Frances M Cowan
Datos Biográficos
| ID | 2111367 |
|---|---|
| NOMBRE | Frances M Cowan |
| NOMBRES | Frances M |
| APELLIDO | Cowan |
| FIRMA | COWAN F M |
| AFILIACIONES | Liverpool School of Tropical Medicine |
| ORCID | 0000-0003-3087-4422 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 66 |
| TOTAL DE CITAS | 32 |
| TOTAL COMO AUTOR | 66 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1994 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2026 |
| ÍNDICE H | 4 |
Values and preferences of female sex workers in Zimbabwe for long-acting injectable pre-exposure prophylaxis and the dapivirine vaginal ring
INTRODUCTION: Female sex workers (FSWs) in sub-Saharan Africa are at high risk of HIV acquisition. Here we explore the values and preferences of Zimbabwean FSW for long-acting pre-exposure prophylaxis (PrEP). METHODS: We employed mixed methods; focus group discussions (FGD) (n=15), a respondent-driven sampling (RDS) survey (n=4444) from 22 sites across Zimbabwe and a nested discrete choice experiment (DCE) (n=435) conducted in 4/22 sites in 2021.…
HIV Prevalence, Virological Suppression, and Consistent Condom Use Among Social Venue-Going Men in Zimbabwe
Men attending social venues face barriers to accessing HIV prevention and care services. These venues-such as bars, guesthouses, nightclubs, and transport hubs-facilitate new sexual partnerships but lack cohesive social networks, making it challenging to design and implement effective HIV prevention strategies. Men who attend social venues are more likely to pay for sex, potentially increasing their risk of acquiring or transmitting HIV. However,…
Feasibility and acceptability of peer-led assessment of HIV risk among female sex workers in Zimbabwe
INTRODUCTION: Female sex workers (FSWs) in sub-Saharan Africa are at higher risk of HIV acquisition and transmission. However, FSWs' life experiences are heterogeneous and are important to characterise in order to tailor responses to individual needs. Peer microplanners are FSWs trained to engage other FSWs and offer each individual a tailored package of support. We sought to assess the feasibility, acceptability and fidelity of implementing peer…
Cost-effectiveness of Zvandiri, a community-based support intervention to reduce virological failure in adolescents living with HIV in Zimbabwe
Improving antiretroviral therapy (ART) adherence among adolescents living with HIV (ALHIV) improves outcomes, but with resource implications. We conducted a cost-effectiveness analysis extrapolating the costs and benefits of a community-based peer-support intervention (Zvandiri) among ALHIV in Zimbabwe. We used a de-novo multistate Markov decision-analytic model that simulated Zvandiri lifetime costs and benefits on viral suppression, death rates…
Perceptions of pre-exposure prophylaxis among sexually active adolescent girls and young women in Zimbabwe–A qualitative study
Adolescent girls and young women (AGYW; aged 15–24 years) in Zimbabwe face high risk of contracting HIV. Despite proven effectiveness of Pre-Exposure Prophylaxis (PrEP), its uptake and continuation among AGYW is low. We aimed to explore views on PrEP, norms around sexual behaviour and how programs can improve PrEP uptake among this group. From December 2021 to March 2023 nine focus group discussions were held with 92 (8–12 per group) sexually act…
Do community-level factors play a role in HIV self-testing uptake, linkage to services and HIV-related outcomes? A mixed methods study of community-led HIV self-testing in rural Zimbabwe
Community-led interventions, where communities plan and lead implementation, are increasingly being adopted within public health programmes. We explore factors associated with successful community-led distribution of HIV self-test (HIVST) kits to guide future service delivery. Twenty rural communities were supported to distribute HIVST kits for 1-month between January and September 2019. Social science researchers observed communities during plan…
Exploring gender stereotypes and norms among peri-urban very young adolescents in Zimbabwe using participatory and qualitative approaches
Gender stereotypes and norms shape very young adolescents’ (VYAs, 10–14 years old) behaviours, including in relation to sexual and reproductive health (SRH). This formative study sought to determine and prioritise the stereotypes and norms to be targeted as part of work to co-develop a gender-transformative intervention for VYAs in Zimbabwe to promote positive masculinities and SRH. In 2023, we collected data from VYAs, using participatory worksh…
Comparing the test performance of dried-blood-spot and plasma HIV recent infection testing samples in a nationally scaled sex worker programme in Zimbabwe
Recency testing can provide strategic insights as to whether a person newly diagnosed with HIV recently acquired their infection or not. To understand potential biases associated with HIV recency testing, we explored the extent sample type influences whether a person is assigned as being recent. Implementing a laboratory-based Recent Infection Testing Algorithm (RITA) across the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) key populat…
