We are a multidisciplinary research group of clinicians, allied health professionals, epidemiologists, statisticians, immunologists, microbiologists, geographical information specialists and social scientists.
We conduct research aimed at improving health and well-being across the life course. We focus on public health issues of relevance to Zimbabwe and the region. Our research group is multidisciplinary and collaborates with a range of local and international academic institutions, so that we can access the expertise to conduct research to the highest standards.
We are committed to generating evidence that has impact on policy and practice. We therefore work in close partnership with policymakers including the Ministry of Health and Child Care, the Ministry of Primary and Secondary Education, the National Tuberculosis Programme, the World Health Organization, UN agencies and non-governmental organisations. Our research has informed national and international guidelines.
Community engagement underpins all our work so that we can ensure that the work is relevant and respectful to our local context and that communities are not simply passive beneficiaries of our research.
We are strongly committed to developing research capacity. We do this through supervision and mentorship of Masters and PhD students, running training courses on research methods and supporting development of data management and laboratory capacity.
Who we are
I obtained my primary medical degree from the University of Newcastle-upon-Tyne and following postgraduate training in internal medicine and clinical specialist training in HIV Medicine and Sexual Health, I joined the London School of Hygiene & Tropical Medicine.
Between 2003-2005, I worked for two years as a clinical lecturer in the Department of Medicine at the University of Zimbabwe and as a physician at Parirenyatwa Hospital. Since 2007, I have been based in Harare, hosted by the Biomedical Research and Training Institute (BRTI) where I I lead the Zimbabwe-LSHTM research partnership. Our focus is on HIV, Adolescent Health, Chronic non-infectious morbidities, Tuberculosis and Infection and Antimicrobial Resistance. I currently hold a Wellcome Trust Senior Fellowship in Clinical Science and I am an Honorary Consultant Physician in HIV Medicine at Barts Health NHS Trust, London.
I go up to Domboshava to relax and think!
I am a medical microbiologist, with my primary medical degree from the Technical University Munich (Germany). Following my MRCP in the UK, I did my clinical specialist training in medical microbiology in London. From 2015-2018 I headed the National Tuberculosis Reference Laboratory in Germany, which also serves as a WHO Supranational Reference Laboratory for several countries in Central Asia and West Africa.
I undertook a Masters in Epidemiology (distance learning) and a Masters in Tropical Medicine and International Health at LSHTM. From 2008-2011 I worked as a Wellcome Trust PhD fellow in Cape Town investigating the effect of active TB case finding and anti-retroviral therapy on TB epidemiology in South Africa. I have worked with Prof Rashida Ferrand and the LSHTM/Zimbabwe Research partnership on adolescent health for 7 years. I have recently re-joined LSHTM and moved to Zimbabwe at the beginning of 2019. It is a great place to work and to do research, mainly because the people are very enthusiastic and interested.
Dr Grace McHugh
I am a clinical researcher with a special interest in HIV epidemiology in youth. I obtained my medical degree from National University of Ireland, Galway in 2002 and since 2013 have been working in HIV care and research in Harare Zimbabwe, completing my MD in 2018.I am a clinical trial coordinator for the BREATHE trial, investigating the effectiveness of azithromycin on lung function in older children and adolescents living with chronic lung disease and HIV. I am also the principal investigator of the FAST study (Feasibility and Acceptability of HIV self-testing in youth) funded through a career development fellowship by EDCTP. This study will investigate whether HIV self-testing may help close the gap in young people’s access to HIV testing services.
|Professor Helen Weiss||
I am a statistician by training, and have been working in epidemiology for the past 20 years, on large-scale observational and intervention studies in sub-Saharan Africa and India. My role is usually to help with the design and analysis of studies. My main focus is on preventing HIV infection and improving mental health, particularly in young people. I am based in London but have been visiting Zimbabwe about twice a year for the past 10 years to work with Prof Rashida Ferrand and the LSHTM/Zimbabwe Research partnership. Current projects I’m involved with include CHIEDZA, BREATHE and B-GAP. In London, I lead a group of statisticians and epidemiologists – the MRC Tropical Epidemiology Group, who work on a broad range of intervention studies to reduce diseases of public health importance in low- and middle-income settings. I am fascinated by human behaviour and psychology and read about these in my down-time!
Dr Vicky Simms
I am a statistical epidemiologist in the MRC Tropical Epidemiology Group at the London School of Hygiene & Tropical Medicine. I work on randomised controlled trials and cohort studies in the areas of HIV, adherence to antiretroviral therapy and mental health, including children and adolescents. I have been working with the Zimbabwe LSHTM research partnership since 2015, moving from the UK to Zimbabwe in 2019.
Dr Sarah Bernays
I am an anthropologist with expertise on HIV and adolescent health. I have been running qualitative studies and supporting social science capacity development in Zimbabwe for the last ten years. My focus is on conducting community participatory research using a range of qualitative methods to inform the design and development of interventions as well as process evaluation of complex interventions. I am a co-investigator on the CHIEDZA and B-GAP studies. I have a split academic appointment as an associate professor between the London School of Hygiene and Tropical Medicine and the University of Sydney. The best part of my role is working with passionate researchers and young people collaboratively as part of an interdisciplinary team.
|Dr Celia Gregson||
I am a musculoskeletal epidemiologist based in the Musculoskeletal Research Unit at the University of Bristol. I also work as a consultant orthogeriatrician. Post clinical training, I completed a MSc in Epidemiology at LSHTM and then a PhD. My interests include genetics of bone disorders, hip fracture epidemiology and the impact of HIV infection on the musculoskeletal system.
