors in this key population. METHODS: We used respondent-driven sampling (RDS) to conduct a cross-sectional behavioral surveillance survey of PWID in two cities of Mozambique lasting six months. Participants were persons who had ever injected drugs without a prescription. Participants completed a behavioral questionnaire and provided blood specimens for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) testing. We performed RDS-adjusted analysis in R 3.2 using RDSAT 7.1 weights. RESULTS: We enrolled 353 PWID in Maputo and 139 in Nampula/Nacala; approximately 95% of participants were men. Disease prevalence in Maputo and Nampula/Nacala, respectively, was 50.1 and 19.9% for HIV, 32.1 and 36.4% for HBsAg positivity, and 44.6 and 7.0% for anti-HCV positivity. Additionally, 8% (Maputo) and 28.6% (Nampula/Nacala) of PWID reported having a genital sore or ulcer in the 12 months preceding the survey. Among PWID who injected drugs in the last month, 50.3% (Maputo) and 49.6% (Nampula/Nacala) shared a needle at least once that month. Condomless sex in the last 12 months was reported by 52.4% of PWID in Maputo and 29.1% in Nampula/Nacala. Among PWID, 31.6% (Maputo) and 41.0% (Nampula/Nacala) had never tested for HIV. In multivariable analysis, PWID who used heroin had 4.3 (Maputo; 95% confidence interval [CI]: 1.2, 18.2) and 2.3 (Nampula/Nacala; 95% CI: 1.2, 4.9) greater odds of having HIV. CONCLUSION: Unsafe sexual behaviors and injection practices are frequent among PWID in Mozambique, and likely contribute to the disproportionate burden of disease we found. Intensified efforts in prevention, care, and treatment specific for PWID have the potential to limit disease transmission.


Subject(s)
Drug Users/statistics & numerical data , HIV Infections/epidemiology , Hepatitis B/epidemiology , Hepatitis C/epidemiology , Substance Abuse, Intravenous/epidemiology , Adolescent , Adult , Aged , Cities/epidemiology , Cross-Sectional Studies , Epidemics , Female , HIV Infections/blood , HIV Seropositivity/epidemiology , Hepatitis B/blood , Hepatitis B Surface Antigens/analysis , Hepatitis B Surface Antigens/blood , Hepatitis B Surface Antigens/immunology , Hepatitis C/blood , Humans , Male , Middle Aged , Mozambique/epidemiology , Population Surveillance/methods , Prevalence , Risk-Taking , Seroepidemiologic Studies , Sexual Behavior/statistics & numerical data , Surveys and Questionnaires/statistics & numerical data , Urban Population/statistics & numerical data , Young Adult
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