Who has never tested for HIV following a community-based distribution of HIV self-test kits? Establishing associated predictors in rural Zimbabwe
In 2023, Zimbabwe attained the 95-95-95 UNAIDS targets. However, some sub-populations are substantially less likely to have tested for HIV. Knowledge of characteristics of these groups is crucial in designing interventions that address their needs. We estimated the prevalence and predictors of “never-having tested for HIV” status following community-based distribution of HIV self-test kits in rural Zimbabwe. We analysed data from a household surv…
Exploring the contribution of self-help groups to sexual and reproductive health and HIV outcomes for female sex workers in sub-Saharan Africa
Self-help groups (SHGs) have been effective in improving the health and wellbeing of women generally but there is little evidence on whether and how they improve HIV and sexual and reproductive health (SRH) outcomes among female sex workers (FSWs), particularly in sub-Saharan Africa. This scoping review attempted to address this gap by identifying and analysing literature on SHGs for FSWs in sub-Saharan Africa. The review followed the 5-step fram…
Provider costs of professional Covid-19 rapid antigen testing in low-income settings
World Health Organization recommends antigen rapid diagnostic tests (RDT) as point of care tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in suspected outbreaks when polymerase-chain-reaction testing is not accessible; to trace the extent of outbreaks; and in areas with widespread community transmission. Annual economic costs were estimated for professional SARS-CoV-2 testing as part of several COVID-19 testing use cases i…
Understanding the acceptability of Covid-19 antigen rapid diagnostic tests
Accessible and timely diagnostic testing was essential during the COVID-19 pandemic to control the virus’s spread and mitigate severe outcomes. However, real-time polymerase chain reaction tests, although sensitive incur high costs and prolonged turnaround times, and face implementation challenges in many resource-constrained settings. Antigen rapid diagnostic tests (Ag-RDT), which can be administered either by providers or as self-tests, are acc…
Mental health and other clinical and social characteristics of young mothers living with HIV in Zimbabwe
Young women living with HIV (YWLHIV) experience numerous stressors including treatment management and poor parent modelling. We investigated YWLHIV’s mental health and other clinical and social characteristics to inform tailored support. YWLHIV (15–24 years old) participating in a peer-support model tailored for young mothers (Young Mentor Mum intervention) completed a self-administered interview and had clinical and psychological assessments in …
Condomless sexual encounters among female sex workers included in a longitudinal coital diary study in Zimbabwe
Condomless sex was common and varied based on FSW age, partner type, experiencing violence during sex, and KP programme contact. These findings emphasize the need for continued condom promotion, counseling, violence mitigation, and training in condom negotiation skills especially given the heightened risk of HIV transmission among FSWs
How do social norms influence the sexual and reproductive health-related attitudes and behaviours of very young adolescents in Sub-Saharan Africa? A scoping review
Scoping review findings affirm the importance of intervening in very young adolescence to positively influence social and gender norms. The review underscores the importance of tailored, multifaceted, culturally sensitive, gender-responsive/gender-transformative interventions to improve young adolescents' SRH-related attitudes and behaviours in Sub-Saharan Africa
Exploring the Interplay of Social and Physical Factors in Risk Dynamics and Transitions Across the Life-Course of Female Sex Workers in Blantyre, Malawi
Sexual risk amongst female sex workers (FSW) varies across the life-course and is influenced by socio-economic and interpersonal factors that affect behavioural choices and engagement in HIV/STI care. We explored transitions in the life-course of FSW to understand the dynamics of sexual risk in Blantyre, Malawi. We implemented a nested longitudinal qualitative study as part of the AMETHIST Consortium, a study testing approaches to reduce HIV tran…
“Getting pregnant during Covid-19 was a big risk because getting help from the clinic was not easy”
The COVID-19 pandemic and associated measures may have disrupted delivery of maternal and neonatal health services and reversed the progress made towards dual elimination of mother-to-child transmission of HIV and syphilis in Zimbabwe. This qualitative study explores the impact of the pandemic on the provision and uptake of prevention of mother-to-child transmission (PMTCT) services from the perspectives of women and maternal healthcare providers…
A conceptualization and psychometric evaluation of positive psychological outcome measures used in adolescents and young adults living with HIV
