BACKGROUND: On average, people with disabilities have greater healthcare needs, yet face a range of barriers in accessing care. OBJECTIVES: Our objectives were to explore the experiences of people with disabilities in accessing care and identify opportunities for the health system to be designed for inclusion in Zimbabwe. METHODS: In-depth qualitative interviews were conducted between May and June 2021 with 24 people with disabilities (identified through purposive sampling) and with 10 key informants from local and national health authorities (identified through expert recommendations). Interviews explored the experience of accessing healthcare prior to the coronavirus disease 2019 (COVID-19) pandemic. Interviews were transcribed, coded and thematically analysed. We used the disability-inclusive health 'Missing Billion' framework to map and inform barriers to inclusive healthcare and disparities in outcomes faced by people with disabilities. RESULTS: People with disabilities experienced difficulties accessing health services in Zimbabwe prior to COVID-19. These experiences were shaped by health literacy, self-stigma and affordability of services, which limited demand. Supply of health services was constrained by the perceived poor capacity of health workers to treat people with disabilities and discrimination. Inclusion was facilitated by clinic staff support of people with disabilities' access to medication through referral to mission hospitals and private clinics, and the lobbying of organisations of people with disabilities. CONCLUSION: Strategies to promote disability inclusion in healthcare include meaningfully engaging people with disabilities, investing in organisations of people with disabilities, protecting funding for disability inclusion, collecting and analysing disability-disaggregated data and strengthening a twin-track approach to health service provision.

BACKGROUND: People with disabilities are at higher risk of adverse coronavirus disease 2019 (COVID-19) outcomes. Additionally, measures to mitigate COVID-19 transmission have impacted health service provision and access, which may particularly disadvantage people with disabilities OBJECTIVES: To explore the perspectives and experiences of people with disabilities in accessing health services in Zimbabwe during the pandemic, to identify perceived challenges and facilitators to inclusive health and key actions to improve accessibility METHODS: We used in-depth interviews with 24 people with disabilities (identified through purposive sampling) and with 10 key informants (from expert recommendation) to explore the impact of COVID-19 on access to health care. Interviews were transcribed, coded and thematically analysed. We used the disability-inclusive health 'Missing Billion' framework to map and inform barriers to inclusive health care during COVID-19 and disparities in outcomes faced by people with disabilities RESULTS: People with disabilities demonstrated good awareness of COVID-19 mitigation strategies, but faced difficulties accessing COVID-19 information and health services. Challenges to the implementation of COVID-19 guidelines related to a person's functional impairment and financial ability to do so. A key supply-side constraint was the perceived de-prioritisation of rehabilitation services. Further restrictions on access to health services and rehabilitation decreased an individual's functional ability and exacerbated pre-existing conditions CONCLUSION: The immediate health and financial impacts of the COVID-19 pandemic on people with disabilities in Zimbabwe were severe. Government departments should include people with disabilities in all communications and activities related to the pandemic through a twin-track approach, meaning inclusion in mainstream activities and targeting with specific interventions where necessary

BACKGROUND: To contain ongoing cholera outbreaks, the World Health Organization has suggested that reactive vaccination should be considered in addition to its previous control measures. OBJECTIVES: To explore the potential impact of a hypothetical reactive oral cholera vaccination using the example of the recent large-scale cholera outbreak in Zimbabwe. Methods. This was a retrospective cost-effectiveness analysis calculating the health and economic burden of the cholera outbreak in Zimbabwe with and without reactive vaccination. The primary outcome measure was incremental cost per disability-adjusted life year (DALY) averted. RESULTS: Under the base-case assumptions (assuming 50% coverage among individuals aged >2 years), reactive vaccination could have averted 1 320 deaths and 23 650 DALYs. Considering herd immunity, the corresponding values would have been 2 920 deaths and 52 360 DALYs averted. The total vaccination costs would have been ~$74 million and ~$21 million, respectively, with per-dose vaccine price of US$5 and $1. The incremental costs per DALY averted of reactive vaccination were $2 770 and $370, respectively, for vaccine price set at $5 and $1. Assuming herd immunity, the corresponding cost was $980 with vaccine price of $5, and the programme was cost-saving with a vaccine price of $1. Results were most sensitive to case-fatality rate, per-dose vaccine price, and the size of the outbreak. CONCLUSION: Reactive vaccination has the potential to be a costeffective measure to contain cholera outbreaks in countries at high risk. However, the feasibility of implementation should be further evaluated, and caution is warranted in extrapolating the findings to different settings in the absence of other in-depth studies.

