Strategically Expanding Family Planning Service Options in Zambian ART Pharmacies

CIDRZ Pharmaceutical Services Department supported Lusaka District Pharmacy Unit to integrate family planning (FP) services into health center Antiretroviral therapy (ART) pharmacies with the goal of increasing access and uptake of these services. Working with pharmacists from Lusaka Province and District offices, the Department conducted two trainings on FP for 45 Pharmacy staff providing ART services in Lusaka District in February 2013 and July 2013. These trainings aimed to sensitize Pharmacy personnel on FP options available in Zambia; means of effective interaction with HIV positive adolescents and women during medication counseling; and to encourage them to play an active role in the provision of FP services in ART Pharmacy.

Afterwards, a planning meeting was held in July 2013 with the Lusaka District Health Office Pharmacist, the Maternal and Child Health Coordinator and CIDRZ Pharmacist to clearly map out how to ensure availability of FP products in ART Clinics. The meeting focused on developing a logistics system for FP products at ART Pharmacies to ensure accountability of these products during the integration process.  Strategies were developed to enable Pharmacy personnel to order and capture consumption of the products and make consumption data available to the Ministry of Health (MOH) for forecasting and planning.
In August 2013, two Lusaka District health facilities located in Kalingalinga and Chawama were selected as integration pilots. Adequate products were ordered from the district warehouse by the Pharmacy personnel to supply both MCH and the ART Pharmacy. In addition, combined oral contraceptives were made available in the ART Pharmacies, and Pharmacy personnel in the selected health centres played an active role in providing FP information to all reproductive age clients during medication counselling.  First-time clients and those needing injectable FP products were actively referred by Pharmacy staff to MCH for adequate and intensive counseling on FP product options, side effects and adherence. Following the integration of FP in the ART Pharmacies, the District Pharmacist noted a significant uptake of FP products at the two pilot health centres.

 

 

CIDRZ Researcher Groesbeck Parham awarded grant to study epidemiology of HPV and cervical cancer

CIDRZ researcher Professor Groesbeck Parham will lead the Zambian ‘EPIC’ biomarker study searching for a biomarker of persistent high-risk Human Papilloma Virus (HPV) infection as part of a grant to the African Collaborative Center for Microbiome and Genomics Research. The U.S. National Institutes of Health (NIH) recently announced the 4-year grant award of $4.16 million to support the work of the Institute of Human Virology in Nigeria, and CIDRZ, to better understand the epidemiology of HPV infection and cervical cancer. “Cancer of the cervix is the most common cancer in Africa. This grant will address a high-impact public health challenge that affects women’s health in Africa and the rest of the world,” NIH said.

The African Collaborative Center for Microbiome and Genomics Research (ACCME) is a multi-country, multi-institutional collaborative research group involving the Institutes of Human Virology Nigeria and CIDRZ in partnership with international organizations, including Institutes of Genome Sciences and Human Virology, Cambridge University, UK; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA; and the Center for Genomics and Global Health, National Human Genome Research Institute, Bethesda, Maryland, USA.

A controlled trial of three methods for neonatal circumcision in Lusaka, Zambia.

Abstract

OBJECTIVE: Neonatal male circumcision (NMC) is not routinely practiced in Zambia, but it is a promising long-term HIV prevention strategy. We studied the feasibility and safety of three different NMC methods.

METHODS: We enrolled healthy newborns in a controlled trial of the Mogen, Gomco, and Plastibell devices. Doctors, nurses, and clinical officers were trained to perform Mogen, Gomco, and Plastibell techniques. Each provider performed at least 10 circumcisions using each device. Neonates were reviewed at 1 and 6 weeks after circumcision for adverse events.

RESULTS: Between October 2009 and March 2011, 17 providers (5 physicians, 9 nurse midwives, and 3 clinical officers) without previous NMC experience were trained, and 640 circumcisions were performed. The median infant birth weight was 3.2 kg (interquartile range: 2.9-3.5 kg), and median age at the time of procedure was 11 days (interquartile range: 7-18 days); 149 babies (23.3%) were exposed to HIV. The overall adverse event rate was 4.9% (n = 31/630), and the moderate-severe adverse event rate was 4.1% (n = 26/630). Rates did not significantly differ by method. Most providers (65%) preferred Mogen clamp over Gomco and Plastibell.

