Introduction:Syndromic management is widely used to treat symptomatic sexually transmitted infect... more Introduction:Syndromic management is widely used to treat symptomatic sexually transmitted infections in settings lacking aetiologic diagnostics. However, heterogeneity in underlying aetiologies and consequent treatment suitability are uncertain without regular assessment. This systematic review characterised aetiologies for vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa (SSA).Methods:We searched Embase, MEDLINE, Global Health, and Web of Science until July 25, 2022, and grey literature until August 31, 2022, for studies reporting aetiologic diagnoses among symptomatic populations in SSA. We adjusted observations for diagnostic test performance and used generalised linear mixed-effects meta-regressions to estimate aetiologic distributions, trends, and determinants.Results:Of 4136 identified records, 198 reports were included from 183 studies in 32 countries between 1969 and 2022. In 2015, primary aetiologies for vaginal discharge were candidiasis (69....
Young women (aged 15-24) who exchange sex for money or other support are among the highest risk g... more Young women (aged 15-24) who exchange sex for money or other support are among the highest risk groups for HIV acquisition, particularly in high prevalence settings. To prepare for introduction and evaluation of the DREAMS programme in Zimbabwe, which provides biomedical and social interventions to reduce adolescent girls' and young women's HIV vulnerability, we conducted a rapid needs assessment in 6 towns using a "social mapping" approach. In each site, we talked to adult sex workers and other key informants to identify locations where young women sell sex, followed by direct observation, group discussions and interviews. We collected data on socio-demographic characteristics of young women who sell sex, the structure and organisation of their sexual exchanges, interactions with each other and adult sex workers, and engagement with health services. Over a two-week period, we developed a "social map" for each study site, identifying similarities and diff...
Introduction Reaching men aged 20–35 years, the group at greatest risk of HIV, with voluntary med... more Introduction Reaching men aged 20–35 years, the group at greatest risk of HIV, with voluntary medical male circumcision (VMMC) remains a challenge. We assessed the impact of two VMMC demand creation approaches targeting this age group in a randomised controlled trial (RCT). Methods We conducted a 2×2 factorial RCT comparing arms with and without two interventions: (1) standard demand creation augmented by human-centred design (HCD)-informed approach; (2) standard demand creation plus offer of HIV self-testing (HIVST). Interpersonal communication (IPC) agents were the unit of randomisation. We observed implementation of demand creation over 6 months (1 May to 31 October 2018), with number of men circumcised assessed over 7 months. The primary outcome was the number of men circumcised per IPC agent using the as-treated population of actual number of months each IPC agent worked. We conducted a mixed-methods process evaluation within the RCT. Results We randomised 140 IPC agents, 35 in...
Introduction:Syndromic management is widely used to treat symptomatic sexually transmitted infect... more Introduction:Syndromic management is widely used to treat symptomatic sexually transmitted infections in settings lacking aetiologic diagnostics. However, heterogeneity in underlying aetiologies and consequent treatment suitability are uncertain without regular assessment. This systematic review characterised aetiologies for vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa (SSA).Methods:We searched Embase, MEDLINE, Global Health, and Web of Science until July 25, 2022, and grey literature until August 31, 2022, for studies reporting aetiologic diagnoses among symptomatic populations in SSA. We adjusted observations for diagnostic test performance and used generalised linear mixed-effects meta-regressions to estimate aetiologic distributions, trends, and determinants.Results:Of 4136 identified records, 198 reports were included from 183 studies in 32 countries between 1969 and 2022. In 2015, primary aetiologies for vaginal discharge were candidiasis (69....
Young women (aged 15-24) who exchange sex for money or other support are among the highest risk g... more Young women (aged 15-24) who exchange sex for money or other support are among the highest risk groups for HIV acquisition, particularly in high prevalence settings. To prepare for introduction and evaluation of the DREAMS programme in Zimbabwe, which provides biomedical and social interventions to reduce adolescent girls' and young women's HIV vulnerability, we conducted a rapid needs assessment in 6 towns using a "social mapping" approach. In each site, we talked to adult sex workers and other key informants to identify locations where young women sell sex, followed by direct observation, group discussions and interviews. We collected data on socio-demographic characteristics of young women who sell sex, the structure and organisation of their sexual exchanges, interactions with each other and adult sex workers, and engagement with health services. Over a two-week period, we developed a "social map" for each study site, identifying similarities and diff...
Introduction Reaching men aged 20–35 years, the group at greatest risk of HIV, with voluntary med... more Introduction Reaching men aged 20–35 years, the group at greatest risk of HIV, with voluntary medical male circumcision (VMMC) remains a challenge. We assessed the impact of two VMMC demand creation approaches targeting this age group in a randomised controlled trial (RCT). Methods We conducted a 2×2 factorial RCT comparing arms with and without two interventions: (1) standard demand creation augmented by human-centred design (HCD)-informed approach; (2) standard demand creation plus offer of HIV self-testing (HIVST). Interpersonal communication (IPC) agents were the unit of randomisation. We observed implementation of demand creation over 6 months (1 May to 31 October 2018), with number of men circumcised assessed over 7 months. The primary outcome was the number of men circumcised per IPC agent using the as-treated population of actual number of months each IPC agent worked. We conducted a mixed-methods process evaluation within the RCT. Results We randomised 140 IPC agents, 35 in...
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