Tackling STIs and Improving SRH for youth in Zimbabwe: SDG 3 and Me interview with Dr Chido Dziva Chikwari

Adolescents and young people are at high risk of HIV and STIs. Our work at the Health Research Unit Zimbabwe includes a cluster randomised trial (CHIEDZA) to evaluate the impact of community-based provision of STI testing and management for youth integrated within HIV and SRH services.
Published in Sustainability
Tackling STIs and Improving SRH for youth in Zimbabwe: SDG 3 and Me interview with Dr Chido Dziva Chikwari
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My name is Chido Dziva Chikwari, I am an Epidemiologist and currently hold an Assistant Professor post at the London School and Hygiene and Tropical Medicine (LSHTM). I am based in Zimbabwe where I have joint affiliation with The Health Research Unit Zimbabwe (THRU-Zim) which is a part of the Biomedical Research and Training Institute (BRTI). My work is primarily around developing, coordinating, and evaluating implementation research studies with particular focus on projects evaluating the provision of sexual and reproductive health services for adolescents and young people in facility and community-based settings, HIV testing interventions as well as community based psychosocial support for children and adolescents living with HIV and their caregivers. This work has involved validation of oral HIV tests for children and evaluating the use of assisted HIV testing for children by their caregivers. I am currently the principal investigator of the STICH trial and the Zimbabwe lead investigator for the GIFT study which are aimed at improving diagnostics and management for sexually transmitted infections (STIs).

What SDG3 target(s) is your work and the work of the organization most closely aligned with?

My organizations work is aimed at improving health and wellbeing across the life-course through research that influences policy and practice. Our vision is to deliver world-class Africa-led research to improve health and as such our projects span across several of the SDG3 targets and include several themes such as Infections and AMR, Tuberculosis and HIV, Sexual and Reproductive Health, Multimorbidity and Musculoskeletal health. Across all these projects we also have a theme focused on integration and focus on all population groups along the life course. We achieve this by cultivating equitable partnerships and nurturing the next generation of global health leaders in Africa. 

What projects are you working on that relate to SDG 3 and how might they help to achieve the SDG 3 targets?

I currently work on research projects that are aligned to adolescents and young people; and more specifically improving their HIV and Sexual and Reproductive Health (SRH). Key among these projects is the CHIEDZA Trial which was aimed at providing an integrated package of HIV and SRH services for youth aged 16-24 years in community-based settings. Nested within CHIEDZA was the STICH trial which offered youth STI testing and management to see if this testing has an impact on population prevalence of STIs. CHIEDZA and STICH are closely aligned with the SDG3 target on SRH to ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. Evidence from CHIEDZA and STICH is critical to inform how we can better programme SRH for young people who at present are underserved by existing health services and have poor outcomes when compared to adult populations.

Where is the project(s) based and what groups are involved?

CHIEDZA and STICH were conducted across three provinces in Zimbabwe and involved youth aged 16-24 years. Over 30 months we managed to reach over 38000 youth with HIV and SRH services and then we did a prevalence survey of over 17000 youth to see if the intervention had an impact on youth at population level.

What are the objectives of the project(s)?

The aim of CHIEDZA is to investigate the impact of a community-based package of integrated HIV services and sexual and reproductive health services (SRH), and general health counselling, for youth on HIV and other health outcomes in a high HIV prevalence setting.

Objectives are:

  1. To measure the impact of a community-based intervention incorporation delivery of HIV (including HIV testing, treatment and adherence support) and SRH services and health counselling, for 16-24 year old’s, on population-level HIV outcomes​
  2. ​To estimate the cost and cost-effectiveness of the intervention.
  3. To conduct a mixed methods process evaluation of the intervention to inform scalability and sustainability​
  4. To estimate population-level prevalence of key health-related risk factors and behaviours in youth

 STICH which is nested within CHIEDZA aims to measure the impact of unselected STI testing and treatment of young people on population-level STI prevalence.

What are the main findings of your project?

Findings from the STICH trial showed that there is a high prevalence of STIs among youth in Zimbabwe with one in five youth aged 18-24 years testing positive for one of three treatable STIs. Most STIs were asymptomatic, and we found that that offering STI testing to youth in community settings resulted in reduced prevalence of Gonorrhea by 43%. This is promising because it shows us there is something that can be done to reduce the burden of STIs among youth. STI testing is not currently accessible for most due to the high costs of testing and limited availability of point of care diagnostic tests.

Findings from CHIEDZA are currently pending.

 Who (or what groups) would you like to work with, or would like to be in contact with, to push forward your ideas/projects?

Moving forward I would like to work closely with Programmers and Policy makers to find ways to integrate STI testing into existing health services and overall ensure improved access to STI testing and SRHR services for youth. This is important in achieving the SRH target for SDG3 which is hinged around access. 

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