I co-supervise Dr Ruramayi Rukuni’s Wellcome funded PhD fellowship and IMVASK study which will determine the impact of adolescent HIV infection on the growing skeleton. I also supervise Cynthia Kahari’s NIH Fogarty funded PhD which will assess the life-course impact of HIV on bone architecture as assessed by pQCT. In 2018 we established the Sub-Saharan Africa Musculoskeletal Network SAMSON to build musculoskeletal research capability within the region. One success has been the new provision of pQCT capacity to Harare.
|Dr Chris Grundy||
I’m the map guy. I have an MSc in Geographical Information Systems (GIS) and I have been at LSHTM for 25 years. My research focuses around how to improve data collection using GIS from population estimation methodology to selection of random locations for surveys. My other area of interest and work extends to public engagement and getting young people involved in science. Maps are a fantastic way to engage with communities, and I encourage communities we work with to map their communities as a means of giving them ownership of research.
I work with the CHIEDZA and B-GAP projects in Zimbabwe and contribute to the Youth Researcher Academy, an initiative to train youth as researchers. I also run GIS courses and supervise any of the PhD students in our research group. Where there are maps you will probably find me. I also supervised the development of Rashida’s garden of succulents.
|Dr Edith Majonga||
I attained my PhD in 2018 at the London School of Hygiene and Tropical Medicine, focused on cardiac abnormalities in older children and adolescents with HIV. This study was embedded in the INHALE project to investigate heart and lung disease in older children and adolescents.
My research interest is in cardiorespiratory diagnostic techniques in children and adults and this will form the basis of my post-doctoral research. I am a radiographer by profession with a BSc from the University of Zimbabwe and an MSc from the National University of Science and Technology, both in radiography.
I am an Academic Clinical Lecturer in paediatric infectious diseases based between University College London and BRTI, Harare.
I am working on a portfolio of studies investigating infection control and antibiotic resistance based in the neonatal unit at Harare Central Hospital with my collaborators Dr Gwen Chimhini and Dr Simba Chimhuya. We are planning to set up an interventional study reducing nosocomial transmission of neonatal sepsis, and have recently introduced tablet-based electronic medical records using the NeoTree application.
PhD students and research fellows
|Ms Arthi Vasantharoopan||I am a PhD student in health economics at the London School of Hygiene and Tropical Medicine. My research interests revolve around infectious diseases in vulnerable populations. I am conducting the economic evaluation of the B-Gap study; a targeted HIV testing and support intervention for children and adolescents in urban and rural Zimbabwe. My supervision team guiding me through the process are Dr Vicky Simms, Dr Lorna Guinness and Dr Hendy Maheswaran. I hold a MSc in Epidemiology and a BSc in Health Sciences.|
Ms Chido Dziva Chikwari
I am an epidemiologist. I completed my first degree in Biomedical Science with Business at the University of Newcastle in 2013. Thereafter I went on to do an MSc in Epidemiology via distance learning at the London School of Hygiene & Tropical Medicine which I completed in 2016. At present I am pursing a PhD, also with LSHTM, and my primary research focus is evaluating a targeted HIV testing strategy for at risk children and adolescents in Zimbabwe.
I am currently working on the B-GAP Project and the CHIEDZA Trial.
When I am not working, I can be found hanging out with my 4-year-old son, Malachi.
|Mr Collins Timire||I am a senior operational research fellow in the Zimbabwe National Tuberculosis Program. In this capacity I have an active role as a mentor in regional and international operational research workshops conducted by the World Health Organisation/Medecins Sans Frontieres and The Union. I am registered for a PhD at LSHTM to understand how TB and MDR-TB impact the livelihood of patients and their families. I hold an MPH (First Class) from the Auckland University of Technology, New Zealand and a BSc in Medical Laboratory Sciences from the University of Zimbabwe.|
Ms Constancia Mavodza
|I am a global health researcher navigating evidence generation for program implementation and policy development. I am registered for a PhD at LSHTM and my research will focus on the process evaluation of the CHIEDZA trial with a particular focus on gender perspectives. My work has included Sub-Saharan Africa focused research and advocacy on HIV/AIDS, human resources for health, gender and health systems, and sexual and reproductive health and rights for adolescents and young people; and coordinating cancer clinical trials. I hold an MPH specialising in Health Systems and Policy research from the University of Cape Town, and my first degree is from Amherst College where I majored in Neuroscience.|
Ms Cynthia Kahari
I am a diagnostic radiographer with experience in bone densitometry research utilising dual-energy x-ray absorptiometry (DXA) and now peripheral quantitative computed tomography (pQCT). I am pursuing a PhD with LSHTM, focusing on use of pQCT in HIV infected patients. The aim of my research is to understand the effect of HIV and its treatment on pQCT measured trabecular and cortical bone architecture at different time points through the life course in two independent populations in sub-Saharan Africa.
I have a BSc (honours) in Radiography and an MPhil, both from the University of Zimbabwe. My MPhil research was on bone mineral density in adult healthy Zimbabwean women.
|Dr Evgeniya Sovershaeva||I have an MD, with residency in internal medicine. I am a lecturer in Global Health at The Arctic University Of Norway, Tromsø, and also a PhD student on the BREATHE trial. My research interests include HIV, lung disorders in children, and medical tools for use in resource-limited settings. My PhD project is focused on factors that may trigger the development of chronic pulmonary complications and the tools to assess pulmonary function in HIV-infected children with pulmonary disorders.|
|Dr Ioana Olaru||I am an infectious diseases physician and researcher currently coordinating the Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study in Zimbabwe conducted in collaboration with the Biomedical Research and Training Institute in Harare. My particular field of interest is in antimicrobial resistance and I have recently registered for a PhD with the London School of Hygiene and Tropical Medicine. My PhD project aims to explore the prevalence and mechanisms of Gram-negative resistance in bacteria causing urinary tract infections in people presenting to primary healthcare clinics in Harare.|
Ms Mandikudza Tembo
I am a PhD research fellow with a focus in menstrual health management and adolescent sexual and reproductive health service delivery. I hold an MSc in Global Health and Development from UCL and a BA in Public Health and Women's Gender Studies.
