CIDRZ 2013 Annual Report

We invite you to read our latest Annual Report to learn more about us and the work we do, and to become inspired to share in our vision.

Screen-and-Treat Cervical Cancer Prevention Programmes in Resource–Constrained Environments: A Manual for Physicians, Nurse Practitioners, and Managers

Cancer is the world’s leading cause of death, and among women in Africa cervical cancer is the most common malignancy and has the highest rate of cancer-related deaths.

With the support of the U.S. President’s Plan for AIDS Relief (PEPFAR), Pink Ribbon Red Ribbon, local governments and other international partnerships, the CIDRZ African Centre of Excellence for Women’s Cancer Control (ACEWCC) has developed a successful and effective programme to rapidly scale-up access to cervical cancer detection and treatment in Zambia, and within Africa.

The ACEWCC has designed this training manual to help healthcare providers develop and manage cervical cancer prevention programmes in their resource-constrained settings. Over 300 images accompany easy-to-read, comprehensive text covering cervical cancer epidemiology, clinical procedures and programme management.

The manual is accompanied by an eLearning course and interested trainees are encouraged to obtain clinical skills during a practicum at the ACEWCC in Lusaka, Zambia, as only qualified providers with practical training should offer clinical care. More information about the Training Manual, the eLearning course, and practicums can be found at the CIDRZ African Centre of Excellence for Women’s Cancer Control website

Age at antiretroviral therapy initiation predicts immune recovery, death, and loss to follow-up among HIV-infected adults in urban Zambia

AIDS Res Hum Retroviruses. 2014 Jul 6. [Epub ahead of print] 24998881

Vinikoor MJ, Joseph J, Mwale J, Marx MA, Mulenga L, Stringer JS, Eron JJ, Chi B


We analyzed the association of age at antiretroviral therapy (ART) initiation with CD4+ T-cell count recovery, death, and loss to follow-up (LTFU) among HIV-infected adults in Zambia.


We compared baseline characteristics of patients by sex and age at ART initiation (categorized as 16-29 years, 30-39 years, 40-49 years, 50-59 years, 60 years and older (P for trend<0.001). We used the medication possession ratio to assess adherence and analysis of covariance to measure the adjusted change in CD4+ T-cell count during ART. Using Cox proportional hazard regression, we examined the association of age with death and LTFU. In a secondary analysis, we repeated models with age as a continuous variable.


Among 92,130 HIV-infected adults who initiated ART, the median age was 34 years and 6,281 (6.8%) were aged ≥50 years. Compared with 16-29 year-olds, 40-49 year-olds (-46 cells/mm3), 50-59 year olds (-53 cells/mm3), and 60+ year-olds (-60 cells/mm3) had reduced CD4+ T-cell gains during ART. The adjusted hazard ratio (AHR) for death was increased for individuals aged ≥40 years (AHR 1.25 for 40-49 year-olds, 1.56 for 50-59 year-olds, and 2.97 for 60+ year-olds). Adherence and retention in care were poorest among 16-29 year-olds but similar in other groups. As a continuous variable, a 5-year increase in age predicted reduced CD4+ T-cell count recovery and increased risk of death.


Increased age at ART initiation was associated with poorer clinical outcomes, while age <30 years was associated with higher likelihood of being lost to follow-up. HIV treatment guidelines should consider age-specific recommendations.

Clinical Performance of Digital Cervicography and Cytology for Cervical Cancer Screening in HIV-infected Women in Lusaka, Zambia

J Acquir Immune Defic Syndr. 2014 Jun 24. [Epub ahead of print] 24977474

Bateman AC, Parham GP, Sahasrabuddhe VV, Mwanahamuntu MH, Kapambwe S, Katundu K, Nkole T, Mulundika J, Pfaendler KS, Hicks ML, Shibemba A, Vermund SH, Stringer JS, Chibwesha CJ.



While there is a growing literature on the clinical performance of VIA in HIV-infected women, to our knowledge none have studied VIA enhanced by digital cervicography. We estimated clinical performance of cervicography and cytology to detect cervical intraepithelial neoplasia grade 2 or worse. Sensitivity and specificity of cervicography were 84% (95% confidence interval [CI]: 72%-91%) and 58% (95%CI: 52%-64%). At the high-grade squamous intraepithelial lesion or worse cutoff for cytology, sensitivity and specificity were 61% (95%CI: 48%-72%) and 58% (95%CI: 52%-64%). In our study, cervicography appears to be as good as cytology in HIV-infected women.


Director’s Letter

It’s a great pleasure to welcome you to CIDRZ, and to our new website. I joined the organisation as Director nearly a year ago, and have enjoyed being welcomed not only into CIDRZ, but also into the vibrant healthcare and research community here in Zambia.

Being part of a mission-driven organisation is special, and I think it drives the dedication that I witness every day among our over 1000 staff, researchers, trainees and volunteers.

This talented community is with us because they want to tangibly improve the health of Zambians. We are collectively able to deliver on that aim through our support for innovative health services delivery within the local public health infrastructure and in close collaboration with the Government and donors, locally relevant research, and training programs for the next generation of researchers, healthcare providers and public health specialists.

During my year with the organisation, we have focused on strengthening our core capacity to function as a newly independent Zambian organisation, while continuing to innovate and deliver on our programmatic and research missions. Through key staff hires, additional training, and investments in business intelligence systems, we’ve grown the effectiveness of our financial and human resources management, internal audit, laboratory services, and numerous other areas.

With broad input from our Government colleagues, clients, staff and donors, we launched a new three-year strategic plan that we think will allow CIDRZ to become even more productive and impactful – all of this is done with the intent of creating a long-term resource to the country of Zambia, that will create knowledge, build capacity of future health leaders and save and improve more lives.

Thank you again for your interest in CIDRZ. We welcome you to be in touch with us – we are always looking for new partnerships and collaborations that will allow us to further our mission here in Zambia.

Signature Holmes2




Charles B. Holmes, MD, MPH