Visit to CeSHHAR in Harare for Recency Study (December 2018)

Left to right:
Sitholubuhle Magutshwa: CeSHHAR – Recency Study Coordinator
Brenda Ashanda: UCSF/EDARP – Recency Study Coordinator
Mariken De Wit: LSHTM – Research Assistant

Mariken De Wit, Research Assistant at LSHTM reports on visit to Harare in November 2018.

The MeSH Consortium has been running three pilot studies in Kenya and Zimbabwe to assess the feasibility and utility of conducting HIV recency testing in routine settings. Implementing these tests has proven to be challenging. The pilot in Zimbabwe focusses on female sex workers and is conducted within the Sisters with a Voice programme run by CeSHHAR. To get a better understanding of the day-to-day work around the recency testing and to discuss analysis plans, I went to Harare to work with the CeSHHAR team.

During the first day, our focus was on data analysis. Our colleagues at CeSHHAR shared the recency data with me, and together we discussed what our analytical approach should be. The recency pilot aims to identify female sex workers with a recent HIV infection and explore potential sociodemographic and behavioural risk factors for a recent infection. HIV incidence estimates will also be calculated based on these data.

Alongside a colleague from one of the pilots in Kenya we visited the laboratory (where the recency tests are conducted) and one of the sex workers clinics in Mbare. The clinics are run by nurses who provide sexual health care and counselling specifically aimed at female sex workers. Clients are tested for HIV infection every three months, for which they can choose to either get tested or do a self-test. During the post-test counselling, and depending on their test result, they discuss how to stay HIV negative or how to be linked to ART treatment. They are also offered the option to participate in the recency study. This recency test will indicate when they are most likely to have become infected. If consent is given, a blood sample is taken and transported to the laboratory at the end of the day.

While the women are in the waiting room, I saw peer educators engage with them – explaining how to use male and female condoms, giving tips on how to please male clients, and discussing ways to prevent HIV infection and other STIs. During my visit to the clinic, the peer educators used well-known melodies to share sexual health information and by the end of the song, everyone was singing and dancing! A great example of how music and dance can contribute to HIV prevention education.

The rest of my time in Harare focused on the qualitative component of the pilot. I was presented with an opportunity to gain a thorough understanding of the challenges faced by the people working in the field in Zimbabwe, our colleague from Kenya and the local lab manager. This has provided invaluable insights into the day-to-day practices and the implementation to help assess the feasibility of the intervention.

My brief visit has highlighted to me how valuable it can be to go visit a study site and learn how the actual work is being done, how planned interventions are implemented in real world settings, and what challenges have arisen and been overcome; before everything is compiled into one database and a few lines of code.