Professor Frances Cowan

Professor of Global Health

Frances joined LSTM on August 1st 2016. Previously a Professor of International Sexual Health and HIV at University College London she has lived and worked full time in Zimbabwe since 1999. Frances has also worked across Southern Africa and in India. In 2012, she founded the Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe and is currently CeSHHAR Executive Director.


MBBS (1984; University of London)
MRCP (1987)
MSc Epidemiology (1990; London School of Hygiene and Tropical Medicine)
MD Epidemiology (1995; University of London)
FRCP and FRCPE (2000)


Frances has lived and worked full time in Zimbabwe since 1999 where she leads a portfolio of HIV prevention research which includes large scale impact evaluations of national HIV programmes. Currently she is evaluating Zimbabwe’s National PMTCT programme, conducting an impact evaluation of ART for prevention in female sex workers and providing evidence to support scale up of voluntary male circumcision. She oversees implementation of Zimbabwe’s “Sisters with a Voice’ program for sex workers which has national coverage and which is informed by a series of implementation research studies. Professor Cowan is PI for a Wellcome Trust Collaborative Award in Science which aims to explore how to optimise differentiated HIV prevention and care among sex workers in southern Africa in order to support virtual elimination of infectious HIV among sex workers in the region. 

She works closely with the Zimbabwe Ministry of Health and Child Care and National AIDS Council to provide evidence for their HIV prevention strategy - most recently as part of a consortium funded by UNITAID to Stimulate and Shape the Market in HIV self-testing in Africa. She is co-chair of HPTN’s Adolescent Science Committee, has been on a number of WHO expert panels and is co-PI on a number of research capacity strengthening initiatives focusing on Southern Africa.

Specific research projects
National program for sex workers in Zimbabwe – ‘Sister’s with a Voice working in 36 sites nationally. Nested within Sisters program are multi methods research projects to estimate size of Zimbabwe’s sex worker population, to determine the impact of intervention to improve linkage to HIV prevention and care (SAPPH-IRe trial; DREAMS impact evaluation) and to determine effects of migration on program engagement.

Part of multi country consortium (with Dr Miriam Taegtmeyer) to explore scale up of HIV self-testing in Africa .

Impact evaluation of Zimbabwe’s national elimination of mother to child transmission programme.

Impact evaluation of the Zvandiri programme; a comprehensive community based programme of psychosocial care for HIV infected adolescents. Determining its impact on ART retention and adherence, psychosocial well being and sexual health.

The CHIDO trial – an impact evaluation of a comprehensive community based. intervention for HIV infected mothers and their HIV exposed infants (aged 0-2 years). The intervention comprises parental skills building, economic strengthening and HIV case care management. Determining impact on early childhood development and retention in HIV care.

Protocol Team for HPTN 082 to evaluate the uptake and adherence to pre-exposure prophylaxis (PrEP) in adolescents in South Africa and Zimbabwe.

Impact evaluation of the Friendship Bench in adolescents – an evaluation to determine feasibility, acceptability and impact of Friendship Bench (lay health care worker delivered mental health intervention) on psychological well-being.

Two further areas of operations research use a behavioural economics approach to generate demand for HIV and reproductive health services, specifically use of non-financial incentives i) to overcome the barriers to HIV testing as a couple and ii) encourage referral for and uptake of long acting methods of contraception.

Frances is co-Chair of the NIH’s HPTN Adolescent Working Group which is tasked to develop adolescent HIV prevention treatment and care proposals for implementation across the HIV Prevention Trials Network. She is a member of the Protocol Team for a proposal to evaluate the uptake and adherence to pre-exposure prophylaxis (PrEP) in adolescents in South Africa and Zimbabwe which we hope will roll out later this year.

In 2011 she led a study to pilot the use of health promoting schools to improve HIV prevention and mental health among Zimbabwean secondary school students on behalf of UNICEF.

Frances is co –PI of a study to explore how parenting of adolescents improves HIV prevention (the FAMILY study).

She was Chair of the DSMB for a trial of using football as a focus for HIV prevention in South Africa.

She is PI of a cluster randomised trial determining the effectiveness of a community based intervention for adolescents living with HIV and Co-PI on research capacity strengthening grant Wellcome Trust funded African Mental Health Research Initiative.

Selected publications

  • Selected publications

    Hakim, James. J, Barry, Michele, Matenga, Jonathan, Cowan, Francesand Campbell, Thomas. B (2017) 'Medical Education Partnership Initiative in Zimbabwe: partnerships for transformation'. Lancet Global Health, Vol 5.

     Hargreaves, J.R, Busza, J, Mushati, P, Fearon, E and Cowan, Frances(2016) 'Overlapping HIV and sex-work stigma among female sex workers recruited to 14 respondent driven sampling surveys across Zimbabwe, 2013'. AIDS Care.