CONCLUSION: Doctors, nurses, and clinical officers can be trained to safely provide NMC in a programmatic setting. The 3 studied techniques had comparable safety profiles. Mogen clamp was the preferred device for most providers.

Authors: Bowa K, Li MS, Mugisa B, Waters E, Linyama DM, Chi BH, Stringer JS, Stringer EM.

Read the full-text article here

Voluntary Medical Male Circumcision (VMMC)

The World Health Organization recommends Voluntary Medical Male Circumcision (VMMC) as a long term HIV prevention strategy for countries like Zambia with low circumcision and high HIV-infection rates.

Male Circumcision (MC) provides men with up to 60% protection against getting HIV from infected women. Other health benefits include prevention of phimosis in infants– a painful tightening of the foreskin, decreased urinary tract infections and risk of penis cancer, and reduced risk of infecting women with the human papilloma virus (HPV) – the cause of cancer of the cervix.

It is important that males are circumcised as early as possible from 12 hours of birth because circumcision of newborns is a simpler procedure with faster wound healing time than circumcision of older babies, boys and adult men.

The CIDRZ MC Program is the premier and sole provider of Early Infant Male Circumcision (EIMC) services in Zambia.

 CIDRZ supports the Zambian government’s VMMC strategy by expanding coverage of both adult male and early infant male circumcision in three ways:

  •       Training local staff on the best techniques,
  •       Ensuring necessary supplies are at hand, and
  •       Providing services.

CIDRZ adult and infant MC services are available in health facilities and mobile sites across Zambia.

Adult MC services can be received at Lusaka province in Mtendere Clinic, Chilenje Clinic, AIDC/University Teaching Hospital and Chongwe General Hospital; at Southern Province in Magoye Clinic, Manungu Clinic, Pemba Rural Health Clinic (RHC), Muzoka RHC, Batoka RHC, Maamba General Hospital, Choma General Hospital, Kalomo Hospital and Mawaya Clinic; at Western province in Sefula RHC and Kaoma General Hospital; and at Eastern province in Chipata MC Clinic.

Early infant MC available for baby boys from 12 hours after birth up to 60 days is provided at Lusaka province in Mtendere Clinic, AIDC/University Teaching Hospital, B01/University Teaching Hospital, Kanyama Clinic, Chawama Clinic, Chipata Clinic, George Clinic, Matero Reference Clinic, Nangongwe Clinic, Chongwe Clinic, Chongwe General Hospital; at Copperbelt province in Main Masala Clinic, Kitwe General Hospital and Buchi Clinic; and at Eastern province in Kapata Clinic

Our Providers ensure patient safety by performing VMMC & EIMC with the least invasive and best practice techniques, and under the highest safety conditions.

Our preferred surgical mode for adult circumcision is the dorsal slit method, while we use Mogen Clamps for infant boys. As of February 2014, we have performed circumcision procedures for over 11000 adult men and almost 8000 infant boys.

For further inquiries on the adult MC and EIMC program, please contact:

Mr Lane Lee-Lyabola, Manager

Lane-Lee.Lyabola@cidrz.org

or Ms Christine Matoba, christine.matoba@cidrz.org

Containing Infection in Zambia Prisons

Developing countries face numerous challenges, with health care and services key among them, and it is often the most vulnerable – such as prison inmates – among an already disadvantaged population who suffer most and have the least access to preventive and curative care. As evidence of this, the landlocked south-central African nation of Zambia, which has the sixth-highest HIV prevalence in the world at 14.3 per cent, has rates of HIV in prisons as high as 33 per cent. Tuberculosis is also endemic, with Lusaka Central Prison having a rate of tuberculosis infection four-and-a-half times that of the surrounding district.

University of Melbourne PhD candidate Stephanie Topp has been working in Lusaka with the Centre for Infectious Disease Research in Zambia (CIDRZ) as a technical adviser and research associate, and has on-the-ground experience of supporting the Zambian Prisons Service to deliver services to this complex population.
“Contrary to popular perception, prison populations are not isolated from the general community, but are in fact highly mobile,” she says, “with people entering, transferring within, and exiting facilities constantly.” Of the nation’s 53 prisons, she says only 17 have access to basic health services. Overcrowding is a huge issue too. “Prisons are at 208 per cent capacity on average, and as bad as 700 per cent in some facilities. The Zambian Prison Service (ZPS) has only 35 health professionals for a system with 17,000 inmates.

