BACKGROUND & AIMS: OBJECTIVES:Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are known to have a tuberculosis (TB) protective effect at the individual level among people living with HIV (PLHIV). In Zimbabwe where TB is driven by HIV infection, we have assessed whether there is a population-level association between IPT and ART scale-up and annual TB case notification rates (CNRs) from 2000 to 2018. DESIGN:Ecological study using aggregate national data. SETTING:Annual aggregate national data on TB case notification rates (stratified by TB category and type of disease), numbers (and proportions) of PLHIV in ART care and of these, numbers (and proportions) ever commenced on IPT. RESULTS:ART coverage in the public sector increased from <1% (8400 PLHIV) in 2004 to ~88% (>1.1 million PLHIV patients) by December 2018, while IPT coverage among PLHIV in ART care increased from <1% (98 PLHIV) in 2012 to ~33% (373 917 PLHIV) by December 2018. These HIV-related interventions were associated with significant declines in TB CNRs: between the highest CNR prior to national roll-out of ART (in 2004) to the lowest recorded CNR after national IPT roll-out from 2012, these were (1) for all TB case (510 to 173 cases/100 000 population; 66% decline, p<0.001); (2) for those with new TB (501 to 159 cases/100 000 population; 68% decline, p<0.001) and (3) for those with new clinically diagnosed PTB (284 to 63 cases/100 000 population; 77.8% decline, p<0.001). CONCLUSIONS:This study shows the population-level impact of the continued scale-up of ART among PLHIV and the national roll-out of IPT among those in ART care in reducing TB, particularly clinically diagnosed TB which is largely associated with HIV. There are further opportunities for continued mitigation of TB with increasing coverage of ART and in particular IPT which still has a low coverage.

背景与目标： 目的：已知在艾滋病毒感染者（PLHIV）个体中，抗逆转录病毒疗法（ART）和异烟肼预防疗法（IPT）对个体具有结核病（TB）保护作用。在津巴布韦，结核病是由HIV感染引起的，我们评估了2000年至2018年IPT和ART扩大与每年结核病病例通报率（CNR）之间是否存在人群水平的关联。
设计：使用全国汇总数据进行的生态研究。
单位：关于结核病病例报告率（按结核病类别和疾病类型分层），ART护理中PLHIV的数量（和比例）的年度国家汇总数据，其中IPT上已经开始。
结果：到2018年12月，公共部门的ART覆盖率从2004年的<1％（8400 PLHIV）增至约88％（> 110万PLHIV患者），而ARTT护理中的PLHIV中IPT覆盖率从<1％（98 PLHIV）增加），到2012年下降到33％（373917艾滋病毒/艾滋病），到2018年12月。这些与艾滋病有关的干预措施与结核病CNR的显着下降有关：介于全国范围内推广使用抗逆转录病毒疗法之前的最高CNR（2004年）至记录的最低水平从2012年开始实施全国IPT后的CNR，（1）所有结核病病例（510至173例/ 10万人口；下降66％，p <0.001）； （2）患有新结核病的患者（501到159例/ 10万人口；下降68％，p <0.001），以及（3）患有临床新诊断为PTB的患者（284到63例/100.000人口；下降77.8％ ，p ＜0.001）。
结论：这项研究表明，在艾滋病毒感染者中继续扩大抗病毒治疗以及在全国范围内开展抗病毒治疗的人群中，IPT的推广对减少结核病，特别是与艾滋病毒相关的临床诊断结核病，具有人口规模的影响。随着ART尤其是IPT覆盖率仍然较低的覆盖面的扩大，还有进一步减少结核病的机会。

BACKGROUND & AIMS: PURPOSE:We assessed 18-month cumulative mother-to-child HIV transmission (MTCT) risk and risk factors for no antiretroviral medication use during pregnancy among adolescent, young women, and adult mothers in Zimbabwe. METHODS:We analyzed data from a prospective survey of 1,171 mother-infant pairs with HIV-exposed infants aged 4-12 weeks who were recruited from 151 immunization clinics from February to August 2013. HIV-exposed infants were followed until diagnosed with HIV, death, or age 18 months. Findings were weighted and adjusted for complex survey design and nonresponse. RESULTS:The 18-month cumulative MTCT risk was highest among adolescent aged ≤19 years (12%) followed by young women aged 20-24 years (7.5%) and adult women aged ≥25 years (6.9%). Across these groups, more than 94% had ≥1 antenatal care visit by 21 weeks of gestation, more than 95% had ≥1 HIV test, and more than 98% knew their HIV status. Of known HIV-positive mothers, maternal antiretroviral medication coverage during pregnancy was 76.8% (95% confidence interval: 65.1-85.5), 83.8% (78.6-87.9), and 87.8% (84.6-90.4) among adolescent, young women, and adult mothers, respectively. Among HIV-positive mothers diagnosed prenatally, the adjusted odds ratio of no ARV use during pregnancy was increased among those who had no antenatal care attendance (adjusted odds ratio: 7.7 [3.7-16.0]), no HIV testing (7.3 [2.3-23.5]), no prepartum CD4 count testing (2.1 [1.3-3.4]), and maternal HIV identification during pregnancy (2.9 [1.8-4.8]). Age was not a risk factor. CONCLUSIONS:With similar coverage of prevention of MTCT services, the 18-month cumulative MTCT risk was higher among adolescents and young women, compared with adults. Additional research should examine the causes to develop targeted interventions.

