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INTRODUCTION: Zimbabwe has a high burden of HIV (i.e., estimated 1.3 million HIV-infected and 13.8% HIV incidence in 2017). In 2017 the country developed and implemented a pilot of HIV case surveillance (CS) based on the 2017 World Health Organisation (WHO) person-centred HIV patient monitoring (PM) and case surveillance guidelines. At the end of the pilot phase an evaluation was conducted to inform further steps. METHODS: The pilot was conducted in two districts (i.e., Umzingwane in Matabeleland South Province and Mutare in Manicaland Province) from August 2017 to December 2018. A mixed-methods cross-sectional study of stakeholders and health facility staff was used to assess the design and operations, performance, usefulness, sustainability, and scalability of the CS system. A total of 13 stakeholders responded to an online questionnaire, while 33 health facility respondents were interviewed in 11 health facilities in the two districts. RESULTS: The HIV CS system was adequately designed for Zimbabwe´s context, integrated within existing health information systems at the facility level. However, the training was minimal, and an opportunity to train the data entry clerks in data analysis was missed. The system performed well in terms of surveillance and informatics attributes. However, viral load test results return was a significant problem. CONCLUSION: The HIV CS system was found useful at the health facility level and should be rolled out in a phased manner, beginning in Manicaland and Matabeleland South provinces. An electronic link needs to be made between the health facilities and the laboratory to reduce viral load test results delays.

BACKGROUND Zimbabwe has a high burden of HIV, with an estimated 1.3 million people living with the virus and an HIV prevalence and incidence of 13.8% and 0.48%, respectively (2017 Spectrum estimates). In 2017, the Zimbabwe Ministry of Health and Child Care (MOHCC) developed and implemented a pilot of HIV case surveillance (CS) based on the 2017 World Health Organisation (WHO) Person-centred HIV patient monitoring (PM) and case surveillance guidelines. As the case surveillance guidelines were new, lessons learned from field implementation experiences were intended to inform the development of HIV case surveillance implementation guidance and tools. OBJECTIVE At the end of the pilot phase, the Ministry of Health and Child Care (MOHCC) commissioned an evaluation to inform further steps. METHODS Two districts, Umzingwane in Matabeleland South Province and Mutare in Manicaland Province were commissioned to run the CS pilot from August 2017 to December 2018. During this period, 1602 people living with HIV (PLHIV) newly diagnosed with HIV were reported in the CS system, while other HIV sentinel events, including ART initiation and first viral load test, were routinely reported. A mixed-methods cross-sectional study of stakeholders and health facility staff was used to assess the following CS system features: design and operations, performance, usefulness, sustainability and scalability. A total of 13 stakeholders responded to an online questionnaire, while 33 health facility respondents were interviewed in 11 health facilities in the two pilot districts. RESULTS The HIV CS system was adequately designed for Zimbabwe’s context, integrated within existing health information systems at the facility level. However, the training was minimal, and an opportunity to train the data entry clerks in data analysis was missed. The system performed well in terms of surveillance and informatics attributes. However, viral load test results return was a significant problem. The system was used at the health facility level to track the HIV positive clients in their catchment area; all facilities that were visited were aware of what is happening to their clients. Almost all respondents believed that the country can roll out the HIV CS system to all facilities with partner support. CONCLUSIONS The HIV CS system was found useful at the health facility level and should be rolled out in a phased manner, beginning with all facilities in Manicaland and Matabeleland South provinces. An electronic link needs to be made between the health facilities and the laboratory to reduce viral load test results delays. Lessons learned from the provincial roll out can be used for a nationwide scale-up.