Introduction Sub-Saharan Africa bears the greatest burden of HIV, with comorbid mental conditions highly prevalent in people living with HIV. It is important to evaluate the mental health of adolescents and young adults living with HIV (AYALHIV) comprehensively by measuring both negative and positive psychological constructs. There has been a proliferation of interest in positive psychological outcome measures, but the evidence of their psychomet…
Impact of the Covid-19 pandemic on the provision and uptake of services for the prevention of mother-to-child transmission of HIV in Zimbabwe
Zimbabwe is targeting elimination of mother-to-child transmission of HIV by December 2025, however the COVID-19 pandemic challenged health service delivery globally. Monthly aggregated data were extracted from DHIS-2 for all facilities delivering antenatal care (ANC). ZIMSTAT and Spectrum demographic estimates were used for population-level denominators. Programme indicators are among those in HIV care and population indicators reflect the total …
The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities
INTRODUCTION: Young women who sell sex (YWSS) in Zimbabwe remain at high risk of HIV infection. Effective HIV prevention strategies are needed. Through support to access a combination of evidence-based interventions, including oral pre-exposure prophylaxis (PrEP), the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) partnership aimed to reduce new HIV infections among adolescent girls and young women by 40% over 24 months. …
Innovative demand creation strategies to increase voluntary medical male circumcision uptake
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 app…
ART initiations following community-based distribution of HIV self-tests
INTRODUCTION: Measuring linkage after community-based testing, particularly HIV self-testing (HIVST), is challenging. Here, we use data from studies of community-based HIVST distribution, conducted within the STAR Initiative, to assess initiation of antiretroviral therapy (ART) and factors driving differences in linkage rates. METHODS: Five STAR studies evaluated HIVST implementation in Malawi, Zambia and Zimbabwe. New ART initiations during the …
Community-based HIV self-testing
BACKGROUND: HIV self-testing (HIVST) requires linkage to post-test services to maximise its benefits. We evaluated effect of supply-side incentivisation on linkage following community-based HIVST and evaluated time-trends in facility-based antiretroviral therapy (ART) initiations. METHODS: From August 2016 to August 2017 community-based distributors (CBDs) in 38 rural Zimbabwean communities distributed HIVST door-to-door in 19-25 day campaigns. C…
Effect of peer-distributed HIV self-test kits on demand for biomedical HIV prevention in rural KwaZulu-Natal, South Africa
Study objective We investigated two peer distribution models of HIV self-testing (HIVST) in HIV prevention demand creation compared with trained young community members (peer navigators). Methods We used restricted randomisation to allocate 24 peer navigator pairs (clusters) in KwaZulu-Natal 1:1:1: (1) standard of care ( SOC): peer navigators distributed clinic referrals, pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) informatio…
Comparison of community-led distribution of HIV self-tests kits with distribution by paid distributors
BACKGROUND: We compared community-led versus an established community-based HIV self-testing (HIVST) model in rural Zimbabwe using a cluster-randomised trial. METHODS: Forty village groups were randomised 1:1 using restricted randomisation to community-led HIVST, where communities planned and implemented HIVST distribution for 4 weeks, or paid distribution (PD), where distributors were paid US$50 to distribute kits door-to-door over 4 weeks. Indi…
Lay Health Workers’ Experience of Delivering a Problem Solving Therapy Intervention for Common Mental Disorders Among People Living with HIV
Mobility and sex work
Suicidal Behavior Among Female Sex Workers in Goa, India
Objectives. We sought to study suicidal behavior prevalence and its association with social and gender disadvantage, sex work, and health factors among female sex workers in Goa, India. Methods. Using respondent-driven sampling, we recruited 326 sex workers in Goa for an interviewer-administered questionnaire regarding self-harming behaviors, sociodemographics, sex work, gender disadvantage, and health. Participants were tested for sexually trans…
My story”—HIV positive adolescents tell their story through film
The global commitment to universal access for people in need of antiretroviral therapy has transformed the lives of adolescents with HIV. In contrast, there has been limited commitment at policy or service level to the need for effective therapeutic interventions which can help them to cope with their life experiences. It is imperative that the scale up of antiretroviral therapy programmes is accompanied by evidence-based therapeutic approaches i…
HIV prevention while the bulldozers roll
Triple jeopardy
Perception of Risk of Vertically Acquired HIV Infection and Acceptability of Provider-Initiated Testing and Counseling Among Adolescents in Zimbabwe