背景与目标： 目的：我们评估了津巴布韦的青少年，年轻妇女和成年母亲在怀孕期间未使用抗逆转录病毒药物的18个月累积母婴HIV传播（MTCT）风险和危险因素。
方法：我们分析了2013年2月至2013年8月从151个免疫诊所招募的1,171对4-12周暴露于HIV的母婴对的前瞻性调查数据。或18岁以下的年龄。对结果进行加权，并针对复杂的调查设计和不答复进行调整。
结果：≤19岁的青少年中18个月累积MTCT风险最高（12％），其次是20-24岁的年轻女性（7.5％）和≥25岁的成年女性（6.9％）。在这些人群中，超过21％的孕妇在21周前接受了≥1次产前检查，超过95％的患者接受了≥1次HIV检测，超过98％的人知道自己的HIV状况。在已知的HIV阳性母亲中，孕期孕妇的抗逆转录病毒药物覆盖率分别为76.8％（95％置信区间：65.1-85.5），83.8％（78.6-87.9）和87.8％（84.6-90.4），分别为青少年，年轻妇女和成年母亲。在产前诊断为艾滋病毒阳性的母亲中，没有进行产前护理的妇女中，未怀孕期间未使用抗逆转录病毒的调整比值比有所增加（调整比值比：7.7 [3.7-16.0]），没有进行艾滋病毒检测（7.3 [2.3-23.5]） ]），未进行产前CD4计数测试（2.1 [1.3-3.4]），孕妇在怀孕期间进行了HIV鉴定（2.9 [1.8-4.8]）。年龄不是危险因素。
结论：在预防MTCT服务的覆盖范围相似的情况下，与成年人相比，青少年和年轻妇女的18个月累积MTCT风险更高。其他研究应检查制定针对性干预措施的原因。

BACKGROUND & AIMS: :Little research has been conducted on how pre-existing indigenous community resources, especially social networks, affect the success of externally imposed HIV interventions. Antiretroviral treatment (ART), an externally initiated biomedical intervention, is being rolled out across sub-Saharan Africa. Understanding the ways in which community networks are working to facilitate optimal ART access and adherence will enable policymakers to better engage with and bolster these pre-existing resources. We conducted 67 interviews and eight focus group discussions with 127 people from three key population groups in Manicaland, eastern Zimbabwe: healthcare workers, adults on ART and carers of children on ART. We also observed over 100 h of HIV treatment sites at local clinics and hospitals. Our research sought to determine how indigenous resources were enabling people to achieve optimal ART access and adherence. We analysed data transcripts using thematic network technique, coding references to supportive community networks that enable local people to achieve ART access and adherence. People on ART or carers of children on ART in Zimbabwe report drawing support from a variety of social networks that enable them to overcome many obstacles to adherence. Key support networks include: HIV groups; food and income support networks; home-based care, church and women's groups; family networks; and relationships with healthcare providers. More attention to the community context in which HIV initiatives occur will help ensure that interventions work with and benefit from pre-existing social capital.

背景与目标： ：关于现有的土著社区资源（尤其是社会网络）如何影响外部施加的艾滋病毒干预措施的成功的研究很少。抗逆转录病毒疗法（ART）是一种外部启动的生物医学干预措施，目前正在整个撒哈拉以南非洲地区推广。了解社区网络如何促进最佳ART接入和遵守的方式，将使决策者能够更好地与这些现有资源互动并为其提供支持。我们与津巴布韦东部马尼卡兰德的三个主要人口群体的127人进行了67次访谈和八个焦点小组讨论：医疗保健工作者，接受抗逆转录病毒治疗的成年人和接受抗逆转录病毒治疗的儿童。我们还在当地诊所和医院观察了超过100小时的HIV治疗地点。我们的研究试图确定土著资源如何使人们获得最佳的抗逆转录病毒药物治疗和依从性。我们使用主题网络技术对数据记录进行了分析，对支持社区网络的引用进行了编码，使社区居民能够实现ART访问和遵守。津巴布韦接受ART治疗的人或接受ART治疗的孩子的照顾者报告说，他们获得了各种社交网络的支持，这使他们能够克服许多坚持遵守的障碍。关键的支持网络包括：艾滋病病毒感染者群体；粮食和收入支持网络；家庭护理，教会和妇女团体；家庭网络；以及与医疗保健提供者的关系。更加关注开展艾滋病行动的社区背景，将有助于确保干预措施与现有的社会资本一起工作并从中受益。

BACKGROUND & AIMS: BACKGROUND:High prevalence of stunting in children under 5 years poses a major threat to child development in developing countries. It is associated with micronutrient deficiency arising from poor diets fed to children under 5 years. Food fortification is amongst the interventions focused at reducing the incidence of stunting in children under 5 years. METHODS:Using a large-scale household data from Zimbabwe, we investigated the gender-based importance of household adoption of food fortification on the proportion of stunted children in the household. We employed propensity score matching to mitigate self-selection bias associated with household adoption of food fortification. RESULTS:We offer three major findings. Firstly, we find statistically weak evidence that female headed households are more likely to adopt food fortification than their male counterparts. Secondly, food fortification reduces the proportion of stunted children in the household. Finally, in comparison to non-adopters, female headed households that adopt food fortification are more able to reduce the proportion of stunted children in their households than their male counterparts. CONCLUSION:The results highlight the need for policy makers to actively promote food fortification, as such interventions are likely to contribute to the reduction of stunting and to involve men in fortification interventions to improve on their knowledge and appreciation of fortified foods and the associated benefits.

