ACADEMIC ENDLINE Survey Launches to Evaluate Rotavirus Vaccine

From 2011-2014, the Programme for the Awareness and Elimination of childhood Diarrhoea (PAED) at CIDRZ organized and implemented interventions to decrease overall and diarrhoea-related post-neonatal Under 5 child mortality in Lusaka Province.  These interventions included the early roll-out of the rotavirus vaccine in a facility-based study and community-based behaviour change programming to improve child hygiene, feeding and diarrhoea treatment practices.

As PAED began activities, CIDRZ initiated the Baseline of ACADEMIC (A Comprehensive Assessment of Diarrhoea and Enteric Disease Management in Children) to establish the pre-intervention levels of child mortality and diarrhoea-related morbidity. Baseline included a multi-centre facility study to evaluate rotavirus vaccine effectiveness as well as a paper-based community survey reaching over 21,000 households in 220 Census Supervisory Areas to estimate child mortality.

After completion of the ACADEMIC Baseline and all PAED activities, training for the ACADEMIC Endline study commenced in January 2015. A study team of 16 Team Leaders and 46 Team Members were trained to conduct household-based surveys using Nexus 7 handheld tablets and Endline household data collection commenced in late February. In addition to meeting their data collection responsibilities, study staff members have also attended bi-weekly all-team meetings. There, they have received professional development training to increase their knowledge of health topics and enhance their research presentation skills. These efforts have boosted the confidence and morale of all staff to perform to the best of their potential.

The ACADEMIC Endline survey is the first tablet-based CIDRZ research study to successfully use electronic data capture in the field. It also marks the first time Open Data Kit-based survey programming and database generation has been managed in-house. ACADEMIC Endline data collection is projected to complete by mid- July of 2015.

Message from CIDRZ CEO Charles Holmes on World TB Day 2015

Today we learned from the CIDRZ Director of TB Programmes, Dr Monde Muyoyeta, that 1.5 million people are still dying every year from TB despite there being an effective treatment regimen available. This is in large part because those suffering from TB are still not being properly diagnosed. We have known the cause of TB – the TB bacillus bacteria since 1882 – yet diagnosis remains a major challenge in resource-constrained settings such as ours where there is also the highest burden of disease. TB infection may be a missed diagnosis due to the long wait time to receive a lab-confirmed diagnosis; or be over-diagnosed by a clinical diagnosis because of lack of lab facilities or skilled lab technicians. Treatment also remains challenging because it takes many months, and can be compromised by poor drug adherence or drug side-effects.

However, today’s presentations on the CIDRZ TB Plus Up programme, the TB OpX, TB Vaccine, and TB Alliance studies, and the TB Lab delivered by our TB Department have been exciting! CIDRZ – and indeed Zambia – are attacking TB from multiple sides at once: diagnosis, treatment and prevention. Defeating TB will take more than drugs and I am incredibly proud that CIDRZ is looking at our programmes and research to support the Ministry of Health from a holistic standpoint. As we’ve seen with HIV, Ebola and other diseases, engaging in better ways of prevention, diagnosis and treatment is the only way to get ahead of an epidemic.

CIDRZ is:

  • Innovating better TB care delivery strategies by working in prisons and improving diagnosis rates among these vulnerable, high-risk individuals
  • Engaging with TB Alliance so that Zambians that need treatment – and may even have Multidrug resistant (MDR) TB – have access to the latest drug combination clinical trials
  • Incorporating better methods to diagnose TB into our programme strategies such as evaluating the GeneXpert MTB/RIF testing technology and providing world class TB diagnostics in our lab
  • Leading prevention of latent TB from becoming active through broader provision of Isoniazid Preventive Therapy (IPT); improving infection control efforts; and conducting the first clinical trial of TB vaccines, EVER, in Zambia!

Although TB rates are dropping by 2% per year, we can’t be satisfied with that and must collectively aim to do better! My sense is that in this Zambezi conference room there is the energy, knowledge and leadership to raise awareness of the regional and national emergency that TB continues to pose. I am proud of the extraordinary work that the CIDRZ TB Department has done, and I am confident when we come together to commemorate World TB Day next year that they will report even further success in driving TB rates down  and will be that much further down the road to the introduction of new drugs, diagnostics and vaccines.

CIDRZ contributes to improved child health in Zambia by donating Vaccine refrigerators and Expanded Programme on Immunisation cold-chain equipment to Government

 

On Friday 27th March, with the support of ELMA Vaccines and Immunizations Foundation, CIDRZ was privileged to handover Kw 14 million worth of Expanded Programme on Immunisation vaccine refrigerators, delivery trucks and allied cold-chain equipment to the Government of the Republic of Zambia in support of the nation’s child immunisation programme. The celebratory event at the Child Health Unit in Lusaka was a culmination of years of work, representing the partnership of the Government with multiple stakeholders, including the WHO, UNICEF, JICA, and the CIDRZ Programme for the Awareness and Elimination of Diarrhoea (PAED) led by Dr Roma Chilengi to strengthen Zambia’s vaccine cold chain system. By working hand-in-hand with government, CIDRZ PAED leadership and other stakeholders were able to perform a National Effective Vaccine Management Assessment and develop a detailed cold chain expansion plan which increased the capacity of the national level vaccine cold storage facility from 144 to 212,000 litres. ELMA Vaccines and Immunizations Foundation generously provided resources for the purchase and transport of the equipment, and training support.