     Mavhu, Webster, Hatzold, Karin, Ncube, Getrude, Fernando, Shamiso, Mangenah, Collin, Chatora, Kumbirai, Dhlamini, Roy, Mugurungi, Owen, Ticklay, Ismail and Cowan, Frances (2017) 'Unpacking early infant male circumcision decision-making using qualitative findings from Zimbabwe'. BMC International Health and Human Rights, Vol 17, Issue 2.


    The HIV care cascade among female sex workers in Zimbabwe: results of a population-based survey from the Sisters Antiretroviral Therapy Programme For Prevention Of Hiv, An Integrated Response (SAPPH-IRE) trial. JAIDS 2016 (in press). Frances M Cowan, Calum Davey Msc, Elizabeth Fearon, Phillis Mushati, Jeffrey Dirawo, Valentina Cambiano, Sue Napierala Mavedzenge, Dagmar Hanisch, Ramona Wong-Gruenwald, Milton Chemhuru, Nyasha Masuka, Karin Hatzold, Owen Mugurungi, Joanna Busza, Andrew Phillips, James R Hargreaves.

    PrEP implementation research in Africa: what is new? Journal of the International AIDS Society  (in press) Cowan FM, Delany Delany-Moretlwe S, Sanders EJ, , Mugo NR, Guedou FA, Alary M, Behanzin L, Mugurungi O, Bekker L-G.

    Underage and underserved: reaching young women who sell sex in Zimbabwe. AIDS Care (in press). Joanna busza, Sibongile Mtetwa, Rumbidzai Mapfumo, Ramona Wong-Gruenwald, Frances M Cowan.

    Option A improved hiv-free infant survival and mother to child HIV transmission at 9-18 months in Zimbabwe. AIDS 2016 (in press) Buzdugan, R. Kang Dufour M, McCoy SI, Watadzaushe CM, Dirawo J, Mushavi A, Mujuru HA, Mahomva A, Kangwende RA, Hakobyan A, Mugurungi O, Cowan FM, Padian N.

    Targeting eMTCT efforts using geospatial analysis of mother-to-child HIV transmission in Zimbabwe. AIDS (in press). SI. McCoy, C Fahey, R Buzdugan, A Mushavi, A Mahomva, NS. Padian, FM. Cowan.

    Statistical design and analysis plan for an impact evaluation of an HIV treatment and prevention intervention for female sex workers in Zimbabwe: a study protocol for a cluster randomised controlled trial. Trials. 2016; 17: 6. James R Hargreaves; Elizabeth Fearon, PhD; Calum Davey; Andrew Phillips; Valentina Cambiano; Frances M Cowan.

    Use of programme data to estimate HIV incidence and engagement with HIV-related services among female sex workers in Zimbabwe, 2009-14.  J Acquir Immune Defic Syndr. 2015 Dec 15. [Epub ahead of print]Hargreaves JR, Mtetwa S, Davey C, Dirawo J, Chidiya S, Benedikt C, Naperiela Mavedzenge S, Wong-Gruenwald R, Hanisch D3, Magure T, Mugurungi O, Cowan FM

    Integrating pre-exposure prophylaxis (PrEP) into combination HIV prevention for female sex workers Female Sex Workers. Current Opinions in HIV/AIDS 2016: 11:27-34. Frances M Cowan, Sinead Delany-Moretlwe

    A Randomized Noninferiority Trial of AccuCirc Versus Mogen Clamp for Early Infant Male Circumcision in Zimbabwe Mavhu W, Larke N, Hatzold K, Ncube G, Weiss HA, Mugurungi O, Mufuka J, Samkange CA, Sherman J, Cowan FM, Ticklay I, Gwinji G. JAIDS 2015;69:e156–e163

    Estimating the Cost of Early Infant Male Circumcision in Zimbabwe: Results from a Randomized Non-inferiority Trial of AccuCirc Device Versus Mogen Clamp. Mangenah C, Mavhu W, Hatzold K, Biddle AK, Madidi N, Ncube G, Mugurungi O, Ticklay I, Cowan FM, Thirumurthy H. JAIDS 2015;69:560–566

    Comparative cost analysis of nurse-midwife versus doctor-delivered early infant male circumcision in Zimbabwe Mangenah C, Mavhu W, Hatzold K, Biddle AK, Ncube G, Mugurungi O, Ticklay I, Cowan FM, Thirumurthy H. JAIDS 2015;69:560–566

    Combination HIV prevention for female sex workers: what is the evidence? Linda-Gail Bekker, Leigh Johnson, Frances Cowan, Cheryl Overs, Donela Besada, Sharon Hillier, Willard Cates Jr. The Lancet, 2015;385:72–87.

    Poverty, food insufficiency and HIV infection and sexual behaviour among young rural Zimbabwean women. Sophie JS Pascoe, Lisa F Langhaug, Webster Mavhu, James Hargreaves, Shabbar Jaffar, Richard Hayes, Frances M Cowan. PLoS One 2015 Jan 27;10(1):e0115290. doi: 10.1371/journal.pone.0115290. eCollection 2015