Grant Murewanhema

Background: Globally, approximately 65% of adolescents undergoing antiretroviral therapy (ART) adhered to their treatment, whereas only 55% achieved viral suppression in 2023. The low rate of viral suppression is concerning, as elevated viral loads are associated with a heightened risk of opportunistic infections, progression to advanced HIV disease, increased mortality, and greater HIV transmission rates. We conducted this scoping review to identify the facilitators and barriers to ART adherence among adolescents and young adults (AYAs) in sub-Saharan Africa (SSA). Methods: We conducted this scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. We searched for peer-reviewed articles published in English from 2014 to 2024 across the SCOPUS, ScienceDirect, PubMed, Africa Journals Online, and Google Scholar databases. Two reviewers independently selected the articles and extracted the data. We used NVivo to develop codes and categories of facilitators and barriers. Results: We used 30 articles reporting on studies conducted in 13 countries in this review. The total number of participants in the studies was 12,250. Sixteen articles reported on qualitative studies, nine on quantitative studies, and five on mixed-methods studies. This scoping review identified various personal (14 articles), interpersonal and social (15 articles), healthcare system-related (9 articles), medication-related (7 articles), and economic (2 articles) factors that facilitate ART adherence among AYAs. Additionally, the scoping review also identified various personal (28 articles), interpersonal and social (13 articles), healthcare system-related (14 articles), medication-related (20 articles), school- or work-related (6 articles), and economic (14 articles) factors that hinder ART adherence among AYAs. Conclusions: Enhancing ART adherence in AYAs requires multiple strategies, including the reduction of internalized stigma, implementation of community awareness campaigns, harm reduction approaches for AYAs who misuse substances, comprehensive education on HIV, and the provision of support from school staff and leadership, alongside the adoption of differentiated service delivery (DSD), which encompasses home-based ART delivery, refills at private pharmacies, community ART distribution centers, and patient-led community ART refill groups, as well as multi-month dispensing practices.

Sub-Saharan African (SSA) women experience a high prevalence of HIV, sexually transmitted infections (STIs), and unintended pregnancies, necessitating effective, integrated prevention strategies. Multipurpose prevention technologies (MPTs) offer a promising approach to address these overlapping health concerns by providing single products that simultaneously prevent HIV, other STIs, and/or unintended pregnancies. Given the persistent sexual and reproductive health (SRH) challenges faced by women in SSA, in this opinion piece, we explore practical considerations for MPT adoption and scale-up within the region. With this opinion article, we discuss the data on MPT development and identify key factors for successful MPT implementation in SSA. We examine the current MPT pipeline, product features, regulatory challenges, and structural, individual, and community barriers that impact MPT acceptance and usage among SSA women. Successful MPT uptake hinges on designing discreet, user-controlled products and engaging end-users, healthcare providers, and communities in product development and promotion. Structural factors such as robust supply chains, regulatory clarity, and financial support are also essential. Addressing socio-cultural norms, especially partner consent, and strengthening demand creation through community-driven, culturally sensitive strategies are critical for scaling MPTs. In conclusion, MPTs represent a transformative opportunity to reduce the burden of HIV, STIs, and unintended pregnancies in SSA. Strategic, culturally attuned approaches are essential to ensure the acceptability and accessibility of MPTs. Expedited pathways for regulatory approval, collaborative partnerships, and community-centered demand creation will be vital to realize the full potential of MPTs in advancing women’s SRH in SSA.

This opinion paper dives into the crucial but challenging space of HIV prevention for adolescents and young persons (AYPs). While their vulnerabilities may be heightened, so too is their potential for resilience, innovation, and positive change. To safeguard their health and empower them to make informed choices, a comprehensive science-to-program and systems approach to HIV prevention is paramount. Recognizing their unique vulnerabilities and immense potential, these authors advocate for a multifaceted approach that bridges the gap between scientific evidence and program implementation within a robust healthcare system. This opinion unpacks how leadership, governance, health policies, human resources, health information systems, and HIV surveillance can be strengthened to create a supportive ecosystem where AYPs have the knowledge, resources, and services they need to thrive. This collective effort, involving policymakers, healthcare providers, educators, and AYPs themselves, is critical to a future where no young person is left behind in the fight against HIV.

