Barriers and facilitators influencing utilization of intrauterine contraceptive device (IUCD) in Zimbabwe.

IUCD (Copper-T) is a safe, effective and long-acting reversible contraceptive and its uptake in Zimbabwe is currently less than 1%. Interventions to improve the uptake of IUCD require evidence on key factors contributing to its low uptake. The study was conducted to identify the gaps and offer opportunities for evidence-based family planning aimed at improving demand for IUCD, supply-side conditions, and influencing attitudes towards IUCD. A descriptive qualitative study design was conducted to explore and understand the perceptions of 169 women, 22 men, 16 community leaders and 20 health care providers regarding the use of IUCDs (Copper-T). In-depth interviews, Key informant interviews and focus group discussions with IUCD users, former IUCD users, and users of modern contraceptives (15-49 years) and men were conducted. Rural women showed reluctance to use IUCD because of myths, misconceptions and fears associated with the method which include barrenness, cancers, birth deformities and pregnancy complications. Negative community perceptions, dominant social norms, religious and socio-cultural beliefs, limited awareness of IUCD among men and weak health service delivery platforms were the major barriers to IUCD uptake in Zimbabwe. Evidence-based strategies on demand generation, supply-side interventions, advocacy and communication for development (C4D) are crucial in improving the uptake and provision of IUCD in Zimbabwe.

Knowledge, attitudes and practices on contraceptive use among young people in selected universities in Zimbabwe.

Contraception is vital, not only because of the statistical evidence on utilisation of the services by women, but for economic and societal reasons. Uptake and use of contraceptives among youth in Zimbabwe is low at 12% for the 15-19 years and 49% for the 20-24 years compared to 67% of all married women in the country. Unmet need for family planning remains high at 13% (15-19 years) and 10.4% (20-24 years) compared to 10% among all women in Zimbabwe. Students in tertiary institutions are within these age groups and use of contraception among them is vital. The study was conducted to explore the knowledge level, attitudes and practices among young people towards the use of contraceptives in purposively selected universities. A mixed method approach using both qualitative and quantitative research design was used. Data was collected from 537 female students aged 18-24 years using structured questionnaires. Twenty Key informant interviews and 12 focus group discussions with bouth young males and females were conducted. Quantitative data was cleaned and analysed using STATA while content analysis was used for qualitative data. Ninety five percent (95%) of the young women in tertiary institutions had ever heard of contraception and 27% had ever used contraceptives. Students had myths and misconceptions regarding use of contraceptives including causing cancers, infertility in future and unbearable side effects. The pill was the most common contraceptive method known (85%). Religion and the involvement of family members, peers as well as other relatives were among the factors contributing to barriers of FP services uptake. The study has provided evidence that awareness on contraceptives among young people in tertiary institutions, does not necessarily lead to increased uptake. Educational campaigns with emphasis on the benefits of contraception will help reduce misconceptions and increase access and utilization of family planning services among the tertiary institution students.

Safety and efficacy of the PrePex device in HIV-positive men: A single-arm study in Zimbabwe.

METHODS: We aimed to determine if the adverse event (AE) rate was non-inferior to an AE rate of 2%, a rate considered the global standard of MC safety. Study procedures, AE definitions, and study staff were unchanged from previous PrePex Zimbabwe trials. After PrePex placement and removal, weekly visits assessed wound healing. Men returned on Day 90. Safety was defined as occurrence of moderate and serious clinical AEs. Efficacy was defined as ability to reach the endpoint of complete circumcision. RESULTS: Among 400 healthy, HIV-positive, consenting adults, median age was 40 years (IQR: 34, 46); 79.5% in WHO stage 2; median CD4 was 336.5c/µl (IQR: 232, 459); 337 (85%) on anti-retroviral therapy. Among 385 (96%) observed completely healed, median days to complete healing was 42 (IQR: 35-49). There was no association between time to healing and CD4 (p = 0.66). Four study-related severe AEs and no moderate AEs were reported: severe/moderate AE rate of 1.0% (95% CI: 0.27% to 2.5). This was non-inferior to 2% AEs (p = 0.0003). All AEs were device displacements resulting in surgical MC and, subsequently, complete healing. CONCLUSION: Male circumcision among healthy, HIV-positive men using PrePex is safe and effective. Reducing the barrier of HIV testing while improving counseling for safer sex practices among all MC clients could increase MC uptake and avert more HIV infections.