“Worryingly, a 2010-11 study of Lusaka Central Prison by CIDRZ showed the rate of HIV infection increased between entry into the prison and exit”. She says factors affecting rate of TB and HIV infection include poor nutrition, stress and limited access to testing and treatment, which speed the progress of the disease, and thus further increase the risk of transmission. “The normalisation of risky behaviours such as interpersonal violence or unprotected sex is also a likely factor in relation to HIV infection.”

Ms Topp says that when prisoners – who have potentially contracted diseases during their incarceration – are released after serving their sentence, this risk of disease spread is transferred from the inmate population to the public at large. “Addressing health and health systems in the prison ‘petrie dish’ is thus critical to any broader attempt to address population health, in Zambia as in any other country,” she says.

Ms Topp has worked to improve health systems in Zambia since 2007 after researching the influences shaping HIV policy in Papua New Guinea as a Rhodes Scholar at the University of Oxford. She is completing her PhD at the University of Melbourne’s Nossal Institute for Global Health, and her thesis is a health systems analysis of primary care centres in Zambia. Her current work is as part of a CIDRZ team that is looking to strengthen the underlying health system in Zambian prisons.
“Currently, the Zambian Prisons Health Directorate lacks a dedicated budget and relies mostly on funds donated for HIV and AIDS interventions, which don’t have a strong focus on health planning and co-ordination. “Dependence on these types of funding makes it almost impossible to improve preventive or curative care in the long term. We needed to address root causes of weak health services in the prisons,” she says.

At the same time, funding for disease-specific activities like tuberculosis screening or safe sex campaigns are more likely to gain the attention of donors and media. Yet, with the extreme political sensitivities, for instance men having sex with men, which remains illegal in Zambia, such activities may be difficult, if not impossible to carry out. “In Zambia there are still many groups – both within government and non-government – unwilling to endorse simple interventions likes condom distribution in prisons. Although there are also many progressive individuals who continue to push the envelope. “Ultimately, our choice to focus our work on basic health infrastructure was driven by our recognition that in order to deliver these disease-specific interventions routinely – not as a one-off campaign – it was absolutely essential to have a functioning, evidence-based system in place. We recognised that without a strong health system in place, improved service delivery and better health outcomes in any area would be difficult to sustain. Through its European Union–funded Zambia Prisons Health Systems Strengthening Project (ZaPHSS), CIDRZ has been working to increase engagement between government ministries and develop systems for coordinated planning and decision-making. “Because the health systems in place to service prison inmates are so weak – we had to start from the top,” she says. “So far, the project has helped the ZPS and health ministries to publish a joint prisons health framework, to address the fact that Zambia’s prison health system has historically worked in isolation from the wider health service and struggled to meet the needs of inmates.”

In the prisons themselves, she says CIDRZ has introduced tuberculosis screening and trained inmates as peer educators who assisted with HIV and tuberculosis screening of 6,436 inmates in 2010-11. In January 2014, the ZPS agreed to the formation of facility-level health committees formed from prison officers and health professionals and with inmate sub-committees who will be trained to deliver preventative information and basic disease surveillance. Prisons Deputy Commissioner Lloyd Chilunkika has described ZaPHSS as helping the prisons service jump start long-needed improvements in prisons health, saying the health directorate had, up to now, been present but not highly functional due to structural and operational challenges.

And in an encouraging development the Ministries of Home Affairs, Health and Community Development will this year commit to collaboration on improved inmate health services. Though such achievements may not have the glamour of traditional health campaigns, Ms Topp says systems-based approaches to health are essential for making health campaigns sustainable. “In the end, the success of vaccine campaigns and treatments activities are rarely sustainable and only partially successful without strong health systems, and our driving rationale is to have a long term-impact on the health services available to this incredibly vulnerable population.”

By Stuart Winthrop
(www.mdhs.unimelb.edu.au)