背景与目标： 背景：5岁以下儿童的发育迟缓率很高，对发展中国家的儿童发展构成了重大威胁。它与因喂给5岁以下儿童的不良饮食引起的微量营养素缺乏有关。食品强化是旨在减少5岁以下儿童发育迟缓发生率的干预措施之一。
方法：使用来自津巴布韦的大规模家庭数据，我们调查了家庭中发育不良儿童所占比例的基于性别的家庭采用食品强化的重要性。我们采用倾向得分匹配来减轻与家庭采用食品强化措施相关的自我选择偏见。
结果：我们提供了三个主要发现。首先，我们发现统计上较弱的证据表明，以女性为户主的家庭比男性家庭更容易采取食品强化措施。其次，强化食品减少了家庭中发育不良儿童的比例。最后，与非采用者相比，采用食品强化的女户主家庭比男户主更有能力减少发育不良儿童的比例。
结论：结果强调决策者需要积极促进食品强化，因为此类干预措施可能有助于减少发育迟缓，并使男性参与强化干预措施，以提高他们对强化食品的知识和欣赏以及相关益处。

BACKGROUND & AIMS: :Zimbabwe does not feature much on the current debate of fertility transition in sub-Saharan Africa. This article is trying to fill this gap by analysing the ZDHS data. The total fertility rate of Zimbabwe was close to 7 births during independence in 1980. However, it has declined to 3.8 in 2006. This does not only show that fertility in Zimbabwe has been declining over the years, but it is one of the lowest in the region. The fertility trend observed is mainly explained by use of contraception. The contraceptive prevalence rate was 60 percent in 2006. It is noted that the contraceptive uptake has continued to increase even during the years when Zimbabwe was going through serious political, economic, social and health challenges. This is because the groundwork done on the family planning programme soon after independence put a solid foundation in motivating women to use contraception.

背景与目标： ：津巴布韦在当前关于撒哈拉以南非洲地区生育力过渡的辩论中作用不大。本文试图通过分析ZDHS数据来填补这一空白。 1980年独立时，津巴布韦的总生育率接近7胎。但是，到2006年，这一数字下降到3.8。这不仅表明津巴布韦的生育率多年来一直在下降，而且是津巴布韦最低的生育率之一。该区域。观察到的生育趋势主要是通过避孕来解释的。 2006年避孕普及率是60％。值得注意的是，即使在津巴布韦经历严峻的政治，经济，社会和健康挑战的年代，避孕药具的吸收仍在继续增加。这是因为独立后不久在计划生育计划上进行的基础工作就为激励妇女使用避孕法打下了坚实的基础。

BACKGROUND & AIMS: BACKGROUND:Diet is an important modifiable risk factor for non-communicable diseases (NCDs) like hypertension (HTN) and type 2 diabetes mellitus (T2DM). A NCD is a disease that cannot be transmitted from person to person. Dietary risk factors account for 5.8% of all-cause mortality in Sub-Saharan Africa (SSA). There has been an increase in the consumption of 'westernized 'diets in SSA. The westernized diets consumed in low-income countries are usually high in salt content, fatty, processed and fast foods; and hence accelerate the development of HTN and T2DM. Previous studies carried out in Zimbabwe showed low levels of knowledge and awareness of HTN and T2DM; and the dietary needs for patients with those conditions. The aim of this study was to explore the dietary habits and awareness of HTN and T2DM of both males and females in a high-density area (HDA) of Zimbabwe. METHODS:We conducted household-based cross-sectional study in a high density area of Hatcliffe, which has a population of close to 50,000 residents. Face to face interviews were conducted using hand-held mobile devices loaded with KoBo Toolbox. We selected two consenting adults, a male and female, from every fourth household in selected areas of Hatcliffe. RESULTS:In this study all the 492 participants that were interviewed responded. Eighty eight point 6% (88.6%) of the participants in the study did not know if they were hypertensive or not. In addition, 91.7% of the participants had never voluntarily checked for hypertension. Similarly, 97.6% of the participants did not know if they had T2DM or not. Ninety eight percent (98%) of the participants had not voluntarily checked their blood glucose level. CONCLUSIONS:The majority of the participants in the study were not aware if they had HTN or T2DM. The participants in the study perceived that the salt they consume is the right quantity. There is a high consumption of vegetable oil in most meals prepared.

背景与目标： 背景：饮食是非传染性疾病（NCD）（例如高血压（HTN）和2型糖尿病（T2DM））的重要可修正危险因素。非传染性疾病是一种无法在人与人之间传播的疾病。饮食风险因素占撒哈拉以南非洲地区（SSA）所有原因死亡率的5.8％。 SSA中“西餐”饮食的消费有所增加。在低收入国家消费的西式饮食通常含盐量高，脂肪多，加工食品和快餐食品高；从而加快了HTN和T2DM的发展。以前在津巴布韦进行的研究表明，他们对HTN和T2DM的知识和意识水平较低。以及患有这些疾病的患者的饮食需求。这项研究的目的是探讨津巴布韦高密度地区（HDA）男性和女性的饮食习惯和对HTN和T2DM的认识。
方法：我们在人口接近50,000的Hatcliffe高密度地区进行了基于家庭的横断面研究。面对面访问是使用装有KoBo Toolbox的手持移动设备进行的。我们从哈特克利夫（Hatcliffe）选定地区的每四个家庭中选出两名同意的成年人，一男一女。
结果：在这项研究中，所有被采访的492名参与者都做出了回应。该研究的参与者中有88％的6％（88.6％）不知道自己是否患有高血压。此外，有91.7％的参与者从未自愿检查过高血压。同样，有97.6％的参与者不知道他们是否患有T2DM。百分之九十八（98％）的参与者没有自愿检查他们的血糖水平。
结论：该研究的大多数参与者不知道他们是否患有HTN或T2DM。研究参与者认为他们食用的盐是正确的数量。大多数准备的饭菜中植物油的消耗量很大。