My research is focused on menstrual health management (MHM) among 16 - 24-year-old young women in Zimbabwe. Nested within the CHIEDZA cluster randomised trial, the MHM sub-study will investigate the acceptability, safety, and effectiveness of a comprehensive intervention that provides MHM education, analgesia, and MHM products such as disposable pads, reusable pads, and the menstrual cup.
|Dr Ruramayi Rukuni||I graduated from Bristol medical school in 2009 and carried out my postgraduate medical training in Cambridge. I have held an academic public health training post in Oxford since 2013 and I was awarded a Wellcome Trust Research Training Fellowship in 2017. I am currently taking time out of training to complete my PhD with the London School of Hygiene and Tropical Medicine. I am the principal investigator for a longitudinal study investigating HIV-associated musculoskeletal disease in children and adolescents in Harare – the IMVASK Study.|
|Ms Rudo Siwela||I am a physiotherapist with an MSc in Anatomy from the University of Zimbabwe. I am working on a research proposal titled ‘Understanding the epidemiology of hip fracture in the context of high HIV prevalence’, where I seek to establish the incidence, risk factors and underlying bone biology of hip fracture in both people living with HIV and people without HIV. I hope to enhance my research capacity so I can in turn mentor other women in Zimbabwe in science and technology based research.|
|Ms Salome Manyau||I am a social scientist with experience in using qualitative research methods, and a research student in the Faculty of Public Health and Policy at LSHTM. I completed a Masters in Development Studies at the Freestate University in the Republic of South Africa. My first degree is a Bsc Honours in Sociology obtained at the University of Zimbabwe. My interests in research are in the areas of HIV/AIDS, antimicrobial use (AMU) and antimicrobial resistance (AMR) as well as drug resistant tuberculosis in Africa. I am on a studentship program in the FIEBRE Social Science Study, investigating the connections between fever and antimicrobial use. Previously I coordinated the implementation of two Population based HIV Impact lmpact Assessment surveys in Zimbabwe (ZIMPHIA) and Lesotho (LePHIA), and coordinated a baseline survey of drug resistant tuberculosis in Harare.|
Mr Tafadzwa Madanhire
|I am a biostatistician by training from the University of Zimbabwe currently supporting observational and longitudinal musculoskeletal studies within the group. My role involves developing statistical plans and performing the subsequent analyses. I am an aspiring PhD research fellow with interests in HIV, modelling mechanistic bone pathways and skeletal growth in children.|
I am a public health specialist with 17 years of experience in research on HIV, TB and adolescent Health. I have coordinated Phase 1, 2, 3 and 4 trials and I have worked with adolescents and young people for more than 10 years. I manage the CHIEDZA trial and provide oversight for other field studies in our group. Before becoming a researcher I was a nurse manager for the Harare City Health Department. I have an MPH, degree in Community Development and diplomas in Community Nursing, Midwifery and General Nursing.Collaborative Research Program (UZ-UCSF). Before becoming a researcher I was a nurse manager for the Harare City Health Department.
|I am the lead data manager/statistician supporting various research study teams. My vast research interests are in HIV and TB research and statistical methodology. I joined the Biomedical Research and Training Institute in 2004 and I have been involved in the development of data management processes and documents and also provide statistical analysis services. Prior to this, I was a data manager for the Zimbabwe Meteorological Services. I graduated with a BSc (Hons) in Statistics and an MSc in Clinical Epidemiology from the University of Zimbabwe.|
Ms Nicole Redzo
Assistant Data Manager
I am a data management professional working as assistant data manager for the BREATHE trial on bronchopulmonary response to azithromycin treatment for chronic lung disease in children and adolescents living with HIV. I have worked in TB and HIV research for the past seventeen years. I have a BSC in Management Information Systems and I am studying for an MSc in Epidemiology by distance learning with LSHTM.
Mr Ivan Chigonde
|I am the group’s finance officer. I joined the research group in 2001 and I have managed all the research grants since then. My role includes preparing financial statements as per donor agency requirements, assisting in preparation of budgets, monitoring of budgets and expenditure to ensure adherence to policies and procedures.
I am currently studying towards completion of my Association of Chartered Certified Accountants (ACCA) qualification, after which I will become a member. I have an ACCA Advanced Diploma in Accounting and Business, a Higher National Diploma in Accountancy with the Southern African Association of Accountants (SAAA) and am a member of Institute of Chartered Secretaries and Administrators in Zimbabwe (ICSAZ). I plan to complete my honours degree in Applied Accountancy in 2020, upon submission of my project with the University of Oxford.
Mr Tendai Muchena
|I am the group’s administrator and my role includes organizing meetings, supporting our overseas research visitors, procurement, managing regulatory applications and visas for our team and working with the field manager to ensure that field procedures run smoothly.
I joined the group in 2008, initially as an administrator for a 1 year project, then joining the research teams as a research assistant. I trained in Marketing and M&E in the past, and I am currently in my final year for a BSc (Hons) degree in Development Studies. I plan to undertake an MSc in 2020.
Ms Nyaradzo Mabido
|I joined BRTI in 2012 and worked as a research assistant on adolescent health studies including ZENITH, B-Gap and IMVASK. I now work as an assistant in accounts and administration. I am also studying with the Institute of Secretaries and Administrators of Zimbabwe and plan to train as an accountant.|
Mr Mufaro Makuni
Public Engagement Co-ordinator
I am the Public Engagement Coordinator for the IMVASK study and am also responsible for coordinating public engagement activities for sub-studies embedded within the wider BRTI group.
Mr Liberty Maheya
|I am the Assistant Coordinator responsible for various studies within the BRTI. I am a Social Scientist holding a BSc degree in Counselling and a Master’s degree in Child and Family Studies from Africa University. I have extensive experience in research gained from my years with Elizabeth Glaser Paediatric AIDS Foundation, the Harare City Health Department and Population Services International. I am currently enjoying the mentorship of experienced researchers at the BRTI and I look forward to doing a PhD in Social Sciences.|
We conduct research on issues of public health importance to Zimbabwe and to the wider region. See below a description of our ongoing studies.