Because vaccines require a strict temperature-regulated “cold-chain” storage and conveyance system to keep them effective, the delivery of 349 vaccine refrigerators, solar panels and batteries, vaccine cold boxes and carriers, and two new 15-ton flatbed trucks brings Zambia closer to the dream that every child regardless of where they live will have access to life-saving vaccines.

In Zambia, combating childhood morbidity and mortality by targeting vaccine preventable diseases is imperative as infants and children under 5 death rates are still unacceptably high. The 2013-14 Zambia Demographic Health survey reported 45 infants of every one thousand live births dying; and 75 children under 5 dying per thousand live births. In efforts to improve child health and reach Millennium Development Goal targets Zambia recently added three important new infant vaccines to the Zambian childhood immunisation system – pneumococcal, second dose measles, and rotavirus.

When delivering the equipment to the Acting Permanent Secretary of the Ministry of Community Development Mother and Child Health Mr Simmy Chapula, CIDRZ CEO Dr Charles Holmes remarked, “Today’s celebration is about the children— this vaccine cold chain equipment will directly provide a positive and healthy impact on the lives of Zambia’s children by ensuring that safe, life-saving vaccines are available for all children and especially those of hard-to-reach families in rural areas. I pledge that CIDRZ will continue to work diligently to ensure that we make a true and dedicated contribution to the improvement of the Zambian health system for all Zambians.”

Preliminary Results from the ACADEMIC Endline: Lessons Learned on Establishing and Implementing Tablet-Based Data Collection in a DHS-style Community Survey at CIDRZ

Lauren Beach JD/PhD
2014-2015 CIDRZ HIVCorps Public Health Fellow

April 2nd 9-10 hours Zambezi Conference Room, CIDRZ Head Office 5032 Great North Road, Lusaka

Lauren is Project/Research Manager and Co-Investigator of ACADEMIC, a large, community-based monitoring and evaluation study assessing the effectiveness of vaccination and behaviour change interventions on reducing under-5 deaths related to enteric pathogens. In December 2012, she earned her law degree Magna Cum Laude from University of Minnesota Law School, with a concentration in Health Law and Bioethics. In July 2014, she received her PhD in Molecular, Cellular, Developmental Biology & Genetics, also from the University of Minnesota. In addition, she holds a B.A. in Social Relations & Policy from James Madison College and a B.S. in Microbiology & Molecular Genetics from the Lyman Briggs School, both from Michigan State University. Lauren has nearly a decade of leadership experience in the non-profit realm. She has served on 6 non-profit boards, including currently serving as a director of Healthy Kids – Brighter Future in Lusaka, Zambia and previously serving as President and board chair of the China AIDS Orphan Fund in Minneapolis, Minnesota, USA

WHO Policy Brief on Chronic Hepatitis B Guidelines recommends APRI to stage chronic liver disease

In Zambia, it is estimated that 6-8% of the population may have chronic Hepatitis B Virus (HBV) infection. Routine Hepatitis B immunization for infants protects the next generation, and the Zambia National Blood Transfusion Service routinely screens for HBV to prevent transfusion-related cases. However, access to hepatitis screening and treatment is still very limited in the region, and community knowledge about hepatitis is low. Many people are unaware of their HBV infection and present for care with advanced disease.

CIDRZ supports HBV screening in the Government of Zambia’s HIV Prevention, Care and Treatment programme in Lusaka District according to Ministry of Health guidelines.

In January, a group of investigators including Ministry of Health, University Teaching Hospital  and CIDRZ authors published the results of their collaborative study evaluating the association between significant liver fibrosis, determined by the now WHO-recommended assessment for use in resource-constrained settings, AST-to-platelet ratio index (APRI), and all-cause mortality among HIV-infected patients prescribed antiretroviral therapy (ART) in Zambia. They concluded that liver fibrosis may be a risk factor for mortality during ART among HIV-infected individuals in Africa and that APRI is an inexpensive and potentially useful test for liver fibrosis in resource-constrained settings. Dr Michael Vinikoor, CIDRZ physician and study lead, welcomes the WHO guidance on the management of HBV in low and middle-income settings, “having the WHO recommend the APRI will help to bring this research finding to policy.”