BACKGROUND & AIMS: :In this literature review based paper we explored the concept of exclusion of local communities from accessing resources in forest protected areas (FPAs) in Zimbabwe. We discussed the colonial and post-colonial forms, causes and mechanisms of exclusion and their social, economic and ecological outcomes. We examined the range of powers embodied in and exercised through various mechanisms, processes and social relations and their impact on local communities' access to FPA resources and associated benefits along the historical trajectory of forest governance in Zimbabwe. Results showed that the forms and extent of exclusion changed over time in tandem with the shifting political and economic landscape. During the colonial period, it was total exclusion whereby people were evicted from forest land as well as being denied access to basic resources for their livelihoods. Local communities' access to low value FPA resources improved during the post-colonial period but access to high value resources like commercial timber as well as sharing income benefits derived from FPA commercial activities remained a pipe dream. Regulation, legitimation, force and markets constituted the mixture of the power elements that FPA governing authorities used to exclude local communities. These powers remained intact despite attempts at collaborative governance in the 1990s. However, from the year 2000, local communities expressed their dissatisfaction with the centralised exclusionary governance system by invading the FPAs rendering them ungovernable. There is therefore a need for policy reform within the FPA sector to improve the current dire situation.

背景与目标： ：在这份基于文献综述的论文中，我们探讨了将当地社区排除在津巴布韦森林保护区（FPA）资源之外的概念。我们讨论了殖民和殖民后的形式，排斥的原因和机制及其社会，经济和生态后果。我们研究了各种机制，过程和社会关系所体现和行使的权力范围，以及它们对津巴布韦森林治理的历史轨迹对当地社区获取FPA资源及相关利益的影响。结果表明，排斥的形式和程度随着时间的推移随着政治和经济格局的变化而变化。在殖民时期，完全被排斥在外，使人们被逐出林地，并被剥夺了谋生的基本资源。在后殖民时期，当地社区获得低价值FPA资源的途径有所改善，但是获得高价值资源（如商业木材）以及分享FPA商业活动所带来的收入收益仍然是梦dream以求的事情。规章，合法性，武力和市场构成了联邦警察管理当局用来排斥当地社区的权力要素的混合体。尽管在1990年代尝试进行协作治理，但这些权力仍然完好无损。但是，从2000年开始，当地社区通过入侵FPA使其无法管理而对集中式排他性治理系统表示不满。因此，需要在FPA部门内进行政策改革，以改善当前的严峻形势。

BACKGROUND & AIMS: BACKGROUND:Mathematical models suggest that 570,000 HIV infections could be averted between 2011 and 2025 in Zimbabwe if the country reaches 80% voluntary medical male circumcision (VMMC) coverage among 15- to 49-year-old male subjects. Yet national coverage remains well below this target, and there is a need to evaluate interventions to increase the uptake. METHODS:A cluster-randomized trial was conducted to assess the effectiveness of Make-The-Cut-Plus (MTC+), a single, 60-minute, sport-based intervention to increase VMMC uptake targeting secondary school boys (14-20 years). Twenty-six schools in Bulawayo, Zimbabwe, were randomized to either receive MTC+ at the start (intervention) or end (control) of a 4-month period (March to June 2014). VMMC uptake over these 4 months was measured via probabilistic matching of participants in the trial database (n = 1226 male participants; age, 14-20 years; median age, 16.2 years) and the registers in Bulawayo's 2 free VMMC clinics (n = 5713), using 8 identifying variables. RESULTS:There was strong evidence that the MTC+ intervention increased the odds of VMMC uptake by approximately 2.5 fold (odds ratio = 2.53; 95% confidence interval, 1.21 to 5.30). Restricting to participants who did not report being already circumcised at baseline, MTC+ increased VMMC uptake by 7.6% (12.2% vs 4.6%, odds ratio = 2.65; 95% confidence interval, 1.19 to 5.86). Sensitivity analyses related to the probabilistic matching did not change these findings substantively. The number of participants who would need to be exposed to the demand creation intervention to yield one additional VMMC client was 22.7 (or 13.2 reporting not already being circumcised). This translated to approximately US dollar 49 per additional VMMC client. CONCLUSIONS:The MTC+ intervention was an effective and cost-effective strategy for increasing VMMC uptake among school-going adolescent male subjects in Bulawayo.

背景与目标： 背景：数学模型表明，如果津巴布韦在15岁至49岁的男性受试者中实现自愿性男性包皮环切术（VMMC）覆盖率达到80％，则该国在2011年至2025年之间可以避免570,000例HIV感染。然而，全国覆盖率仍远低于这一目标，因此有必要评估干预措施以增加吸收。
方法：进行一项整群随机试验，以评估Make-The-Cut-Plus（MTC）的有效性，这是一项以运动为基础的单项60分钟干预措施，旨在增加针对中学生（14-20岁）的VMMC摄入量。津巴布韦布拉瓦约的26所学校被随机分配在4个月（2014年3月至2014年6月）开始（干预）或结束（控制）期间接受MTC。通过试验数据库中参与者（n = 1226名男性参与者；年龄14-20岁；中位年龄16.2岁）的参与者的概率匹配以及Bulawayo的2家免费VMMC诊所中的寄存器（n = 5713）来测量这4个月内VMMC的摄入量），使用8个识别变量。
结果：有力的证据表明，MTC干预使VMMC摄取的几率增加了约2.5倍（优势比= 2.53； 95％的置信区间为1.21至5.30）。仅限于那些尚未报告已接受基线割礼的参与者，MTC将VMMC的摄取增加了7.6％（12.2％对4.6％，优势比= 2.65； 95％的置信区间为1.19至5.86）。与概率匹配相关的敏感性分析并没有实质性地改变这些发现。需要进行需求创建干预以产生一名额外的VMMC客户的参与者人数为22.7（或尚未割包皮的13.2报告）。这相当于每个额外的VMMC客户大约49美元。
结论：MTC干预是增加布拉马约州在校青少年男性受试者VMMC摄入量的有效且具有成本效益的策略。