Background: Maternal mortality remains a major challenge in sub-Saharan Africa (SSA), accounting for 70% of world's maternal deaths. Hemorrhage is the leading direct cause of maternal mortality worldwide, with postpartum hemorrhage (PPH) responsible for more than two-thirds of hemorrhage-related deaths. This systematic review and meta-analysis integrated data from studies conducted in SSA to provide an accurate estimation of the prevalence of PPH and to identify regional risk variables. Methods: We conducted a search across multiple databases for peer-reviewed articles published between 2013 and 2023. This study included quantitative research employing cross-sectional, case-control, or cohort designs, regardless of sample size, and published in English. This review excluded literature reviews, meta-syntheses, qualitative studies, editorials, systematic reviews, and meta-analyses. We used MetaXL to estimate the pooled magnitude of PPH in SSA, and employed the Q test, I2 statistic, and funnel plots to assess statistical heterogeneity. Furthermore, we used MetaXL to perform subgroup and sensitivity analyses. Finally, we used IBM SPSS Statistics for Windows (Version 29.0.2.0 Armonk, NY, USA), to estimate the pooled effect size of the factors associated with PPH. Results: 26 methodologically rigorous articles were included in this review and meta-analysis. The pooled magnitude of PPH in SSA was 8.6%. The studies exhibited significant heterogeneity. Individual factors associated with PPH include the woman's age (crude odds ratio [OR] = 4.37, 95% confidence interval [95% CI] = 3.03–6.29), place of residence (OR = 2.06, 95% CI = 1.51–2.82), and parity (OR = 3.13, 95% CI = 1.38–7.11). Antenatal factors include antenatal care (ANC) attendance (OR = 3.43, 95% CI = 1.12–10.05), antepartum hemorrhage (APH) (OR = 6.83, 95% CI = 3.64–12.80), and twin pregnancy (OR = 8.25, 95% CI = 3.80–17.92). Intrapartum factors include induction of labor (OR = 4.39, 95% CI = 2.01–9.61), and mode of delivery (OR = 2.61, 95% CI = 1.80–3.78). Postpartum factors include previous history of PPH (OR = 10.86, 95% CI = 3.71–31.84), and oxytocin use after delivery (OR = 0.17, 95% CI = 0.09–0.32). Conclusions: The pooled magnitude of PPH in SSA in this study was considerably higher than that in other regions. Therefore, there is a need to strengthen strategies aimed at improving ANC attendance in SSA to ultimately reduce PPH. Additionally, close monitoring of women with risk factors for PPH and the careful use of oxytocin for labor induction are strategies that can also be used to reduce PPH in SSA.

Caesarean sections (CSs) have increased globally, with concerns being raised involving overutilisation and inequalities in access. In Zimbabwe, where healthcare access varies greatly, we aimed to analyse factors associated with ever having a CS using the 2019 National Multiple Indicator Cluster Survey. The weighted national CS rate was 10.3%, and CS happened more commonly among women in urban than rural areas (15.7% v. 7.4%; odds ratio (OR) 2.34; (95% confidence interval (CI)) 1.71 - 3.20; p=0.001). Percentages of those having a CS significantly increased with education: overall χ2 for a trend of p=0.001 and wealth quintile, and overall χ2 for a trend of p=0.001. Women with insurance coverage were more likely to have had a CS than those without: 26.7% v. 8.7%; OR 3.82; 95% CI 2.51 - 5.83; p=0.001. The same was the case for women with access to the internet: 15.4% v. 7.0%, OR 2.42; 95%CI 1.71 - 3.41; p=0.001). These findings show an association that could indicate this being overutilised by insured women in urban settings, rather than being accessible based on clinical needs. Further research should explore reasons for these disparities and inform interventions to ensure equitable access to optimum childbirth in Zimbabwe.