Read the paper here

Read the 2015 WHO Policy Brief Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection here

Dual elimination of HIV/syphilis initiatives globally and an update on the status of dual HIV/syphilis RDT Research

March 26th  9-10 hours

Zambezi Conference Room, CIDRZ Head Office 5032 Great North Road, Lusaka

Maura Laverty

Research Nurse Clinician, WHO Department of Reproductive Health

Maura Laverty has been a registered nurse for over 40 years, and has been heavily involved in the earliest research efforts to combat HIV/AIDS. After graduating from the Kings County Hospital School of Nursing in Brooklyn, NYC, USA in 1975, Mrs Laverty worked in emergency departments in New York City for a decade, during which time she witnessed the beginning of the AIDS epidemic in the US. In 1986, she was one of the first nurses to join the New York University School of Medicine clinical research team that conducted early HIV/AIDS research on AZT and every drug that came after, as well as several therapeutic and preventative HIV vaccines under Dr Fred Valentine. From 2002-2012, Mrs Laverty worked through a PEPFAR grant awarded to NYU School of Medicine to assist colleagues in Mombasa, Kenya to establish HIV care and treatment centers, eventually scaling up to treating over 20,000 adults and children with HIV. For the last year, Mrs Laverty has been working for the WHO under the direction of Dr Lori Newman studying strategies around the elimination of congenital syphilis and use of dual HIV/syphilis point of care rapid diagnostic tests.

CIDRZ Welcomes Dr Monde Muyoyeta MBChB, PhD who joins as Director, TB Department

Dr. Monde Muyoyeta joins CIDRZ from ZAMBART where she served as Head of Diagnostic Studies and spent over nine years designing and conducting field epidemiological and laboratory studies. She holds Bachelor degrees in Human Biology, Medicine and Surgery from the University of Zambia, and a PhD in Infectious Disease Epidemiology from The London School of Hygiene and Tropical Medicine, University of London, U.K.

While at ZAMBART Dr Muyoyeta held several key positions including Investigator in the ZAMSTAR study, a large, two-country randomized control trial of community-level interventions aimed at reducing the burden of TB and HIV. She is also an Investigator on the AERAS TB vaccine trial, and has led studies evaluating computer-aided TB diagnosis using digital radiography and field evaluations of Xpert MTB/RIF, a new TB diagnostic technology.  Her research interests include implementation and evaluation of new diagnostic technologies specifically in patients with both TB and HIV, and for TB control and prevention.

CIDRZ Welcomes Dr Samuel Bosomprah MSc, PhD who joins as Head, Analysis Unit

CIDRZ Welcomes Dr Samuel Bosomprah MSc, PhD who joins as Head, Analysis Unit

Dr Sam Bosomprah earned his MSc in Medical Statistics, and PhD in Biostatistics and Epidemiology from The London School of Hygiene and Tropical Medicine, University of London.

In his immediate previous role he served as Senior Lecturer and Head of Department of Biostatistics at the School of Public Health, University of Ghana.

His research interests include the design and analysis of intervention trials; methods for health surveys in developing countries; vaccine evaluation; and application of advanced statistical methods to answer complex questions that involve multi-level/hierarchical data. He is broadly interested in maternal health, newborn health and child survival, and has published a number of research articles/methodology in peer-reviewed journals. Dr Bosomprah has facilitated courses in biostatistics, epidemiology, and monitoring and evaluation of health interventions for a broad range of health programme managers and health professionals from across Africa.

CROI 2015: Data Relevant to Zambia

March 19th 2015

Dr Mike Vinikoor

Paediatrician and Infectious Disease Specialist

“The annual Conference on Retroviruses and Opportunistic Infections (CROI) is the world’s leading scientific HIV conference bringing together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments, and best research methods in the ongoing battle against HIV/AIDS and related infectious diseases. CROI is a global model of collaborative science and the premier international venue for bridging basic and clinical investigation into clinical practice in the field of HIV and related viruses. CROI 2015 was held in February in Seattle, Washington, USA.” (www.croiconference.org)

Dr Michael Vinikoor is a Paediatrician and Infectious Disease Specialist—who has been based at CIDRZ since 2012. His research focuses on HIV and viral hepatitis clinical epidemiology and implementation science.

Cryotherapy on HPV Clearance among HIV-Positive Women

March 5th  2015

Katundu Katunda MSc,

Laboratory Manager & Virology Scholar, Cervical Cancer Research Capacity Initiative (CCRCI)

In 2011, as the virology scholar in the National Cancer Institute-funded CCRCI training program, Katundu spent one year in the laboratory of Professors Thomas Broker and Louise Chow at the University of Alabama at Birmingham, his main focus being to determine the diagnostic capability of protein biomarkers of human papillomavirus (HPV) disease. Following this Katundu returned to Zambia and, in addition to several other projects, developed the HPV DNA testing capability at the CIDRZ Central Laboratory. His research focus is HPV and their oncogenic potential in cancer of the cervix. Until recently, Katundu had been coordinating a study on the effect of cryotherapy on HIV shedding and HPV clearance. His current research focuses on the diagnostic capability of HPV point-of-care tests to identify women that are most-at-risk of developing cervical cancer.

Katundu received a BSc in Pharmacology from the University of Leeds, UK and an MSc in Molecular Biology of Parasites and Disease Vectors from the University of Liverpool, UK and has been a Research Associate at Novartis Pharmaceuticals, under the umbrella of the Novartis Next Generation Scientist program.