BACKGROUND & AIMS: BACKGROUND:In developing countries with limited access to ENT services, performing emergency cricothyroidotomy in patients with upper airway obstruction may be a life-saving last resort. An established Danish-Zimbabwean collaboration of otorhinolaryngologists enrolled Zimbabwean doctors into a video-guided simulation training programme on emergency cricothyroidotomy. This paper presents the positive effect of this training, illustrated by two case reports. CASE REPORTS:A 56-year-old female presented with upper airway obstruction due to a rapidly progressing infectious swelling of the head and neck progressing to cardiac arrest. Cardiopulmonary resuscitation was initiated and a secure surgical airway was established via an emergency cricothyroidotomy, saving the patient. A 70-year-old male presented with upper airway obstruction secondary to intubation for an elective procedure. When extubated, the patient exhibited severe stridor followed by respiratory arrest. Re-intubation attempts were unsuccessful and emergency cricothyroidotomy was performed to secure the airway, preserving the life of the patient. CONCLUSION:Emergency cricothyroidotomy training should be considered for all surgeons, anaesthetists and, eventually, emergency and recovery room personnel in developing countries. A video-guided simulation training programme on emergency cricothyroidotomy in Zimbabwe proved its value in this regard.

背景与目标： 背景：在获得耳鼻喉科服务机会有限的发展中国家，对上呼吸道阻塞的患者进行紧急环颈切开术可能是挽救生命的最后选择。丹麦-津巴布韦的耳鼻喉科医生建立了良好的合作关系，使津巴布韦的医生参加了有关紧急环颈切开术的视频指导模拟培训计划。本文通过两个案例报告展示了这种培训的积极效果。
病例报告：一名56岁的女性由于快速发展的头颈部传染性肿胀发展为心脏骤停而出现上呼吸道阻塞。开始进行心肺复苏术，并通过紧急环颈切开术建立了安全的手术气道，从而挽救了患者的生命。一名70岁的男性因插管手术而出现继发于插管的上呼吸道阻塞。拔管时，患者表现出严重的喘鸣，随后呼吸停止。重新插管尝试未成功，并进行了紧急环颈切开术以确保气道安全，从而挽救了患者的生命。
结论：应考虑对发展中国家的所有外科医生，麻醉师，以及最终急诊室和恢复室人员进行紧急环颈切开术培训。在津巴布韦进行紧急环颈切开术的视频指导模拟培训计划证明了其在这方面的价值。

BACKGROUND & AIMS: OBJECTIVE:Peer education is an intervention within the voluntary medical male circumcision (VMMC)-adolescent sexual reproductive health (ASRH) linkages project in Bulawayo and Mount Darwin, Zimbabwe since 2016. Little is known if results extend beyond increasing knowledge. We therefore assessed the extent of and factors affecting referral by peer educators and receipt of HIV testing services (HTS), contraception, management of sexually transmitted infections (STIs) and VMMC services by young people (10-24 years) counselled. DESIGN:A cohort study involving all young people counselled by 95 peer educators during October-December 2018, through secondary analysis of routinely collected data. SETTING:All ASRH and VMMC sites in Mt Darwin and Bulawayo. PARTICIPANTS:All young people counselled by 95 peer educators. OUTCOME MEASURES:Censor date for assessing receipt of services was 31 January 2019. Factors (clients' age, gender, marital and schooling status, counselling type, location, and peer educators' age and gender) affecting non-referral and non-receipt of services (dependent variables) were assessed by log-binomial regression. Adjusted relative risks (aRRs) were calculated. RESULTS:Of the 3370 counselled (66% men), 65% were referred for at least one service. 58% of men were referred for VMMC. Other services had 5%-13% referrals. Non-referral for HTS decreased with clients' age (aRR: ~0.9) but was higher among group-counselled (aRR: 1.16). Counselling by men (aRR: 0.77) and rural location (aRR: 0.61) reduced risks of non-referral for VMMC, while age increased it (aRR ≥1.59). Receipt of services was high (64%-80%) except for STI referrals (39%). Group counselling and rural location (aRR: ~0.52) and male peer educators (aRR: 0.76) reduced the risk of non-receipt of VMMC. Rural location increased the risk of non-receipt of contraception (aRR: 3.18) while marriage reduced it (aRR: 0.20). CONCLUSION:We found varying levels of referral ranging from 5.1% (STIs) to 58.3% (VMMC) but high levels of receipt of services. Type of counselling, peer educators' gender and location affected receipt of services. We recommend qualitative approaches to further understand reasons for non-referrals and non-receipt of services.

背景与目标： 目的：同伴教育是自2016年以来在津巴布韦布拉瓦约和芒特达尔文市开展的自愿性男性包皮环切术（VMMC）-青少年性生殖健康（ASRH）链接项目中的一项干预措施。除结果之外，人们对结果的了解还很少。因此，我们评估了受同伴教育者推荐和接受HIV检测服务（HTS），避孕，性传播感染管理（STIs）和年轻人（10-24岁）的VMMC服务的影响程度和因素。
设计：一项队列研究，在2018年10月至12月期间，由95位同伴教育者对所有年轻人进行了咨询，对常规收集的数据进行了二次分析。
地点：达尔文山和布拉瓦约的所有ASRH和VMMC站点。
参加者：所有年轻人均受到95位同伴教育者的指导。
观察指标：评估接受服务的截止日期是2019年1月31日。影响未推荐和不接受推荐的因素（服务对象的年龄，性别，婚姻和就学状况，咨询类型，位置以及同伴教育者的年龄和性别）。服务（因变量）通过对数二项回归进行评估。计算调整后的相对风险（aRRs）。
结果：在3370名接受咨询的人（66％的男性）中，有65％的人至少接受了一次服务。 58％的男性因VMMC而被转诊。其他服务的推荐率为5％-13％。 HTS的非推荐人随着客户年龄的增长而减少（aRR：〜0.9），但在团体咨询的情况下更高（aRR：1.16）。男性（aRR：0.77）和农村地区（aRR：0.61）的咨询减少了VMMC不推荐的风险，而年龄增加了（AMR≥1.59）。服务的接收率很高（64％-80％），另外还有STI推荐（39％）。团体咨询和在农村地区居住（aRR：〜0.52）和男性同伴教育者（aRR：0.76）减少了未接受VMMC的风险。农村地区增加未接受避孕的风险（aRR：3.18），而婚姻减少的风险（aRR：0.20）。
结论：我们发现推荐率从5.1％（STIs）到58.3％（VMMC）不等，但服务接收率很高。咨询的类型，同伴教育者的性别和受地点影响的服务获得情况。我们建议您使用定性方法，以进一步了解不推荐和不接受服务的原因。