Background: In Zimbabwe, Harare was the first province to implement “Treat All” for people living with human immunodeficiency virus (PLHIV). Since its roll out in July 2016, no study has been conducted to assess the changes in key programme indicators. We compared antiretroviral therapy (ART) uptake, time to ART initiation from diagnosis, and retention before and during “Treat All”. Methods: We conducted an ecological study to assess ART uptake among all PLHIV newly diagnosed before and during “Treat All”. We conducted a cohort study to assess time to ART initiation and retention in care among all PLHIV newly initiated on ART from all electronic patient management system-supported sites (n=50) before and during “Treat All”. Results: ART uptake increased from 65% (n=4619) by the end of quarter one, 2014 to 85% (n=5152) by the end of quarter four, 2018. A cohort of 2289 PLHIV were newly initiated on ART before (April-June 2015) and 1682 during “Treat all” (April-June 2017). Their age and gender distribution was similar. The proportion of PLHIV in early stages of disease was significantly higher during “Treat all” (73.2% vs. 55.6%, p Conclusion: Although there were benefits of early ART initiation during “Treat All”, the programme should consider strategies to improve retention.

Background: Rugby is a popular sport played in many countries worldwide. There has been recent growing interest for the sport in Zimbabwe especially among adolescents. However, no study has been done to documentthe profile of rugby-related injuries among Zimbabwean adolescents between the ages of 10 and 19 years. The goal of the present study is to describe the injuries sustained by adolescent males during the 2014 high school rugby season. Methods: A cross-sectional survey was conducted involving 275 male adolescents’ rugby players who competed in the Super Eight School Rugby League in Harare, Zimbabwe. Results: The mean age of the sample was 16 years (SD = 1.4). 58.2% of participants sustained at least one rugby-related injury. There were 561 injuries reported in total, of which 63.3% (n = 355) were new injuries and the remainder were recurrent cases. 7.7% (n = 43) of the injuries were graded as severe with participants missing rugby activities for more than 28 days. Of the 561 injuries that occurred, 59.4% (n = 333) occurred during competitive matches in the second half (59.5%). Injuries due to tackles were the most frequent accounting for 48.3% (n = 271) of all injuries sustained. The lower limbs were the most frequent body region affected (38.6%, n = 217). When comparing position of play, flankers sustained the most injuries (14.1%) and there were no differences in incidence of injury between forward and backline players. Conclusion: Our findings on the profile of rugby injuries among male Zimbabwean adolescents were similar to those of other studies in certain aspects but differed in others. Most injuries occurred in competition during the second half of the game mainly from tackles. Both junior and senior players were equally affected. The lower limbs were frequently injured especially the knee region.

Objective: Recurrent non-specific low back pain (NSLBP) is a common occurrence in adolescents. There is limited data on the factors associated with the condition in Zimbabwe. The study sought to determine the association between physical activity and psychological status with recurrent non-specific low back pain among high school adolescents. Methods: An analytical cross sectional study was conducted among 199 randomly selected adolescents between the ages of 12-19 years from government schools in Harare. Recurrent non-specific low back pain data was collected using a reliable and validated questionnaire. Level of physical activity and psychological status were evaluated using the Physical Activity Questionnaire for Adolescents (PAQ-A) and the Mental Health Inventory-5 (MHI-5), respectively. Results: The students’ response rate was 98.5%. The 12-month prevalence of recurrent NSLBP was 30.7 % [95% CI = 24.3%-37.1%]. Girls were significantly affected than boys [X2(1) =4.73, p= 0.03]. The majority with recurrent NSLBP (68.9%) reported between 2-7 episodes, with an average duration per episode of less than thirty minutes in 62% of cases. There was no association between level of physical activity and recurrent NSLBP [X2 (1) =0.86, p= 0.35]. However, the majority (n=42) of those who reported recurrent NSLBP reported a low level of physical activity. Psychological status was not found to be associated with recurrent NSLBP [X2 (1) =0.76, P= 0.38]. Conclusion: Recurrent non-specific low back pain is a common condition among Zimbabwean adolescents affecting mainly girls. However, the episodes are of a short duration and are not significantly associated with the level of physical activity and psychological status