Youth HIV services in the context of COVID-19 pandemic in Sofala Province, Mozambique

Abstract Background After the first COVID-19 case in Mozambique, the government established a state of emergency in period April - September 2020. To reduce exposure for people living with HIV (PLWHIV), the Ministry of Health modified service delivery guidance, interrupting community activities, and revising patient flow within health facilities. The study aimed to measure the impact of the COVID-19 pandemic on HIV testing and treatment services in Sofala Province, Mozambique. Methods The study analysed the activities in 9 youth HIV services called SAAJs (Serviço amigo do adolescente e jovem) supported by Doctors with Africa CUAMM in 2020 and 2021. The following data were gathered and analysed: number of counselling sessions, number of HIV tests performed, number of people who tested positive and therefore started the antiretroviral treatment (ART), number of PLHIV on ART. Data were disaggregated by sex and age. Results In 2020 and 2021 85466 and 141844 counselling sessions were performed, respectively. A decrease of 41% was observed in the second trimester of 2020 compared with the previous one. The number of counselling sessions came back at pre-pandemic levels in the 2nd trimester of 2021. People aged 20-24 accessed more in 2020, while those aged 15-19 in 2021. In 2020 people tested for HIV were 22753, while the number was twice in 2021: the increase was higher among males(p<.05). In 2020 females were more likely to be tested, while in 2021 it was the opposite(p<.05). The positivity rate was 2.5% and 1.5%, respectively; in both years males were more likely to be tested positive(p<.05). In 2020 86.1% of people tested positive started the ART, in 2021 98%. Males were more at risk of not starting the ART(p<.05). The number of PLWHIV on ART did not decrease over time. Conclusions ART provision was generally maintained during the COVID-19 pandemic, while other services were heavily impacted. The difference observed among sex was significant and may inform future interventions. Key messages The pandemic impacted severely HIV services in 2020, especially counselling and testing activities. It is relevant to assess how the population responded to services’ restoration.


Background:
Biomass fuel use for cooking is widespread in low-and middle-income countries.Previous studies have mainly focused on adverse health outcomes in adults or specific diseases.In a cohort among young children living in Bhaktapur, Nepal, we aimed to describe the association between the use of biomass cooking fuels in families with child health using measures of linear growth, cognition and chronic illness.Methods: Caregivers of 600 marginally stunted children aged 6-11 months were interviewed about their primary source of cooking fuel at enrolment into a randomized controlled trial.Children's body length (n = 572) was measured at age 18-23 months.At the same time, blood samples (n = 497) were taken, and we measured leukocyte telomere length (LTL) as a marker of chronic disease risk.We chose LTL expressed as zscores as a measure of chronic disease.Cognitive abilities were measured by the Wechsler Preschool and Primary Scale of Intelligence, 4th edition (WPPSI-IV) and NEPSY-II subtests when the children were 4 years old (n = 531).Associations were estimated in multiple regression models.

Results:
About 18% of all families used biomass as primary cooking fuel.Children from families using biomass fuel were on average slightly shorter (mean difference 0.14 Z-scores, 95% CI: 0.28, 0.00), had lower IQ scores (mean difference 2.2 (95% CI: 0.5, 3.9), and shorter LTL (mean difference: 0.09 (95% CI: 0.05 to 0.13) compared to those not using biomass fuel.The observed associations were unaltered after adjusting for relevant confounders.

Conclusions:
In children from households in poor, urban neighborhoods in Nepal, biomass fuel use for cooking was associated with health indicators for child growth and cognition as well as longevity and chronic illnesses reflected in shortening of telomeres.As this was an observational study, residual confounding cannot be excluded.Our findings support the ongoing effort to reduce exposure to biomass fuel in low-resource settings.

Background:
After the first COVID-19 case in Mozambique, the government established a state of emergency in period April -September 2020.To reduce exposure for people living with HIV (PLWHIV), the Ministry of Health modified service delivery guidance, interrupting community activities, and revising patient flow within health facilities.The study aimed to measure the impact of the COVID-19 pandemic on HIV testing and treatment services in Sofala Province, Mozambique.

Methods:
The study analysed the activities in 9 youth HIV services called SAAJs (Servic ¸o amigo do adolescente e jovem) supported by Doctors with Africa CUAMM in 2020 and 2021.The following data were gathered and analysed: number of counselling sessions, number of HIV tests performed, number of people who tested positive and therefore started the antiretroviral treatment (ART), number of PLHIV on ART.Data were disaggregated by sex and age.

Results:
In 2020 and 2021 85466 and 141844 counselling sessions were performed, respectively.A decrease of 41% was observed in the second trimester of 2020 compared with the previous one.The number of counselling sessions came back at pre-pandemic levels in the 2nd trimester of 2021.People aged 20-24 accessed more in 2020, while those aged 15-19 in 2021.In 2020 people tested for HIV were 22753, while the number was twice in 2021: the increase was higher among males(p<.05).In 2020 females were more likely to be tested, while in 2021 it was the opposite(p<.05).The positivity rate was 2.5% and 1.5%, respectively; in both years males were more likely to be tested positive(p<.05).In 2020 86.1% of people tested positive started the ART, in 2021 98%.Males were more at risk of not starting the ART(p<.05).The number of PLWHIV on ART did India has the largest share of neonatal mortality, accounting for 21.7 per 1,000 in 2019, while the global goal is at least 12 per 1,000 by 2030.More than 20% of deliveries still occur at home in India for various reasons.Several national interventions were designed to ensure essential practices even at home by engaging skilled birth attendants (SBAs), antenatal care (ANC), and community health workers (CHWs).This study evaluates the effectiveness of these interventions on essential newborn care practices (EP); clean cord care, thermal care, and breastfeeding.Using data from the 2015-2016 India Demographic andHealth Survey (n = 9,273), this study employs structural equation modeling to confirm the relationship between SBA, ANC, CHWs counseling, and EP, including indirect effects of ANC and CHWs and moderating effects of women's empowerment.The results show that SBA and ANC have significant direct effects (standardised coefficient = 0.105 and 0.056, respectively) on EP, and ANC and CHWs have significant indirect effects (0.015 and 0.004) in the well-fitted model (CFI = 0.938, TLI = 0.920, RMSEA (upper 90% CI) = 0.028 (0.029), SRMR = 0.044).The empowermentrelated factors which had a significant positive moderating effect on the paths from SBA to EP and from ANC to EP are decision-making power (0.007, 0.003), allowed mobility (0.002, 0.001), and education (0.009, 0.004).More than 90% of EP variance is not associated with the factors in this model (standardised coefficient = 0.958).SBA demonstrated the most considerable effectiveness for EP, while ANCs and CHW indirectly impacted EP.Improving women's empowerment can be an effective strategy to enhance EP.Previous literature said that the other factors explaining EP could be quality of care, other interventions for a safe birth, and cultural characteristics.Policymakers are recommended to consider comprehensive factors to address barriers to safe home birth