BACKGROUND & AIMS: OBJECTIVE:To assess reported HIV knowledge and attitudes, sexual behaviours and HIV testing in Zimbabwe. METHODS:Representative household surveys of all 18-24 year olds and a proportion of 25-44 year olds were conducted in six purposefully selected rural districts in two provinces in 2007 and 2009. Both surveys used the same methods and questionnaires. We compared differences in reported HIV knowledge, sexual behaviours and HIV testing, controlling for differences in socio-demographics at baseline, using cross-tabulations and multivariate regression analyses. RESULTS:Analysis was restricted to districts included in both baseline (n = 1891) and mid-term (n = 2746) surveys. Comparisons indicate increased reports of HIV knowledge (35%vs. 22% had high knowledge) and more favourable individual attitudes towards HIV. There was an increase in reported HIV testing (men: 41%vs. 31%, women: 55%vs. 36%) and condom use (men: adjusted odds ratio (AOR) = 1.35, women: AOR = 1.22) and a decrease in number of sexual partners (men: 67%vs. 49% reported 1 partner/previous 6 months, women: 77%vs. 68%). CONCLUSIONS:As Zimbabwe continues to document declines in HIV prevalence, this analysis offers insight into recent and continuing positive changes in knowledge, attitudes and behaviours among the rural population.

背景与目标： 目的：评估津巴布韦报道的艾滋病毒知识和态度，性行为以及艾滋病毒检测。
方法：在2007年和2009年，在两个省的六个有针对性地选择的农村地区中，对所有18-24岁年龄段和一部分25-44岁年龄段的代表家庭进行了调查。两次调查使用的方法和问卷均相同。我们使用交叉表和多元回归分析比较了报告的艾滋病毒知识，性行为和艾滋病毒检测的差异，控制了基线时社会人口统计学的差异。
结果：分析仅限于基线（n = 1891）和中期（n = 2746）调查中包括的地区。比较表明，关于艾滋病毒知识的报道有所增加（35％的人对22％的人具有较高的知识），并且个人对艾滋病毒的态度更加有利。报告的艾滋病毒检测率有所增加（男性：41％vs。31％，女性：55％vs.36％）和使用安全套（男性：调整后的优势比（AOR）= 1.35，女性：AOR = 1.22）和性伴侣数量减少（男性：67％vs. 49％，报告有1个伴侣/之前的6个月，女性：77％vs. 68％）。
结论：随着津巴布韦继续记录艾滋病毒感染率下降的情况，该分析提供了对农村人口知识，态度和行为的近期和持续积极变化的见识。

BACKGROUND & AIMS: BACKGROUND:This study aimed to document the clinical practices and attitudes of health care providers in South Africa and Zimbabwe on male circumcision for human immunodeficiency virus (HIV) prevention. METHODS:We conducted national surveys of physicians and nurses in both countries in 2008-2009 (N = 1444). Data on male circumcision for HIV prevention were analyzed; outcomes were patient counseling, provision of services, and desire for training. We used multivariable logistic regression to examine associations between these outcomes and clinician, practice, and attitudinal variables. RESULTS:Overall, 57% of clinicians reported counseling male patients on male circumcision, 17% were offering services (49% referrals), and 61% desired training. In the multivariable analyses, provision of services was more common in South Africa (P ≤ 0.001) but desire for training higher in Zimbabwe (P ≤ 0.01). Provision of services was highest among physicians (P ≤ 0.01) and in hospital settings (P ≤ 0.001). However, nurses had greater desire for training (P ≤ 0.05) as did younger clinicians (P ≤ 0.001). Clinicians in rural and clinic settings were just as likely to express training interest. Clinician attitudes that patients would be upset due to cultural beliefs and would increase risky behaviors were associated with less counseling and service provision (P ≤ 0.05). CONCLUSIONS:Many clinicians in South Africa and Zimbabwe showed willingness to integrate new HIV prevention evidence into practice and to become trained to offer the procedure to patients. Results suggest that both countries should consider involving nurses in male circumcision for HIV prevention, including those in rural areas, and should help clinicians to address cultural concerns.