HIV and adolescent health
- CHIEDZA: improving HIV outcomes in Zimbabweans aged 16-24
Lead researcher: Rashida Ferrand
Funding: Wellcome Trust, 2017-2022
CHIEDZA, which stands for Community based interventions to improve HIV outcomes in adolescents: a cluster randomised trial in Zimbabwe, is a two-year study to develop and evaluate the impact of a community-based, youth-friendly reproductive and sexual health service on improving HIV outcomes in people aged 16-24.
Adolescents and young people aged 16-24 rarely visit health care facilities for help and advice about sexual and reproductive health. These facilities are often remote and therefore difficult or expensive to get to. Young people can also perceive them as intimidating places where they will be judged by health care staff, who may also not respect young people’s need for confidentiality.
In order to address these challenges, the CHIEDZA study will investigate the effectiveness of a community-based, youth-friendly approach that makes use of mobile clinics to deliver sexual and reproductive health services. A group of young Zimbabweans aged 16-24 will help us to design and configure the service, and the health team will be trained in respect, confidentiality and non-judgement.
CHIEDZA is a cluster-randomised trial, which means that we will deliver the new service in 12 randomly selected areas in Harare, Bulawayo and Mashonaland East. Other areas will have access to existing services only. The trial will run for two years, starting in 2019. In 2021, we will conduct a survey to measure levels of HIV viral suppression in the population and then compare the results to see whether the youth-friendly service has made a difference.
For more information see the CHIEDZA website.
Lead investigators: Rashida Ferrand, Grace McHugh
Partners: London School of Hygiene and Tropical Medicine, Biomedical Research & Training Institute, Ministry of Health and Child Welfare, City Health Chitungwiza, University of Ghana School of Public Health and Mwanza Intervention Trials Unit.
Accessing routine health care services is not something widely embedded within most health settings. The Y-CHECK study seeks to develop and evaluate, in Chitungwiza, an intervention programme to screen and treat/refer adolescents for a range of common health conditions using routine health check-ups undertaken at two time points (the first between the ages of 10 to 14 years, and the second between the ages of 15 to 19 years). The study is being conducted in two phases. Phase 1 is a process evaluation with the purpose of assess the fidelity, acceptability, and feasibility of conducting routine health check-ups, as well as to document the experiences and perceptions of routine health check-ups. It entails a detailed situation analysis that will include a review of existing programmes and their results, key informant interviews and workshops using participatory approaches with stakeholders (adolescents, parents, teachers, nongovernmental organizations, programme implementers and key stakeholders in the government). Results of the situation analysis will be critically reviewed and will inform the intervention and implementation of Phase 2, the effectiveness, costs and cost-effectiveness of the intervention, pending funding.
- MAE study: Menstrual Hygiene Management for Young Women
Lead Researcher: Mandi Tembo
Funding: Fogarty Grant
Partners: BRTI, Ministry of Health and Child Care
The MAE study, which stands for Menstrual health management Acceptability and Effectiveness, is a two-year study to investigate and evaluate the acceptability, uptake, and impact of a comprehensive menstrual health management intervention among women aged 16-24 in Zimbabwe.
Menstruation is a monthly occurrence in the life of almost every girl and woman between the age of puberty and menopause. However, due to a lack of access to appropriate education, affordable and accessible menstrual hygiene care products and adequate sanitation, many girls and women in low- or middle-income countries, such as Zimbabwe, struggle to manage menstruation safely and with dignity. This can result in women and girls being denied basic human rights, such as access to education, or access to work.
In order to address the need for menstrual health management (MHM), we worked with a group of young Zimbabwean women to develop a suitable MHM intervention. It will include comprehensive educational materials, analgesia and menstrual health products, such as the menstrual cup, reusable pads and period pants.
We will implement, and then evaluate, the MHM intervention within the two-year CHIEDZA study, an ongoing cluster-randomised trial of community-based, youth-friendly services to improve HIV outcomes in people aged 16-24 in Zimbabwe.
We will investigate the uptake of the MHM intervention by looking at participants’ product choices and their use of the products over time. We will assess its effectiveness by looking – over time – at participants’ pain management and their MHM knowledge, practices, and perceptions. And we will assess the acceptability of the intervention via a comprehensive qualitative appraisal of the products within the intervention and a process evaluation of the MHM intervention overall.
- STITCH Study: STI in CHIEDZA
The STITCH study aims to evaluate the effectiveness of community-based screening for STIs using newer diagnostic technologies among youth in Zimbabwe. The study measures the uptake and yield of STI screening and comprehensive case management including partner notification. The impact of this intervention on population level prevalence of STIs will be measured in a subset in the CHIEDZA end line survey.
- FAST: HIV self-testing for young people
Lead researcher: Grace McHugh
Funding: European & Developing Countries Clinical Trials Partnership (EDCTP), 2018-2020
Partners: SolidarMed, PSI, Ministry of Health and Child Care
Young people have the highest incidence of HIV in sub-Saharan Africa, but the lowest rates of testing. The Feasibility and Acceptability of HIV Self-Testing in adolescents and young people (FAST) study will investigate whether self-testing using oral mucosal transudate (OMT) tests could be a solution. An OMT test is a small oral swab that can be used to detect HIV antibodies in the inside cheek and around the gums.
We will distribute 5,000 OMT self-testing kits to young people aged 16-24 at tertiary education institutions. We will measure the proportion of people who complete a test and, if necessary, are referred for health care. We will also conduct qualitative interviews to understand young people’s experiences of HIV self-testing and the referral process.
Young people who receive the test kits will have the option of downloading a mobile app, ITHAKA, which gives step-by-step instructions on how to carry out the OMT test and allows users to submit their test results via the app; the cost of which will be covered by pre-paid mobile phone data. Alternatively, they can choose to test at the distribution point, in a private booth.
- B-GAP: identifying and supporting children with HIV
Lead researcher: Chido Dziva Chikwari
B-GAP (Bridging the Gap) aims to investigate the impact and feasibility of interventions to identify and support children aged 2–18 years who may have HIV.
