Barcelona 2013
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| Abstract #247 - Prevention | ||||
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Session: 24.1: Prevention (Parallel) on Tuesday @ 11.00-13.00 in Teatre Chaired by Cate Hankins, Juanse Hernandez Authors: Presenting Author: Dr Nadine Schur - Imperial College London, United Kingdom |
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| Additional Authors: Mr Henry Luyombya, Dr Eleanor Maticka-Tyndale, Dr Alan Li, Dr Josephine Wong, Dr Kenneth Fung, | ||||
| Aim: Zimbabwe has experienced one of the world?s most severe HIV crises since the first reported case of AIDS in the country in 1985. HIV prevalence in the adult population rapidly increased till the mid-1990s from around 10% in 1990 up to an estimated peak at 29% in 1997. Over the last decade, the Zimbabwe Government has implemented a range of national services to prevent new infections and to support people living with HIV, e.g. HIV testing and counselling (HTC), anti-retroviral treatment (ART), prevention of mother-to-child transmission (PMTCT), and male circumcision (MC). HIV steadily declined during this period with an estimated prevalence of less than 15% in 2010. Despite these encouraging changes, the number of people infected and dying from HIV remains unacceptably high. The objectives of this study are to investigate individual-level factors associated with greater levels of coverage and equitable access of different HIV prevention and treatment services, and analyse shortfalls in order to inform future policies on the scale-up of HIV services. We also aim to study trends in awareness and uptake of services over time to observe specific patterns and to analyse shortfalls in order to predict potential future developments. | ||||
| Method / Issue: The Manicaland HIV/STD Prevention Project is a collaborative scientific research initiative in the rural areas of eastern Zimbabwe. In July 1998, the project implemented a large (n≈12,000) prospective population-based open cohort study which is currently doing it?s the sixth round of data collection. Data from the latest completed round conducted between 2009 and 2011 will be used in logistic regression models to analyse associations between demographic, socio-economic, behavioural and other factors, and knowledge and uptake of services. Temporal trends in uptake of services will be measured using data from earlier rounds of the study. | ||||
| Results / Comments: HIV prevalence in the general population of Manicaland province remained comparably high (15.1%; 95% confidence interval: 14.5%-15.7%). Preliminary univariate results suggest that knowledge of HIV services was high for HTC (82.3%; 95% CI: 91.6%-82.9%) and PMTCT (93.0%; 92.0%-93.9%). Knowledge of ART was low overall (40.1%; 39.3%-40.9%) but high in self-reported HIV-positives (88.9%; 86.8%-90.7%). Overall uptake of services in the last three years was moderate for HTC (44.0%; 43.2%-44.8%) and PMTCT (65.2%; 57.1%-72.6%). Current uptake of ART in self-reported HIV positives (79.2%; 76.3%-81.8%) almost reached universal coverage, which is defined at 85% in Zimbabwe, but only about every second lab-confirmed HIV positive person in the study population was on treatment (52.2%; 49.2%-55.1%). MC uptake in the male population remained low (8.2%; 7.5%-8.9%). Knowledge and uptake of services varied by sex and age and may also differ by other factors. | ||||
| Discussion: Our results will hopefully provide a guide on how to scale up on the different services in the future, e.g. MC services for which awareness and uptake is strikingly low. Studying the dynamics of awareness and uptake over time will further assist us in providing guidelines on how to improve awareness and uptake especially for those individuals who are at high risk of acquiring or transmitting HIV. | ||||
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