We are a multidisciplinary group including clinicians, epidemiologists, microbiologists, data managers and social scientists.
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 |
|
 Director |
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! |
 Deputy Director |
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 Clinical Lead |
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. |
 |
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 Statistical Lead |
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 Social Scientist |
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. |
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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. |
 Tsitsi Bandason Data Manager |
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. |
 Ethel Dauya Field Manager |
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. |
| 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. |
 Mr Ivan Chigonde Finance Officer |
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 Administrator |
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 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. |
 Ms Nyaradzo Mabido Finance assistant |
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. |
Post-doctoral researchers |
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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. |
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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 |
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 |
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. |
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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. |
 |
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. |
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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. |
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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. |
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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. |
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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. |
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
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Lead researcher: Rashida Ferrand
Funding: Wellcome Trust, 2017-2022
Partner: OPHID
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.
- MAE study: Menstrual Hygiene Management for Young Women
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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.
- FAST: HIV self-testing for young people
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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
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Road to Mangwe Clinics Lead researcher: Chido Dziva Chikwari
Funding: UK Medical Research Council and DfID, 2017-2020. Also supported by Orasure.
Partners: OPHID, PSI, MMPZ, Duke Global Health Institute
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.
Sub-studies
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
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A ‘green book’ for recording individual HIV care 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
- BREATHE: antibiotic trial for adolescents with HIV and chronic lung disease
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The BREATHE clinical team meeting children at Harare hospital Lead researcher: Grace McHugh
Funding: Medical Research Council of Norway, 2014-2019
Partners: Malawi-Liverpool Wellcome Programme
Nuffield Department of Medicine, University of Oxford
University of Tromso - the Arctic University of Norway
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.
Key paper
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
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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).
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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
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Lead researcher: Edith Majonga
Funders: Wellcome Trust, Nina Ireland Program for Lung Health
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
Key Papers
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.
DOI: https://doi.org/10.1016/j.ijcard.2017.06.109
http://researchonline.lshtm.ac.uk/4121180/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.
DOI: https://doi.org/10.1097/QAD.0000000000002031
http://researchonline.lshtm.ac.uk/4649646/
Infection and AMR
- FIEBRE: causes of fever and antimicrobial resistance
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FIEBRE Study investigator meeting in Harare (December 2018). Credit: Ruth Lorimer 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.
Mycobacterial blood culture bottles 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.
- ARGUS
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Antibiotic susceptibility testing showing resistant Salmonella Typhi 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
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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.
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
Chiedza’s Song
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.
Science Fairs
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.
Research meetings
On the third Tuesday of every month BRTI host an evening research meeting to bring together researchers from many different institutions including University of Zimbabwe, Zvitambo Institute of Maternal and Child Health, CeSHHAR and others. Research degree students are particularly welcome. Meetings are at 10 Seagrave Road, Avondale.
Next meeting dates:
Tuesday 5 November, 5pm
- Constancia Mavodza: Process evaluation of the family planning intervention for young women (16-24 years old), accessing CHIEDZA services in Bulawayo and Mashonaland East.
- Ronnie Matambo: Treatment outcomes of multi drug resistant and Rifampicin resistant tuberculosis in Zimbabwe: A cohort analysis of patients initiated on treatment during 2010 to 2015
Tuesday 3 December, 5pm
To join the mailing list, contact one of the organisers, Ruramayi Rukuni, Chido Dziva Chikwari and Ceri Evans.
MSc students
Every year, a few lucky MSc students at the London School of Hygiene and 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. There was also an opportunity to present the study design at the monthly research group meeting. Rashida and the rest of the team gave lots of advice about places to visit during my time off, and I was able to see the best Zimbabwe has to offer.
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!
My advice:
- My research project required ethical approvals to be sought from several places; this took a long time and there were a few difficulties along the way. Rashida and my supervisor, Grace, were so helpful during this process, resolving issues that arose. However, for peace of mind, I recommend you start planning and applying early, and be flexible with the dates if you can.
- Take a warm jumper because the BRTI office is freezing during the UK’s summer months and it can be cold at night – I didn’t fully believe this before I went but it really is true!
- Explore the country as much as you can whilst you’re there. It is really beautiful, with lots of wildlife and places to visit. Rashida gave us loads of great advice about what to do to make the most out of our time there.”