背景与目标： 背景：本研究旨在记录南非和津巴布韦的医疗服务提供者对男性包皮环切术预防人类免疫缺陷病毒（HIV）的临床实践和态度。
方法：我们在2008-2009年对这两个国家的医师和护士进行了全国调查（N = 1444）。分析了男性包皮环切术预防艾滋病的数据；结果是患者咨询，服务提供和培训需求。我们使用多元逻辑回归分析了这些结果与临床医生，实践和态度变量之间的关联。
结果：总体而言，有57％的临床医生报告了对男性包皮环切术进行男性咨询的患者，有17％的患者提供服务（49％的转诊），以及61％的期望培训。在多变量分析中，服务的提供在南非更为普遍（P≤0.001），但在津巴布韦需要更高的培训（P≤0.01）。在医生中（P≤0.01）和在医院环境中（P≤0.001）提供的服务最高。但是，护士对培训的渴望更大（P≤0.05），而年轻的临床医生也是如此（P≤0.001）。农村和诊所环境中的临床医生也很可能表达出培训兴趣。临床医生认为患者会因文化信仰而感到不高兴，并会增加危险行为，这与较少的咨询和服务提供有关（P≤0.05）。
结论：南非和津巴布韦的许多临床医生都表示愿意将新的艾滋病毒预防证据纳入实践，并愿意接受培训以向患者提供该程序。结果表明，两国都应考虑让护士参加男性包皮环切术以预防艾滋病毒，包括在农村地区，并应帮助临床医生解决文化问题。

BACKGROUND & AIMS: INTRODUCTION:Adolescent girls and young women (AGYW), including those who sell sex in sub-Saharan Africa, are especially vulnerable to HIV. Reaching them with effective prevention is a programmatic priority. The HIV prevention cascade can be used to track intervention coverage, and identify gaps and opportunities for programme strengthening. The aim of this study was to characterise gaps in condom use and identify reasons underlying these gaps among young women who sell sex (YWSS) in Zimbabwe using data from enrolment into an impact evaluation of the DREAMS programme. DREAMS provided a package of biomedical, social and economic interventions to AGYW aged 10 to 24 with the aim of reducing HIV incidence. METHODS:In 2017, we recruited YWSS aged 18 to 24 using respondent-driven sampling in six sites across Zimbabwe. We measured knowledge about efficacy of, access to, and effective (consistent) use of condoms with the most recent three sexual partners, separately by whether YWSS self-identified as female sex workers (FSW) or not. Among YWSS without knowledge about efficacy of, not having access to, and not effectively using condoms, we described the potential reasons underlying the gaps in the condom cascade. To identify socio-demographic characteristics associated with effective condom use, we used logistic regression modelling. All analyses were RDS-II weighted and restricted to YWSS testing HIV-negative at enrolment. RESULTS:We enrolled 2431 YWSS. Among 1842 (76%) YWSS testing HIV-negative, 66% (n = 1221) self-identified as FSW. 89% of HIV-negative YWSS demonstrated knowledge about efficacy of condoms, 80% reported access to condoms and 58% reported using condoms consistently with the three most recent sexual partners. Knowledge about efficacy of and effective use of condoms was similar regardless of whether or not YWSS self-identified as FSW, but YWSS self-identifying as FSW reported better access to condoms compared to those who did not (87% vs 68%; age- and site-adjusted (adjOR) = 2.69; 95% CI: 2.01 to 3.60; p < 0.001). Women who reported experiencing sexual violence in the past year and common mental disorder in the past week were less likely to use condoms consistently (43% vs. 60%; adjOR = 0.49; 95% CI: 0.35 to 0.68; p < 0.001) and (51% vs. 61%; adjOR = 0.76; 95% CI: 0.60 to 0.97; p = 0.029), respectively. CONCLUSIONS:Despite high knowledge about efficacy of and access to condoms, there remain large gaps in self-reported consistent condom use among YWSS. Addressing the structural determinants of YWSS' inconsistent condom use, including violence, could reduce this gap. YWSS who do not self-identify as FSW have less access to condoms and may require additional programmatic intervention.

背景与目标： 简介：包括在撒哈拉以南非洲地区出售性行为的少女和青年妇女（AGYW）特别容易感染艾滋病毒。通过有效的预防措施达到这些目标是一项计划优先事项。艾滋病毒预防级联可用于跟踪干预措施的覆盖范围，并找出差距和加强计划的机会。这项研究的目的是使用从DREAMS计划的效果评估中纳入的数据，来描述津巴布韦使用安全套的空白，并找出导致这些空白的年轻女性（YWSS）造成这些空白的原因。 DREAMS为10至24岁的青年妇女提供了一揽子生物医学，社会和经济干预措施，目的是减少艾滋病毒的发病率。
方法：2017年，我们在津巴布韦的六个地点进行了由受访者驱动的18至24岁的YWSS。我们通过YWSS是否自我确定为女性性工作者（FSW）来分别评估与最近三个性伴侣的避孕套的功效，使用和有效（一致）使用的知识。在没有了解安全套功效，无法使用和无法有效使用安全套的YWSS中，我们描述了安全套级联中存在差距的潜在原因。为了确定与有效使用避孕套相关的社会人口统计学特征，我们使用了逻辑回归模型。所有分析均按RDS-II加权，并仅限于YWSS在入院时检测HIV阴性。
结果：我们注册了2431 YWSS。在1842年（76％）的YWSS测试呈阴性的YWSS中，有66％（n = 1221）自我确定为FSW。 89％的HIV阴性YWSS表现出对安全套功效的了解，80％的人报告使用安全套，58％的人报告与最近三个性伴侣保持一致使用安全套。不论YWSS是否自我识别为FSW，关于安全套功效和有效使用的知识都是相似的，但是YWSS自我识别为FSW的情况与不使用安全套的人相比，安全套的使用情况更好（87％vs 68％；年龄-且网站调整后（adjOR）= 2.69； 95％CI：2.01至3.60； p <0.001）。在过去一年中报告经历过性暴力和在过去一周中患有常见精神障碍的妇女较少持续使用避孕套的比例（43％vs. 60％; adjOR = 0.49; 95％CI：0.35至0.68; p <0.001）和分别为（51％vs.61％; adjOR = 0.76; 95％CI：0.60至0.97; p = 0.029）。
结论：尽管对避孕套的功效和使用有很高的了解，但在YWSS中，自我报告的一致使用避孕套仍存在很大差距。解决YWSS避孕套使用不一致（包括暴力）的结构性决定因素，可以缩小这一差距。没有自我认定为FSW的YWSS使用安全套的机会较少，可能需要其他程序干预。