Safety Profile of PrePex Male Circumcision Device and Client Satisfaction With Adolescent Males Aged 13-17 Years in Zimbabwe.

BACKGROUND: The safety and efficacy of the PrePex device for voluntary medical male circumcision (VMMC) has been demonstrated in studies in Rwanda, Uganda, and Zimbabwe, leading to the conditional prequalification of the device for use in adults. Because the majority of VMMC clients in the 14 priority countries are adolescents under 18 years, research to establish the safety and efficacy of the device for males <18 years is required. METHODS: One-arm, prospective study included 402 adolescents, aged 13-17 years, using PrePex device between August 2013 and January 2014 at a VMMC centre in Harare. Endpoints are number and grade of adverse events associated with device circumcision, time to complete wound healing, client satisfaction with the procedure, and outcome. RESULTS: The rate of medical ineligibility among adolescent males was high; 237/402 (35.9%) of study participants had to be excluded based on medical reasons. The severe/moderate adverse event rate was low at 2/402 (0.5%). No device displacements/self-removals were observed. Time to complete wound healing was shorter than in adults; 367/398 (92.2%) adolescents had completed wound healing by day 35, whereas 90% of adults had completed wound healing by day 56 as demonstrated in previous studies. Overall, adolescents were highly satisfied with the results of their circumcision. CONCLUSIONS: The study demonstrates that the PrePex device can be safely used in adolescents aged 13-17 years. The significant proportion of males opting for surgical circumcision and the high medical ineligibility suggest that surgical circumcision needs to be provided alongside PrePex services in programs targeting young age groups.

A Phase II Randomized Controlled Trial Comparing Safety, Procedure Time, and Cost of the PrePex™ Device to Forceps Guided Surgical Circumcision in Zimbabwe.

BACKGROUND: The World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS promote MC (male circumcision) as a key HIV prevention strategy where HIV prevalence and incidence are high and MC prevalence is low. In Zimbabwe, to achieve the 1.26 million circumcisions needed to be performed by 2015 to achieve optimal MC coverage, a new approach was needed. The primary objective of the current trial was to assess the performance (safety, procedure time, and cost) of the PrePex device compared to forceps-guided surgical circumcision. METHODS AND FINDINGS: This Phase II, randomized, open-label trial in Zimbabwe involved healthy, non-circumcised adult male volunteers who were randomly assigned to the PrePex device (n = 160) or surgical arm (n = 80). Three doctors and 4 nurses, all certified on both circumcision methods, performed the procedures. The PrePex device procedure involves a plastic ring with a rubber O-ring that necrotizes the foreskin to facilitate easy and minimally invasive removal. Total procedure time was the primary endpoint. Adverse event (AE) data were also gathered for 90 days post-procedure. All 80 participants in the surgical arm and 158 participants in the PrePex arm achieved complete circumcision. The total procedure time for the PrePex device was approximately one-third of the total surgical procedure (4.8 minutes, Standard Deviation [SD]: 1.2 versus 14.6 minutes; SD: 4.2; p<0.00001). There were 2 AEs for 2 participants (rate of 1.3%, 95% Confidence Interval: 0.0025-4.53%), which were resolved with simple intervention. The AEs were device related, including 1 case of pain leading to device removal and 1 case of removal of the device. CONCLUSIONS: The trial supports previous studies' conclusions that the PrePex procedure is safe, quick, easy to apply, and effective in terms of procedure time as an alternative to traditional surgical circumcision. The PrePex device has great potential for use in overburdened health systems and in resource-limited settings and is recommended for use in rapid scale-up of adult MC in Zimbabwe. TRIAL REGISTRATION: ClinicalTrials.gov NCT01956370.