Objectives. We investigated attitudes toward provider-initiated HIV testing and counseling (PITC) in the suburbs of Harare, Zimbabwe, where late presentation after mother-to-child HIV transmission (MTCT) is a major cause of adolescent mortality. Methods. Adolescents (10–18 years) attending 2 primary clinics were offered PITC. Participants completed a questionnaire investigating acceptability of PITC, and in-depth interviews with 41 adolescents an…
Atlas of Aids
Book reviewsaiming to vasectomise rural males on a large scale led to the perception of community health workers as merely agents of central government.Options for financing programmes are dis- cussed ranging from the voluntary system in Tanzania, the payments of low level honoraria in Nepal to the option of "fee for service" which has emerged in China.Results and evaluations of the programmes are presented and their individual strengths and weak…
Improving young people's access to reproductive health care in rural Zimbabwe
The aim of this study was to explore ways to improve the accessibility of clinics for young people with reproductive health problems in rural Zimbabwe. This study, which took place in rural Masvingo, was part of a project to develop a comprehensive adolescent reproductive health intervention for Zimbabwean youth. Six focus group discussions were held with secondary school pupils aged 16-19; four focus group discussions were held with nurses. Addi…
What is ‘sex’ exactly? Using cognitive interviewing to improve the validity of sexual behaviour reporting among young people in rural Zimbabwe
Self-reporting of sensitive data is often unreliable, particularly when questions are asked about culturally or socially censured behaviours. This study aimed to improve the validity of questionnaire responses through cognitive interviewing of young people in Zimbabwe to better understand their underlying thought processes when responding to sexual behaviour questions. A questionnaire was developed in English and translated into Shona. Three roun…
Suicidal Behavior Among Female Sex Workers in Goa, India
Objectives. We sought to study suicidal behavior prevalence and its association with social and gender disadvantage, sex work, and health factors among female sex workers in Goa, India. Methods. Using respondent-driven sampling, we recruited 326 sex workers in Goa for an interviewer-administered questionnaire regarding self-harming behaviors, sociodemographics, sex work, gender disadvantage, and health. Participants were tested for sexually trans…
HIV prevention while the bulldozers roll
How to improve the validity of sexual behaviour reporting
Acceptability and challenges of implementing voluntary counselling and testing (VCT) in rural Zimbabwe
Voluntary counselling and testing (VCT) is an important component of HIV prevention and care. Little research exists on its acceptability and feasibility in rural settings. This paper examines the acceptability and feasibility of providing VCT using data from two sub-studies: (1) client-initiated VCT provided in rural health centres (RHCs) and (2) researcher-initiated VCT provided in a non-clinic community setting. Nurses provided client-initiate…
Increased risk of HIV-infection among school-attending orphans in rural Zimbabwe
In Zimbabwe around 1.1 million children have been orphaned due to AIDS. We conducted a survey among school-attending youth in rural south-eastern Zimbabwe in 2003, and examined the association between orphaning and risk of HIV. We enrolled 30 communities in three provinces. All students attending Year 2 of secondary school were eligible. Each completed a questionnaire and provided a finger-prick blood specimen for testing for HIV-1 and HSV-2 anti…
A Post-Trial Assessment of Factors Influencing Study Drug Adherence in a Randomized Biomedical HIV-1 Prevention Trial
A novel tool to assess community norms and attitudes to multiple and concurrent sexual partnering in rural Zimbabwe
Concurrent sexual partnerships are important in understanding the evolution and maintenance of the HIV heterosexual epidemic in sub-Saharan Africa. While it is possible to measure individual attitudes around sensitive behaviours through questionnaire surveys, studies suggest that responses may be subject to social desirability bias and may not reflect community norms. This study used a novel tool to collect data on community norms relating to the…
Problem-solving therapy for depression and common mental disorders in Zimbabwe
ISRCTN: ISRCTN25476759
Perception of Risk of Vertically Acquired HIV Infection and Acceptability of Provider-Initiated Testing and Counseling Among Adolescents in Zimbabwe
Objectives. We investigated attitudes toward provider-initiated HIV testing and counseling (PITC) in the suburbs of Harare, Zimbabwe, where late presentation after mother-to-child HIV transmission (MTCT) is a major cause of adolescent mortality. Methods. Adolescents (10–18 years) attending 2 primary clinics were offered PITC. Participants completed a questionnaire investigating acceptability of PITC, and in-depth interviews with 41 adolescents an…
You are wasting our drugs”