OBJECTIVE: To assess the validity of oral mucosal transudate (OMT) specimens for HIV testing in children using enzyme-linked immunosorbent assay (ELISA). METHODS: A cross-sectional descriptive study was conducted asThe overall sensitivity of OMT specimens for HIV part of a community-based behavioural and HIV sero-status survey testing in children using ELISA was low. Stratifying the analysis of adults and children in the Chimanimani district of Zimbabwe. by sector showed that OMT samples are good specimens for HIV Dried blood spot (DBS) and OMT samples were collected from testing. It is important to note that factors such as the low HIV children aged between 2 and 14 years, inclusive. Both samples were prevalence in our study population, quality of the OMT, diet and tested for HIV using the Vironostika Uniform II plus O kits. The oral hygiene could have influenced the results. main study outcomes were the sensitivity and specificity of OMT samples, with DBS as the gold-standard specimen. RESULTS: Paired DBS and OMT specimens were available from 1 274 (94.4%) of the 1 350 children enrolled. Using the DBS, HIV prevalence was 3.2%. Overall sensitivity of OMT was 48.8% (95% confidence interval (CI) 33.3 - 64.5), and specificity was 98.5% (95% CI 97.7 - 99.1). CONCLUSION: The overall sensitivity of OMT specimens for HIV testing in children using ELISA was low. Stratifying the analysis by sector showed that OMT samples are good specimens for HIV testing. It is important to note that factors such as the low HIV prevalence in our study population, quality of the OMT, diet and oral hygiene could have influenced the results.

OBJECTIVE: To determine the factors influencing cervical cancer diagnosis and treatment in countries of East, Central and Southern Africa (ECSA). METHODS: Data were collected from randomly selected primary health care centres, district and provincial hospitals, and tertiary hospitals in each participating country. Health care workers were interviewed, using a questionnaire; the facilities for screening, diagnosing, and treating cervical cancer in each institution were recorded, using a previously designed checklist. FINDINGS: Although 95% of institutions at all health care levels in ECSA countries had the basic infrastructure to carry out cervical cytology screening, only a small percentage of women were actually screened. Lack of policy guidelines, infrequent supply of basic materials, and a lack of suitable qualified staff were the most common reasons reported. CONCLUSIONS: This study demonstrates that there is an urgent need for more investment in the diagnosis and treatment of cervical cancer in ECSA countries. In these, and other countries with low resources, suitable screening programmes should be established.

OBJETIVO: Determinar los factores que influyen en el diagnóstico y el tratamiento del cáncer cervicouterino en países de África oriental, central y meridional (AOCM). MÉTODOS: Los datos proceden de una muestra seleccionada al azar de centros de atención primaria, hospitales distritales y provinciales y hospitales terciarios de cada país participante. Se entrevistó a los agentes de salud mediante un cuestionario, y se utilizó una lista de comprobación previamente establecida para registrar los servicios de cribado, diagnóstico y tratamiento del cáncer cervicouterino de que disponía cada institución. RESULTADOS: Aunque el 95% de las instituciones de todos los niveles asistenciales de los países de AOCM disponían de la infraestructura básica para llevar a cabo análisis citológicos del cuello uterino, en la práctica sólo se cribaba a un pequeño porcentaje de mujeres. Las razones más citadas para explicar ese hecho fueron la falta de directrices de política, el insuficiente suministro de material básico y la falta de personal cualificado. CONCLUSIÓN: Este estudio demuestra que es urgente invertir más medios en el diagnóstico y el tratamiento del cáncer cervicouterino en los países de AOCM. Es necesario emprender programas de cribado adecuados tanto en esos países como en otros con recursos escasos.

OBJECTIF: Déterminer quels sont les facteurs qui influencent le diagnostic et le traitement du cancer du col de l’utérus dans les pays d’Afrique orientale, centrale et australe. MÉTHODES: Dans chacun des pays participants, les données ont été recueillies auprès d’établissements de différentes catégories - centre de soins de santé primaires, hôpitaux de district et de province et hôpitaux tertiaires - choisis par tirage au sort. Le personnel soignant a été interrogé au moyen d’un questionnaire, et on a utilisé une liste de contrôle préétablie pour noter les moyens de dépistage, de diagnostic et de traitement du cancer du col de l’utérus en usage dans chaque établissement. RÉSULTATS: Bien que 95% des établissements de santé des pays d’Afrique orientale, centrale et australe disposent, quel que soit leur niveau, de l’infrastructure de base pour le dépistage cytologique du cancer du col de l’utérus, seul un faible pourcentage de femmes en bénéficient réellement. L’absence de lignes directrices, les lacunes de l’approvisionnement en fournitures de base et le manque de personnel qualifié en sont les raisons les plus fréquemment avancées. CONCLUSION: Cette étude montre qu’il est urgent que les pays d’Afrique orientale, centrale et australe investissent davantage dans le diagnostic et le traitement du cancer du col de l’utérus. Dans ces pays, ainsi que dans d’autres pays dont les ressources sont limitées, des programmes de dépistage appropriés devront être établis.