HIV/AIDS remains one of the world's most significant public health and economic challenges, with approximately 36 million people currently living with the disease. Considerable progress has been made to reduce the impact of HIV/AIDS in the past years through successful multiple HIV/AIDS prevention and treatment interventions. However, barriers such as lack of engagement, limited availability of early HIV-infection detection tools, high rates of HIV/sexually transmitted infections (STIs), barriers to access antiretroviral therapy, lack of innovative resource optimisation and distribution strategies, and poor prevention services for vulnerable populations still exist and substantially affect the attainment of the UNAIDS 95-95-95 targets. A rapid review was conducted from 24 October 2022 to 5 November 2022. Literature searches were conducted in different prominent and reputable electronic database repositories including PubMed, Google Scholar, Science Direct, Scopus, Web of Science, IEEE Xplore, and Springer. The study used various search keywords to search for relevant publications. From a list of collected publications, researchers used inclusion and exclusion criteria to screen and select relevant papers for inclusion in this review. This study unpacks emerging opportunities that can be explored by applying machine learning techniques to further knowledge and understanding about HIV service design, prediction, implementation, and evaluation. Therefore, there is a need to explore innovative and more effective analytic strategies including machine learning approaches to understand and improve HIV service design, planning, implementation, and evaluation to strengthen HIV/AIDS prevention, treatment, and awareness strategies.

Understanding the pattern of contraceptive use among women living with HIV is critical for formulating relevant public health interventions to improve the uptake and use of reliable methods in this population. This helps to reduce the incidence of unintended pregnancies. In this secondary data analysis, we aimed to describe contraceptive use by HIV-positive and HIV-negative sexually active adolescent girls and women, using data from the Zimbabwe Demographic and Health Survey (2015-16). We used statistical analysis to determine the association between the use of various methods of contraception and HIV status using the Zimbabwe Demographic and Health Survey, 2015-16 data. Overall, the contraceptive use prevalence in this study was 60%. Sexually active adolescent girls and women on the Pill and injections were less likely to be HIV-positive compared with those not using any method of contraception (odds ratio (OR)=0.54, 95% confidence interval (CI) (0.45 - 0.64), p=0.001; and OR=0.75, 95% CI (0.59 - 0.96), p=0.020, respectively). Those using either a male or female condom were more likely to be HIV-positive, OR=3.36, 95% CI (2.63 - 4.28), p=0.001. This study revealed that there is still a considerable unmet need for contraception among the study population, highlighting the need to devise strategies to increase contraception uptake among women. Statistically significant differences were noted in the use of condoms, with those who are HIV-positive having a higher use of condoms compared with those who are HIV-negative. This may reflect that HIV-positive individuals have received appropriate counselling messages on the need to use barrier methods.

BACKGROUND:Considerable progress has been made globally in improving maternal and child health. However, Sub-Saharan Africa (SSA) and South Asia together accounted for 86% of all maternal deaths in the world during the 2000–2017 period. It is estimated that more than 60% of global maternal deaths occur during the postnatal period. The utilization of postnatal care (PNC) services remains low in SSA. This scoping review aimed to determine factors that influence PNC utilization among women in SSA.METHODS:Peer-reviewed articles published in English from 2018 to 2023 were searched from Google Scholar, ScienceDirect, MEDLINE, African Journals Online, SCOPUS, and PubMed databases. Two authors independently screened the articles and extracted the data.RESULTS:Thirty-nine articles were included in this review. Thirty-three of the studies were of a quantitative cross-sectional study design, four were mixed-methods, and two were qualitative studies. The review identified several enablers and barriers to PNC utilization among women, which were categorized into individual, community-level, and healthcare system factors. Some of the individual factors included the place of residence, marital status of the woman, employment status, educational level of both the woman and her partner, and household income. Health system factors included accessibility of healthcare facilities, availability of resources, and the quality of healthcare.CONCLUSION:To improve PNC utilization in SSA, several strategies should be implemented. These strategies should address issues such as women’s empowerment, accessibility of healthcare facilities, the quality of healthcare services, and healthcare services financing.