Improving treatment access for SWs is critical for their own health, programme equity, and public health benefit. Programmes working to reduce SW attrition from HIV care need to proactively address the quality and environment of public services. Sensitising health workers through specialised training, refining referral systems from sex-worker friendly clinics into the national system, and providing opportunities for SW to collectively organise fo…
“I don't feel shy because I will be among others who are just like me…”
As access to paediatric antiretroviral therapy (ART) continues to improve in sub-Saharan Africa, a new historically specific cohort of HIV-perinatally infected children surviving into adolescent has emerged. Although remarkable successes have been made clinically in keeping this cohort alive and in reasonable health, their social support experiences are still unknown. The research being reported here sought to explore peer social support experien…
Triple jeopardy
My story”—HIV positive adolescents tell their story through film
The global commitment to universal access for people in need of antiretroviral therapy has transformed the lives of adolescents with HIV. In contrast, there has been limited commitment at policy or service level to the need for effective therapeutic interventions which can help them to cope with their life experiences. It is imperative that the scale up of antiretroviral therapy programmes is accompanied by evidence-based therapeutic approaches i…
Combination HIV prevention for female sex workers
Competition is not necessarily a barrier to community mobilisation among sex workers
Women reported being most likely to support each other when confronted with serious danger but maintained high levels of competition for clients, suggesting competition at work does not represent a barrier to support. Examples of practical assistance between SWs provide entry points for our planned community mobilization activities, which aim to broaden trust and support among SWs while acknowledging their professional competition
Food insecurity is a barrier to prevention of mother-to-child HIV transmission services in Zimbabwe
Among women with a recent birth, food insecurity is inversely associated with service utilization in the PMTCT cascade and severe household food insecurity may be positively associated with MTCT. These preliminary findings support the assessment of FI in antenatal care and integrated food and nutrition programs for pregnant women to improve maternal and child health
Manuscript title
The study highlights that adherence knowledge and desire alone is insufficient to overcome the familial and structural barriers to maintaining CTX-p. Improving adherence to CTX-p among HEI will require interventions to improve male involvement, reduce HIV stigma in communities and ensure adequate supply of drugs
Underage and underserved
Young women who sell sex (YWSS) in Southern Africa are highly vulnerable to HIV, as the risks of being young and female in a high prevalence setting coalesce with those of commercial sex. YWSS are less able to negotiate safe sex, more likely to have higher risk partners, and less likely to use available health services compared to older sex workers. In Zimbabwe's national HIV programme for sex workers, fewer than 1% of clients were 15-29. We deve…
Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe
Caregivers of patients attending psychiatry hospitals in Zimbabwe carry a substantial and frequently unrecognised burden of caring for a family member with a mental disorder. Better support is needed from health professionals and social services to help them cope better. Further research is required to quantitatively measure caregiver burden and evaluate potential interventions in Zimbabwe
Scaling up interventions for depression in sub-Saharan Africa
Key requirements for success included early buy-in from key stakeholders, extensive consultation at each point of the scale-up journey, financial support both locally and externally, and a coherent sustainability plan endorsed by both government and private sectors
Lay Health Workers’ Experience of Delivering a Problem Solving Therapy Intervention for Common Mental Disorders Among People Living with HIV
Unpacking early infant male circumcision decision-making using qualitative findings from Zimbabwe
BACKGROUND: Early infant male circumcision (EIMC) has been identified as a key HIV prevention intervention. Exploring the decision-making process for adoption of EIMC for HIV prevention among parents and other key stakeholders is critical for designing effective demand creation interventions to maximize uptake, roll out and impact in preventing HIV. This paper describes key players, decisions and actions involved in the EIMC decision-making proce…
Medicine (52 obras) · HIV/AIDS Research and Interventions (50 obras) · Family medicine (29 obras) · Nursing (28 obras) · Adolescent Sexual and Reproductive Health (24 obras) · Sex work and related issues (23 obras) · Psychiatry (22 obras) · Psychological intervention (22 obras) · Environmental health (20 obras) · Psychology (19 obras)