The interventions are:
- Counselling and HIV tests for children identified as living in households with HIV positive individuals (known as targeted testing, or index-linked testing)
- Visits by community health workers to support children who test positive for HIV, and their caregivers
By also estimating the costs and cost-effectiveness of the interventions, we will be able to determine what may be needed for these interventions to be implemented on a much wider scale and sustainable in the long term.
We will investigate the effectiveness of the HIV counselling and testing in identifying children with undiagnosed HIV, and we will also investigate the effectiveness of the community health worker visits in improving the children’s links with health care services and suppressing their viral load.
Another important component of the study is for us to learn as much as possible about the process of implementing the interventions, including the local context and the ‘mechanisms of impact’: the interplaying factors that determine to what extent the interventions will achieve the desired outcomes. These are: identifying children with HIV who are undiagnosed, improving their access to health care, and lowering their viral load.
As part of the bigger B-GAP study, we are carrying out a sub-study on behalf of the World Health Organization (WHO) that involves evaluating whether caregivers can use a self-test kit to to test children and adolescents for HIV. The WHO will use our results to determine whether to approve the test kit or to make changes.
Another sub-study took place in 2018, when Chris Grundy and MSc student Edom Wessenyeleh did a mixed-methods pilot study to assess the feasibility and acceptability of strategies that would help allow people to record the location of their home in urban and rural areas using their own smartphones, a borrowed smartphone or a borrowed GPS device. This information is useful in many studies, for example to assess how far people have to travel to reach health services.
- ZENITH: supporting families to help suppress children's HIV viral load
Lead researcher: Rashida Ferrand
Funding: Wellcome Trust
Partner: Child Protection Society
Older children and adolescents with HIV need help from their families to stay in care and adhere to treatment, but families do not always know how to support them.
In the ZENITH study (Zimbabwe study for Enhancing Testing and Improving Treatment of HIV in Children), we worked with a group of volunteers who visited the households of children aged 6-15 years who were newly diagnosed with HIV and discussed issues such as how to get access to other resources, the importance of adherence to treatment, and how to tell the child about their HIV status. We carried out a randomised controlled trial to test whether these visits could help children take their medication and stay virally suppressed.
In the group of families who were visited (the intervention group), 67% of children were virally suppressed a year after starting ART, compared to 51% in the control group. This is the first trial ever to show that community health workers could improve HIV viral suppression.
Key results paper
Ferrand RA, Simms V, Dauya E, Bandason T, McHugh G et al (2017). The effect of community-based support for caregivers on the risk of virological failure in children and adolescents with HIV in Harare, Zimbabwe (ZENITH): an open-label, randomised controlled trial. Lancet Child and Adolescent Health 1(3): 175-183
HIV and co-morbidities
- Determine the prevalence of low BMD among children with HIV compared to children without HIV
- Analyse the risk factors for low BMD among children with HIV Compare the rate of bone mass accrual between children with and without HIV
Lead Researchers: Rashida Ferrand (Zimbabwe), Celia Gregson (UK), Lisa Micklesfield (South Africa)
Funders: University of Bristol Global Challenges Research Fund (GCRF) Investment Grant Scheme (UK)
Partners: BRTI, University of Bristol, University of the Witwatersrand, MRC Lifecourse Epidemiology Unit, University of Southampton, MRC Nutrition and Bone Health Research Group, Cambridge
Summary: MENOPAUSE study: Understanding the impact of HIV infection and its treatment on the effect menopause has on the musculoskeletal health of African women
The scale-up of antiretroviral treatment has dramatically improved survival, such that across Africa, increasing numbers of women with chronic HIV are now reaching the menopause and beyond. The menopause is a period of metabolic change with effects on the skeleton associated with increased fracture risk. Research has seldom focused on African woman at this stage of life. We are investigating whether HIV infection and its treatments worsen menopausal bone loss, and whether good viral suppression, achieved through antiretroviral treatment (ART), attenuates this HIV effect. We are examining whether certain ARTs, eg. tenofovir, may have more detrimental effects on bone mass and architecture, and if HIV infection is associated with earlier menopause. Understanding patterns and mechanisms of bone loss in the context of HIV infection will help inform future interventions and guidelines.
The study has three work packages, firstly we will analyse data already collected 471 women followed-up over a 4 year period in Soweto, Johannesburg, secondly we will collect new data from 320 pre-, peri- and post-menopausal women in Harare in whom we will measure bone mineral density (BMD), muscle mass and function, amongst a wide range of co-morbidities. Thirdly we will interview women at different stages of menopause to understand country-specific contexts and women’s priorities at this stage in life. This body of work will involve team training and build musculoskeletal research capability in these areas, and expand the Sub-Saharan African MuSculOskeletal Network (SAMSON).
Principal Investigator: Rashida Ferrand
Funders: European & Developing Countries Clinical Trials Partnership (EDCTP)
Partners: University of Bristol, University Teaching Hospital of Zambia, Research Centre Borstel Leibniz Lung Center, Biomedical Research & Training Institute, University of Oxford, London School of Hygiene & Tropical Medicine, Sub-Saharan African Musculoskeletal Network, Ministry of Health & Child Welfare
One of the adverse effects of the HIV infection among children are bone deficiencies (skeletal development). Therefore, the purpose of this trial is to establish whether supplementation with vitamin D3 (weekly) and calcium carbonate (daily) improves musculoskeletal health among peripubertal CWH (children living with HIV) aged 10-19 years in Zambia and Zimbabwe over a period of 48 weeks. In addition to this, the study will also investigate the intervention's effect on muscle mass and strength and to determine the sustainability of the intervention's effects by performing a follow-up at 96 weeks after the supplementation period.
- BREATHE: antibiotic trial for adolescents with HIV and chronic lung disease
Lead researcher: Grace McHugh
Funding: Medical Research Council of Norway, 2014-2019
Partners: Malawi-Liverpool Wellcome Programme
One of the most common conditions in children and adolescents with perinatal HIV is chronic lung disease, which may be caused by repeated infections that damage lung function over time.