BACKGROUND & AIMS: OBJECTIVE:To determine the prevalence and characteristics of myocardial dysfunction and other cardiac manifestations in acutely ill hospital patients infected with human immunodeficiency virus (HIV) in Zimbabwe. DESIGN:A prospective echocardiographic survey of acutely ill HIV seropositive patients. SETTING:General medical ward, Harare Central Hospital, Zimbabwe. PATIENTS:One hundred and fifty seven HIV seropositive patients admitted with various acute medical conditions over a 12 month period, January to December 1994. MAIN OUTCOME MEASURES:Detection of myocardial dysfunction and other cardiac abnormalities by cross sectional echocardiography. RESULTS:Eighty (51%) men and 77 women were studied (mean (SD) age 34.4 (8.5), range 15-60 years for males and 31.6 (9.0), range 16-65 years for females). They were all heterosexual. None was haemophiliac or an intravenous drug user. Echocardiographic abnormalities were found in 79 (50%) patients: 14/151 (9%) had dilated cardiomyopathy, 33/151 (22%) left ventricular dysfunction, 9/151 isolated right ventricular dilatation, and 30/157 (19%) pericardial disease (28 with effusions, three having tamponade). There were two cases of constrictive pericarditis and one of ascending aortic aneurysm. CONCLUSIONS:There is a high prevalence of echocardiographically detected myocardial and pericardial disease in this group of acutely ill HIV infected patients. Left ventricular dysfunction without dilatation was common, but its significance was not ascertained.

背景与目标： 目的：确定津巴布韦感染人类免疫缺陷病毒（HIV）的急症医院患者的心肌功能障碍和其他心脏表现的患病率和特征。
设计：对急性病HIV血清反应阳性患者的前瞻性超声心动图调查。
地点：津巴布韦哈拉雷中央医院普通病房。
患者：1994年1月至12月的12个月期间，有157名HIV血清反应阳性的患者接受了各种急性医疗条件治疗。
主要观察指标：横断面超声心动图检测心肌功能障碍和其他心脏异常。
结果：研究了80名（51％）男性和77名女性（平均（SD）年龄34.4（8.5），男性15-60岁，女性31.6（9.0），女性16-65岁）。他们都是异性恋。没有人是血友病患者或静脉吸毒者。在79名（50％）患者中发现了超声心动图异常：14/151（9％）患有扩张型心肌病，33/151（22％）左心功能不全，9/151单独的右心室扩张和30/157（19％）心包疾病（28例有积液，三例有填塞物）。缩窄性心包炎2例，升主动脉瘤1例。
结论：在这组急性感染艾滋病毒的患者中，超声心动图检测到的心肌和心包疾病的患病率很高。没有扩张的左心功能不全是常见的，但其意义尚未确定。

BACKGROUND & AIMS: OBJECTIVES:To determine the extent of self reported symptoms perceived to be related to sexually transmitted infections and the patterns of subsequent treatment seeking behaviour in a predominantly rural population of Zimbabwe. METHODS:A population based survey of 4331 men and 5149 women was conducted in rural Zimbabwe during 1998-2000. Structured confidential interviews collected data on self reported sexually transmitted infection symptoms, treatment seeking behaviour, sociodemographic characteristics, and sexual behaviour. RESULTS:25% of men aged 17-54 years report experiencing genital sores and 25% of men report experiencing urethral discharge; 30% of women aged 15-44 years report experiencing vaginal discharge. The lifetime number of sexual partners, age, and years of sexual activity were all significant predictors of symptoms for both men and women (all p values <0.001). 92% of men and 62% of women had sought treatment for their symptoms in the past year (p value <0.001). Men and women were equally likely to have sought treatment at a local hospital or clinic, but women were much less likely than men to have sought treatment at a different hospital or clinic. Among those who had sought treatment, men sought treatment faster than women and were more likely to report being "very satisfied" with their treatment than women. CONCLUSIONS:The gender differences in treatment seeking are of major concern for control efforts and further work on determining the reasons for these should be a priority. This would inform the likely impact of both increasing availability of local services and further reducing the stigma faced by those wishing to access such services.

背景与目标： 目的：确定在津巴布韦以农村为主的人群中，与性传播感染有关的自我报告症状的程度以及寻求行为的后续治疗方式。
方法：1998-2000年在津巴布韦农村地区进行了基于人口的4331名男性和5149名女性的调查。有组织的机密访谈收集了有关自我报告的性传播感染症状，寻求治疗的治疗方法，社会人口统计学特征和性行为的数据。
结果：年龄在17-54岁之间的男性中有25％的人患有生殖器疮，而有25％的男性中的人患有尿道分泌物。 15-44岁的女性中有30％报告有白带。性伴侣的终生数量，年龄和性活动年限都是男女症状的重要预测指标（所有p值均<0.001）。在过去的一年中，有92％的男性和62％的女性就症状寻求过治疗（p值<0.001）。男性和女性在当地医院或诊所寻求治疗的可能性相同，但是女性在男性在另一家医院或诊所寻求治疗的可能性要小得多。在寻求治疗的人中，男性寻求治疗的速度比女性快，并且比女性更容易报告对治疗“非常满意”。
结论：寻求治疗中的性别差异是控制工作的主要关注点，确定这些原因的进一步工作应作为优先事项。这将说明增加本地服务的可用性以及进一步减少希望访问此类服务的人所面临的污名化的可能影响。