"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 zimbabwegroup@lshtm.ac.uk if you are interested in carrying out your MSc summer project with the Zimbabwe LSHTM research partnership.
MSc projects library
Vitality, an upcoming project to be funded by European & Developing Countries Clinical Trials Partnership (EDCPT) and sponsored by the London School of Hygiene & Tropical Medicine held its first meeting on 27-29 January 2020 at the Biomedical Medical Research &Training Institute, Harare, to discuss the clinical and trial aspects with its research team members.
The agenda included:
- Finalising the protocol
- Establishing project time lines
- Developing a list of SOPs, questionnaires and consent forms
- A drug procurement plan
- Public engagement strategy
Vitality is a trial designed to investigate whether if the provision of Vitamin D (vitamin D3 – cholecalciferol) and calcium supplements (calcium carbonate) optimises musculoskeletal health among peri-pubertal children with HIV, aged 8 to 16 in Zambia and Zimbabwe. The chief investigator, Rashida Ferrand, along with her research team (Suzanne Filteau, Celia Gregson, Lackson Kasonka, Katharina Kranzer, Grace McHugh, Hilda Mujuru, Sarah Rowland Jones, Ruramayi Rukuni, Ulrich Schaible, Victoria Simms, Helen Weiss) will lead this investigation.
Read about Kevin Martin's summer research project in Zimbabwe on the LSHTM student blog. It focused on identifying the barriers young people in the country face in accessing sexual health care.
A Christmas-themed party was held on 6 December 2019 for all teams from the various studies, as gesture of appreciation for all the hard work carried out during the year. Highlights of this event included presentations from all the studies: FIEBRE (ARGUS, Social Science and laboratory teams), IMVASK, FAST & CHIEDZA (Harare, Bulawayo and Mashonaland East Teams).
The teams explained the different elements involved in their work which included the use additional of visual aids such as skits, videos, dance and live musical performances. Gifts were also handed out to all teams in an appraisal exercise led by Prof Rashida Ferrand and Dr Katharina Kranzer.
The International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2019) was held at Kigali Convention Centre, Rwanda, from 2-7 December 2019. ICASA 2019 provided an opportunity for researchers from across the globe to speak on the diverse nature of the African region’s HIV epidemic and to share their latest scientific advances in the field of HIV. The conference also enabled participants to learn from one another’s expertise, and develop strategies to end AIDS by 2030.
Our research fellow, Chido Dziva Chikwari, represented the group and spoke about using the HIV oral mucosal tests on children (which have been shown to perform well) which resulted in the WHO allowing for these to be dispensed for children. In addition, Chido shared data from the B-Gap and Step-Up study which is based in Kenya.
The Annual Ethics Research Forum, hosted by the Medical Research Council of Zimbabwe, was held in Harare on Friday 29 November 2019. The theme of the event was fostering and enabling a conducive and ethical environment for conducting health research and development in Zimbabwe. BRTI/LSHTM Zimbabwe were represented by Prof. Rashida Ferrand, Chido Dziva Chikwari (Research Fellow), Ethel Dauya (Field Manager), Dylan Sean Chishava and Brian Zhuwao (Youth Workers). They all participated in the key populations round table discussion on involving children, adolescents and marginalised groups that includes sex workers and LGBT individuals.
The Zimbabwe/LSHTM (BRTI) Group, in partnership with HIVOS, attended the 8th African Population Conference in Entebbe, Uganda from 18-22 November 2019, with a team of youth researchers who presented their research findings in Sexual and Reproductive Health and Rights (SRHR) service delivery.
A pre-conference was held at the Imperial Resorts Beach Hotel on 17 November that focused on addressing the missing link of meaningfully engaging youth in research.