In the BREATHE study (Bronchopulmonary function in response to azithromycin treatment for chronic lung disease in HIV-infected children), we are carrying out a randomised placebo-controlled trial of the antibiotic azithromycin, which is used in adolescents in Malawi and Zimbabwe who have HIV and symptoms of chronic lung disease. The trial is due to end in August 2019.
Gonzalez-Martinez C, Kranzer K, McHugh G, Corbett EL, Mujur H et al (2017). Azithromycin versus placebo for the treatment of HIV-associated chronic lung disease in children and adolescents (BREATHE trial): study protocol for a randomised controlled trial. Trials 18(1):622
- IMVASK: the impact of HIV on bone density in children
Lead Researcher: Ruramayi Rukuni
Funder: Wellcome Trust UK, 2018-2020
Impaired linear growth (stunting) is one of the most common manifestations of perinatally-acquired HIV and can adversely impact bone and muscle development and function, particularly during adolescence – a critical period of growth.
We hypothesise that children with HIV may have reduced bone mass accrual during adolescence, which will put them at increased risk of adverse musculoskeletal outcomes such as osteoporosis and fracture.
In the IMVASK study (the IMpact of Vertical HIV infection on child and Adolescent SKeletal development), we aim to determine the impact of HIV infection on bone mineral density (BMD) in peri-pubertal children aged 8–16 years who are established on antiretroviral therapy (ART).
We are part of the Sub-Saharan African Musculoskeletal Network (SAMSON), a research partnership across West, East and Southern Africa.
We will recruit two groups of children aged 8–16 years in Harare: 300 children with HIV and who are established on ART, and 300 HIV-negative children, who will be followed up over time in a prospective cohort study. Detailed musculoskeletal assessments including dual-energy X-ray absorptiometry (DXA) will be conducted at baseline and one year.
- INHALE: chronic lung and cardiac disease in children and adolescents with HIV
Lead researcher: Edith Majonga
Partners: University of Oxford, UCL Institute of Cardiovascular Science
Chronic lung and cardiac disease are very common in children and adolescents with perinatal HIV. The INHALE study: (Investigation of Heart and Lung Diseases in HIV among older children) aims to explore the features and causes of chronic lung and cardiac disease among older children and adolescents with perinatally-acquired HIV.
We aim to:
- Understand the risk factors clinical features, prevalence and progression of lung and cardiac disease in older children and adolescents (aged 6-16 years) living with perinatally-acquired HIV
- Explore the possible pathogenic mechanisms that may be associated with chronic lung disease in these children
- Determine normal ranges for heart structure and lung capacity among older children in Zimbabwe who do not have HIV, using echocardiography and spirometry
Majonga ED, Rehman AM, McHugh G, Mujuru HA, Nathoo K, Patel MS, Munyati S, Odland JO, Kranzer K, Kaski JP and Ferrand RA. Echocardiographic reference ranges in older children and adolescents in sub-Saharan Africa. International Journal of Cardiology. 2017; 248: 409-13.
Majonga ED, Rehman AM, Simms V, McHugh G, Mujuru HA, Nathoo K, Odland JO, Patel MS, Kaski J and Ferrand RA. High prevalence of echocardiographic abnormalities in older HIV-infected children taking antiretroviral therapy. AIDS. 2018.
Infection and AMR
Impact of the COVID-19 pandemic on health care workers and the health care system in Zimbabwe
Lead researcher: Prof Katharina Kranzer
Funder: University of Bristol
Host institute: Biomedical Research & Training Institute (BRTI)
Collaborators: Dr Justen Manasa (BRTI), Prof Chiratidzo Ndhlovu (University of Zimbabwe), Dr Hilda Mujuru (University of Zimbabwe), Prof Simbarashe Rusakaniko (University of Zimbabwe)
We hypothesise that frontline health care workers are pivotal to SARS-CoV-2 response and establishing rapid SARS-CoV-2 testing and communication of results for healthcare workers will help to prevent nosocomial transmission, reduce transmission in the community and lay the foundation for an effective and robust surveillance system.
The aim of this study is to implement comprehensive occupational health services including SAR-CoV-2 testing integrated with screening for major causes of morbidity and mortality in frontline health care workers, with rapid feedback of results to reduce nosocomial spread and trace household contacts.
- Erase TB
Principal Investigators: Dr Theodora Mbunda, Dr Celso Khosa, Dr Junior Mutsvanga
Funders: European & Developing Countries Clinical Trials Partnership (EDCPT), European Union
Partners: London School of Hygiene & Tropical Medicine, Biomedical Research & Training Institute, Mbeya Medical Research Centre, Karolinska Institutet, Medical Center of the University of Munich, Instituto Nacional de Saúde, Ministry of Health & Child Welfare, Harare City Health, National TB Program, Cepheid, Biomerieux, Beckman Coulter, SD Biosensor
Erase TB is a study that seeks to evaluate new diagnostic tests for detecting tuberculosis (TB) in its early stages. Recent studies demonstrate that the infection transitions between less active and more active states and therefore if the disease is detected in its early stages, we can prevent it from becoming infectious.
The study will enrol 2100 household contacts, people living in close proximity with someone recently diagnosed with TB. We will perform a follow-up every six months over a minimum period of 18 months and a maximum period of 24 months. We will actively diagnose TB using CXR and WHO symptom screen followed by Xpert MTB/RIF testing, if screened positive. All participants will have blood and urine samples stored for investigation at a later point in time.
- FIEBRE: causes of fever and antimicrobial resistance
Principal Investigator: Dr Katharina Kranzer
Lead researcher: Ioana Olaru
Social scientist: Salome Manyau
Funding: UK Department for International Development (DfID)
Across sub-Saharan Africa and Asia, one of the most common symptoms to prompt someone to seek healthcare or be admitted to hospital is fever. With limited diagnostic facilities the cause of fever can be difficult to determine, and often patients are given antibiotics they may not need. The aim of FIEBRE is to identify the causes of fever, and the antimicrobial susceptibility of bacterial pathogens causing fever, in low- and middle-income country settings where few data are available.
