'The tablets make a certain noise': uncovering barriers and enablers related to providing PMTCT services to adolescents and young women living with HIV in Zimbabwe.

BACKGROUND: Zimbabwe antenatal HIV prevalence rate is 16.1%. HIV-positive pregnant adolescent girls and young women (AYW) are at high risk to experience perinatal mental health challenges, attributed to a combination of factors including HIV status, stigma and perinatal depression. Perinatal depression and stigma among AYW is understudied in Zimbabwe and may affect short- and long-term health of HIV positive mothers and their children, and can impact treatment adherence. METHODS: Qualitative data was gathered from four focus group discussions with (2 urban and 2 rural) PMTCT providers (N = 17). Focus group discussions were also conducted among AYW clients (N = 20) from two clinics in Mashonaland East. RESULTS: Qualitative analyses identified patterns related to: (1) drop out and loss to follow up, (2) retention and adherence, (3) recurring feelings of internalized stigma; and (4) acceptability of potential MH interventions. MH services are not available and AYW have limited access to adherence counseling (1-2 times at onset). Psychological support was not available at either clinic, despite both providers and clients perceiving high rates of stigma, discrimination, and challenges with disclosure. Challenges related to long waits for ART distribution and gaps in disclosure support emerged as barriers. Providers noted that AYW present as anxious (non-diagnosed), and attribute depression to those clients who are lost to follow up, stating lack of time to screen for MH related issues or actively refer them for services. Challenges related to the ability to provide strong advice and support for disclosure also emerged among providers. CONCLUSIONS: This study can contribute to policy and practice recommendations to better integrate MH into HIV services and develop person-centered service models for HIV positive AYW. HIGHLIGHTSPerinatal adolescents and young women (AYW) living with HIV have gaps in retention and care in the current Zimbabwe PMTCT service model.Mental health stigma must be addressed to integrate mental health into HIV services.HIV providers are aware of the need to provide mental health support to reduce loss to follow-up.Mental health screening and referrals for services are not part of standard care for perinatal HIV positive AYW in Zimbabwe.Linkages between disclosure and AYW mental health was identified as a challenge by HIV providers.Context responsive interventions can support integration of mental health screening, services, and referrals.

An Exploration of Barriers and Enablers of Retention in a Program to Reduce Vertical Transmission of HIV at Health Centers in Zimbabwe.

BACKGROUND: Poor retention in the prevention of women in prevention of vertical transmission programs remains a formidable common setback in elimination of HIV/AIDS. It creates new problems such as poor health outcomes and increased incidence of vertical transmission of HIV. There is a dearth of qualitative information to explain poor retention of women in prevention of mother-to-child transmission (PMTCT) programs in Zimbabwe. The purpose of the study was to explore the enablers and barriers of retention of women in PMTCT programs. METHODS: This was a basic qualitative study conducted at four health centers in Zimbabwe. Four audiotaped focus group discussions were conducted with 34 pregnant or breastfeeding women coming for PMTCT services at the health centers. Descriptive statistics was used for sample demographics. Transcripts were analyzed through latent content analysis based on the Graneheim and Lundman method. RESULTS: Maternal determination, a four-tier support system, and an inspiring health package were enablers to retention in the PMTCT program while uninspired individual engagement, paternalism, and undesirable PMTCT-related events were barriers to retention of women in the PMTCT program. CONCLUSIONS: Reinforcing hope for the women and their children, active management of side effects of antiretroviral medicine, consistent peer support, enhancing confidentiality among community cadres, and commitment from community or religious leaders may improve retention of women in PMTCT programs; for women with HIV during pregnancy, delivery and post-natal care.

Malaria Outbreak Investigation in Chipinge, Zimbabwe: A Case-control Study.

BACKGROUND: Malaria outbreaks are common in Zimbabwe. They are common in Manicaland, which has the greatest burden of malaria in the country. METHODS: A matched case control study was conducted to investigate the malaria outbreak in ward 13 and 14 of Chipinge district in Manicaland Province in Zimbabwe, week 30 to week 40 of year 2015. A sample size of 92 (46 cases and 46 controls) was used. Guided interviews were conducted with the aid of a structured questionnaire and a checklist. The investigation assessed factors associated with contracting malaria and the community knowledge levels on malaria. RESULTS: Participants who stayed in houses with open eaves had 2.4 odds (95% CI=1.0; 5.6) of contracting malaria compared to those who lived in houses without open eaves. Staying within a radius of 3 km from the river or swamp also predisposed people to contracting malaria (OR =2.7, 95%CI=1.2; 6.3). People who had no insecticide treated mosquito nets hanged in their bed rooms had odds of 2.2 (95%CI=1.2; 6.4) of contracting malaria compared to those that hanged insecticide-treated mosquito nets in their bedrooms. Consequently, among people exposed to outdoor activities in the evening and at night, those that had insecticide-treated mosquito nets hanged in their rooms were more protected from malaria than those that did not. CONCLUSION: There is high need to intensify all pillars in the malaria prevention and control programs and maintenance of a strong surveillance system to prevent future occurrences of outbreaks.