The main conference featured the following presentations:
- Evaluating Peoples use of Technology in Zimbabwe; An opportunity for increasing uptake and Access to Sexual Reproductive Health Services – Caroline Masuku, Nonhlanhla Sibanda, Sezile Mloyi, Chido Dziva Chikwari (BRTI)
- Supporting Period Positive Interventions: A Menstrual Health Management (MHM) Research Project – Rozinah Chuchu, Yvonne Kaseke, Maria Tapfuma, Tendai Losi, Mandikudza Tembo (LSHTM/BRTI)
- An assessment of the factors that prohibit access and utilisation of youth friendly Sexual Reproductive Health (SRH) information and services among young people with disabilities in Mutare – Anyway Mugobiwa, Tinotenda Makora, Vanessa Toro, Talent Makate, Shalom Maguwa
- SRHR needs for undocumented Youth Migrants in Selected Cities – Sandile Simelane (United Nations Population Fund)
Katharina Kranzer has been awarded the 2019 Scientific Prize by the International Union against Tuberculosis and Lung Disease 2019 for her work on TB and lung health over the past five years. Katharina accepted the prize at the 50th Union World Conference on Lung Health in Hyderabad, India. In awarding it, the Union particularly noted her "exemplary work characterised by the appropriate use of research methods across different disciplines with an emphasis on collaboration and capacity building".
On 19 October 2019, the Annual Medical Research Day (AMRD), hosted by the University of Zimbabwe, took place in Harare. The purpose of the AMRD is to showcase and share research results with other researchers and a variety of stakeholders. Our group took part in the event where a few of our research leads, scientists and youth researchers from Bulawayo submitted posters and presented their work.
Presentations
| Presenter | Presentation topic | |
|---|---|---|
| Janice Martin (FIEBRE Scientist) | Emergence of diminished ciprofloxacin-susceptibility Salmonella Typhi In an ongoing outbreak | |
| Sezile Mloyi representing Bulawayo-based Youth Researchers Academy | Evaluating young peoples use of technology in Bulawayo; an opportunity for increasing uptake and access to sexual reproductive health services | |
| Dr Katharina Kranzer (Principal Investigator, FIEBRE) | Knowledge, attitudes and practices of youth towards sexually transmitted infections and STI testing in Harare, Zimbabwe |
Posters
| Presenter | Poster title |
|---|---|
| Mandikudza Tembo (PhD Research Fellow) | Menstrual product choice and uptake of a menstrual health management intervention among young women aged 16–24 years old within a community-based sexual and reproductive health intervention in Zimbabwe |
Grace McHugh (Principal Investigator, FAST) |
Feasibility and Acceptability of HIV self-testing amongst tertiary level students in Zimbabwe |
| Edith Majonga (Radiographer, PhD Researcher) | Carotid intima media thickness in children with HIV taking antiretroviral therapy |
Two members of the team won prizes:
- Janice Martin - Abraham Harid Prize for best clinical paper on Emergence of diminished ciprofloxacin-susceptibility Salmonella Typhi in an ongoing outbreak
- Mandikudza Tembo - Prof J Meikle Prize for her findings on Menstrual Product Choice and menstrual hygiene management intervention among young women (16-24 years)
On 10 October 2019, the Zimbabwe Youth Researchers Academy Dissemination meeting was held at UNICEF Harare. The event was hosted by Hivos Regional Sexual and Reproductive Health and Rights (SRHR) Fund in partnership with Restless Development, the Biomedical Research & Training Institute (BRTI)/London School of Health & Tropical Medicine. Representatives from the Embassy of Sweden, UNDP, UNESCO, UNAIDS, USAID, SAT Zimbabwe, Heart & Soul, Nzeve Trust, Ministry of Public Service Labour and Social Welfare, and Childline Mutare were present.
The key objective of the Youth Researchers Academy (YRA) is to to provide an opportunity for young people to take ownership of their sexual and reproductive health agenda and actively inform and determine their needs. The aim of the dissemination meeting was to introduce models of youth led research initiatives, which can increase capacity for youth driven research, youth engagement and leadership in the field of adolescent sexual and reproductive health.
Each group of youth researchers presented their work. Seven groups were hearing, and one group from Restless Development consisted of deaf young researchers, who investigated and reported on the barriers to healthcare faced by deaf young people in Mutare.
Presentations from Chiedza YRs:
- The Youth-friendliness Research Project
- Talking Periods – The Menstrual Health Management Study
- Increasing Young Men’s Engagement with HIV SRH services
- Evaluating Young Peoples Use of Technology
- Creating Social Maps for Chiedza Clusters
- Engaging Young People Through Social Mapping
Presentations from Restless Development YRs:
- Restless Development Presentation - Hearing YRs
- Nzeve Youth Presentation – Deaf YRs
The presenters raised important issues regarding sexual and reproductive health service provision in their respective communities and suggested calls to action such as raising awareness of deaf culture among health personnel and the wider community, providing comprehensive sexuality education in schools, leveraging social mapping tools in understanding communities to establish sexual and reproductive health service sites, and the use of technology playing an instrumental role in helping youth gain access to sexual and reproductive health services.