Listen to Dr Katharina Kranzer explain the study:
The Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study will investigate the causes of fever in five countries: Zimbabwe, Lao PDR, Malawi, Mozambique and Myanmar. The results will help to inform updated, evidence-based algorithms for the management of febrile illnesses and provide data that may be used to design new diagnostics and rational approaches to disease surveillance. These outputs will ultimately help health systems and providers to provide more appropriate care to patients and lead to better clinical outcomes. In Zimbabwe, the FIEBRE study has contributed to the detection of ciprofloxacin-resistance in Salmonella Typhi which will lead to collaborations with the National Microbiology Reference Laboratory.
FIEBRE also includes social science research to understand how fever and antimicrobial use are understood and conceptualised, and how social factors shape access to and use of antimicrobials.
Lead researcher: Ioana Olaru
Funder: UK Department for International Development (DfID), 2018-2021
Antimicrobial Resistance in Gram-negative bacteria from Urinary Specimens (ARGUS) is a study of the prevalence, risk factors and molecular mechanisms of AMR. The aims of this study are
- to determine prevalence of and underlying molecular mechanisms for antimicrobial resistance in gram negative bacteria causing urinary tract infections in Zimbabwe
- to investigate risk factors for antimicrobial resistance
- to examine how antimicrobial resistance impacts on clinical outcome
- to evaluate antibiotic consumption and prescribing practices at the primary clinic level
The study is expected to provide valuable information on the prevalence of antibiotic resistance and will inform treatment guidelines, as well as strategies to prevent development of antibiotic resistance. The information on antibiotic consumption will be used to optimise prescription practices and contribute to limiting the spread of antimicrobial resistance.
- Neonatal sepsis: reducing mortality of babies in hospital
Lead researcher: Felicity Fitzgerald
Funding: Healthcare Infection Society
The Neonatal Sepsis study will investigate ways of reducing mortality from infection (sepsis), usually bacterial, in newborn babies (neonates) in Zimbabwe.
This pilot study uses a mixed-methods approach and will include ethnographic observations and in-depth interviews to:
- Identify key factors that limit effective infection prevention and control (IPC) in the neonatal unit at Harare Children’s Hospital
- Examine how these factors can be modified to improve IPC
We will also evaluate the impact of NeoTree, a tablet-based application that allows health professionals to collect data in real time, receive blood culture results as soon as they are available, and receive support when making decisions about management and treatment.
We want to know whether the use of NeoTree:
- Reduces the length of stay in the neonatal unit
- Increases the use of appropriate antibiotics – i.e. the correct antibiotic for a particular blood culture result
- Reduces the mortality rate
We believe research should be done in partnership with the communities with whom we work. See below for our public engagement initiatives.
The outbreak of the coronavirus pandemic has significantly altered our lives as Zimbabweans and the world over. In keeping with international health organisations’ efforts in disseminating important information to reduce the spread of the virus, our research group has developed COVID-19 preventative measures infographic visuals, for the community and public health sector to follow. We are committed to ensuring the safety and welfare of the general public during this period by urging them to adhere to these practices when engaging in everyday activities and when performing healthcare work in community settings.
Unpacking COVID-19 - For our communities
COVID-19 Precautions for Health Workers
Chiedza Mobilisation 2020
Since the start of the year, the Chiedza study has been actively executing their mobilisation strategy to increase awareness of the study’s core activities (sexual reproduction health services) aiming to increase service uptake in the communities where they operate (Harare, Bulawayo and Mashonaland East). Ms Tino Mavimba (Head of Operations, Ardent Creative), one of the study’s key partners, heads up a team of enthusiastic community mobilisers to ensure these mobilisation objectives are met. Her statement reflects their progress thus far;
‘’Our dynamic teams of community mobilisers operate across three provinces (Harare, Mashonaland East and Bulawayo) and act as the bridge between the CHIEDZA Centres and the vibrant communities in which they operate. You cannot miss them, singing, dancing and engaging with young people in their bright blue tees! Since mobilisation efforts began in February 2020, we have seen a significant increase in service uptake in the various communities. We expect this to increase even further as the team continue to devise tailored strategies for community engagement.’’
Global Health in Mbare
On 28 February 2020, Research fellow, Chido Dziva Chikwari, presented at the UCHI event on sexual health in Mbare in partnership with the Australian Embassy and Global Health Dorcas.
The programme included a presentation on:
- Unpacking Sexual and Reproductive Health for Young People in Mbare; Views through a Gender and Cultural Lens
Youth Researchers Academy
The Youth Researchers Academy (YRA) is a programme to enable young people aged 18-24 to conduct research that will inform development of sexual and reproductive health interventions. It is supported by the Regional SRHR Fund of Hivos Southern Africa.
Find out more see the YRA Manual (pdf).
Residential Training Programme
From 6-10 May, 18 selected young people attended a residential training programme where they learned research concepts, methodology and implementation, focusing on sexual and reproductive health. At the end of the week youth researchers presented their research project plans to national and international stakeholders. Over the next 3 months youth researchers conducted their research projects with a mentor, and presented the results at a stakeholder ceremony hosted by UNICEF/UNESCO in October 2019.
For International Youth Day 2019 the youth researchers created their own videos about their experiences, representing the theme 'Transforming Education'.
It has been such a wonderful experience for me ... I know a lot about the youth, the problems they face.
Rosina Chuchu, menstrual health management team YRA
Funded by a Wellcome Trust International Engagement Award, we created Chiedza’s Song in 2016, a 1-hour film telling the true story of an adolescent girl growing up with HIV in Zimbabwe. It was filmed and produced by Picturing Health, a UK-based non-profit organisation specialising in health-related films, in collaboration with the award-winning Zimbabwean filmmaker Joe Njagu. The film was based on more than 50 interviews with HIV positive young people in Harare. it was designed to encourage dialogue about the challenges faced by adolescents living with HIV.