For full details of the meeting read the report (pdf).
Leading up to the Zimbabwe Youth Researchers Academy dissemination meeting held at UNICEF on Friday 10th October, the CHIEDZA and Restless Development youth researchers took part in a 2-day presentation skills and public speaking training workshop at the Biomedical Training and Research Institute.
The aim was to develop effective public speaking skills, to help the youth researchers present their findings with confidence and clarity. Communications expert Ms Buhlebenkosi Tshabangu-Moyo facilitated the training, with a programme that included body language, eye contact, microphone training, and group work practice sessions, as well as dance competitions and singing during the breaks. The youth researchers gave 12-minute mock presentations that were recorded and watched the film of themselves to help them improve. Helped by the training, all youth researchers gave excellent presentations at the dissemination meeting.
On 4 October 2019, a workshop was held to train youth workers on how to provide sexual reproductive health and rights (SRHR) services to LGBT clients. This involved LGBT issues such as intersex, transsexualism and transgender as a gender identity. The training was part of the broader Chiedza Mashonaland East training workshop to prepare youth workers to deliver SRHR services at the Marondera site.
Key issues and challenges
The issues addressed included: (i) Definition of concepts of human sexuality in relation to (young) Key Populations; (ii) Barriers and Enablers to YKP-friendly services; (iii) Service Provider values and how they impact YKP health service providers; (iv) Making a health service/ facility YKP-friendly.
Several activities took place including: a values clarification process where participants filled in a questionnaire on their thoughts and feelings on issues impacting LGBT people, youth who use and inject drugs, and sex workers; a boxes and binaries process; a lived realities process where a consultant shared his life story; and a video session.
Main outcomes
Participants believed that the workshop gave good overview of KP-service provision, as well as providing a broader understanding of human sexuality, the concepts of sex, gender, sexual orientation, and sexual behaviours in minority communities. In general, the participants were comfortable with minority groups but they identified that there was a limited knowledge or awareness of the various intersex conditions and that the largest source of stigma and discrimination that intersex people face is from their own communities.
Suggestions on making service/facility more KP-friendly were proposed:
- Ensuring service providers are non-judgmental and open minded
- Placing visible markers showing facility and service are KP-friendly e.g. rainbow posters and stickers
- Ensuring physical structure of facility is KP-friendly e.g. gender neutral bathrooms
- Making information systems more KP-friendly e.g. questions in intake forms should be considerate of trans persons
- Guaranteeing adequate medicines and knowledgeable service providers for KP-specific services.
Future sessions should cover a more in-depth discussion of legal issues, service provision for YKPs, and issues of religion and KPs.
To find out more read the full report (pdf).
This week the CHIEDZA programme began offering tests and treatment for chlamydia and gonorrhoea using 3000 CT/NG GeneXpert cartridges kindly donated by Cepheid. Eight staff members completed laboratory training on 23 May. In the first week in which tests were available, 6 cases of chlamydia and 1 case of gonorrhoea have been identified.
Chido Dziva Chikwari was awarded the 2018 Medical Research Council of Zimbabwe prize for Best Overall Paper at the Annual Medical Research Day prize giving ceremony of the Institute of Continuing Health Education (ICHE) in Harare.
Mandi Tembo co-ordinated a two-day workshop of the East and Southern Africa Menstrual Health Research Network in Harare in April. Aims of the workshop were to hear updates from key researchers on their plans, to share and critically appraise the findings of the four working groups, and to meet key stakeholders in Zimbabwe. UNICEF hosted a garden reception and keynote presentation. The next Network meeting will be in London in July 2019.
The Network has four multidisciplinary working groups focused on the following themes:
- Understanding and working with marginalized and vulnerable groups and their communities
- Standardized monitoring and evaluation programmes & outcome measures
- Ethics of menstrual hygiene management research with adolescent girls in East/Southern Africa
- Developing educational material on menstrual hygiene