The film has two versions, both available here. One version, intended for showing in community halls in Harare, is interactive, with a pause during which one of the main characters would appear on stage to host a group discussion. The second version includes film of a community hall discussion, and plays through without a break.
A Facilitation Guide is available for use by teachers or community groups showing the film, in any context. It is a guide to stimulate conversations about the key issues faced by children and adolescents living with HIV, such as discrimination and the challenges of taking lifelong treatment.
CHIEDZA Life Skills course
Since 2008, we have been running a life skills course for adolescents living with HIV in Harare. This is a 12 session course run by volunteers from our research group, Tendai Muchena and Godwin Chizano along with staff at Harare Hospital and Parirenyatwa Hospital.
The sessions are delivered monthly on a Saturday and focus on issues that adolescents face. Sessions are interactive and participatory and include group activities, videos, games. Q&A sessions and individual activities. The sessions are updated based on feedback received from participants.
The Chiedza Life Skills Training Manual is for facilitators wishing to lead sessions with young people on HIV within a high HIV prevalence context such as Zimbabwe. It includes session outlines and guidance on how to talk through the disease and treatment and some of the difficult emotions which might arise.
Further resources are available from Mesh, a collaborative open-access web space for people involved with community engagement with health research in low and middle-income countries.
The IMVASK study of bone growth and skeletal development has links with three secondary schools in Harare. As part of its public engagement, the IMVASK team are holding a series of one-day science fairs hosted by the schools. The aims are to give high school students who are passionate about science the opportunity to test and present their ideas to their peers, interact with health care and research professionals to explore how science is applied to health, and open up their career options and aspirations.
Every year, a few lucky MSc students at the London School of Hygiene & Tropical Medicine will have the opportunity to conduct their summer projects with the Zimbabwe adolescent research group. Annie Brunskill (Control of Infectious Diseases 2018) describes her experience.
“For my summer project (MSc Control of Infectious Diseases) I spent 3 weeks in Harare researching the impact of decentralisation on the quality of HIV care. This involved working with local research assistants to collect data on a variety of indicators in a primary health centre and hospital HIV clinic. The experience was really positive and enabled me to gain invaluable experience in designing and conducting research in a low- or middle-income country. The team at BRTI were so friendly and helpful with all aspects of the project and there was always support available throughout the process. I had very little previous research experience and thus found it particularly helpful when designing questionnaires and training research assistants.
I would highly recommend a project with Rashida's group if you are interested in undertaking a valuable piece of work and seeing more of Zimbabwe!
"The team at BRTI were so friendly and helpful with all aspects of the project"
Crissi Rainer from Duke Global Health Institute completed her Global Health MSc thesis on the diagnostic accuracy of an HIV oral mucosal transudate (OMT) test in children, as part of the B-GAP project. She spent several months in Zimbabwe collecting data, and shared her experience of 'learning to let go' when study findings are not as expected.
Email firstname.lastname@example.org if you are interested in carrying out your MSc summer project with the Zimbabwe LSHTM research partnership.
MSc projects library
ICAROZ study staff held a training workshop in preparation to provide frontline healthcare workers at risk of contracting COVID-19 with SARS-CoV-2 testing integrated with screening for major causes of morbidity and mortality.
Celebrating her latest achievement within the group, our research fellow, Mandikudza Tembo, has joined the Senior Leadership team at the Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH) LSHTM . Find out more in this interview.
Our two bright research fellows, Cynthia Kahari and Farirayi Kowo, who have done some outstanding work for our group, BRTI and the Bone Research Society (BRS), took part in the "Paediatric Bone Disease Oral Communications" section of the BRS Virtual conference with talks on:
- "Children living with HIV in Zimbabwe have impaired trabecular and cortical bone architecture, despite treatment with antiretroviral therapy" , Cynthia Kahari (Harare, Zimbabwe)
- "The Impact of HIV on Skeletal Maturation in Zimbabwean Children and Adolescents", Farirayi Nyakoko (Harare, Zimbabwe)
This resulted in them receiving the BRS New Investigator Awards.
In celebration of this latest achievement, the ARGUS team enjoyed some down time together as the study has made substantial progress in recruiting 1000 participants.
The study has established workshops based upon youth perspectives on routine health check -ups. These youths also have an opportunity to determine where health intervention programmes should take place, kinds of incentives that should be offered and other important topics to be covered.
The study is grateful to receive continued support from its key stakeholders in sustaining its MHM (Menstrual Health Management) component.
The study is proud to be a part of the ongoing conversation towards reducing MHM stigma in our communities and ensuring these services remain a top priority. Read about a few highlights of the activities that took place throughout the day which involved client and staff feedback in light of this intervention.
A remote meeting was held on this day in which our research fellow, Ms Chido Dziva Chikwari, together with colleagues from the University of Washington presented their findings on Caregiver Provided HIV testing (pdf) to the WHO to determine if caregiver provided HIV testing can be included as a testing strategy for children during the COVID-19 pandemic. Representatives from CDC, PEPFAR and Catholic Relief Services were present.
Published by the AMIS newsletter, the article outlines some of the complexities in conducting field work for studies on antimicrobial resistance from home in light of the Zimbabwe COVID-19 shutdown. Read the article on the AMIS website.
Congratulations to Cynthia Kahari, a research fellow with the Zim-LSHTM research group and PhD student at LSHTM , who has received the American Society for Bone and Mineral Research (ASBMR) Phoebe Leboy Professional Development Award.
The inaugural VITALITY project Investigators meeting was held from 27-29 January 2020. Vitality is a trial of Vitamin D and calcium supplementation to improve musculoskeletal health in adolescents with HIV. The meeting was attended by consortium members from BRTI, University of Zimbabwe, LSHTM, University of Bristol and University of Oxford, as well as our EDCTP Programme manager, Johanna Roth. The Borstel co-investigators joined us via Skype.
An inside look at Kevin Martin's summer research project in Zimbabwe identifying the barriers to and facilitators of young people accessing STI testing and their preferences for how they should receive STI services is available on the LSHTM student blog.