CAGs – offering emotional support, retention to ART clients in Magoye

CAG members in Ceembe village of Magoye, with CIDRZ staff during the Community visit

This week, we have been visiting communities in Magoye district, visiting Community Adherence Groups – CAGS. Interesting to visiting communities and see how they appreciate the efforts that CIDRZ is making in ensuring that people access ART with “ease” CIDRZ, with support front the Bill & Melinda Gates Foundation.

With support from CIDRZ, the CAGs have brought a difference in individuals lives as well as communities – both intended and unintended. People are now free to talk about their HIV status and offer each other support for the challenges they encounter. Some of them have even broken the barrier that previously existed and are freely talking about their status in their communities.

CAG members watering the vegetable gardens in Ceembe village

One of the communities we visited, we were happy to find that the CAG has even gone a step further to start a livelihood project – they have a vegetable garden and a considerable amount of hectares for groundnuts.

We visited three communities to hear their views about the CAG’s and challenges they used to face prior to the introduction of the CAG’s. In one of the communities we visited, about 45km from Mazabuka, people face different challenges that include movement from their homes to the nearest clinic, Magoye.

“We have to cross the dam when going to the clinic and this is usually a challenge in the rain season when the dam overflows. When this happens we can’t use our bicycles, we just have to walk to the clinic to get medication. This is particularly a challenge especially for women,” narrates Herbert Mwiinga, CAG supervisor for one of the CAGs Ceembe village.

Herbert Mwiinga demonstrating on how they cross the part of the dam that overflows during the rain season

At clinic level, “we used to go and get our drugs on a monthly basis, often with long queues spending more time at the facility, but from the time CAGs were introduced at Magoye Healthy Facility, we alternate on drug collection amongst ourselves. We each go there twice in a year. This is indeed a good initiative,” he adds.

The ART in Charge at Magoye clinic is full of praise for the model, “the CAGs have helped us in terms of retention of ART clients. We no longer have long queues and ART clients don’t have to come here on a monthly basis as the case was previously. We are proud of this and thanks to CIDRZ and the donors for this initiative,” says Leah Mwale.

CAGs are a community-based HIV treatment model promoted to improve long-term retention in care. It combines clinical visit spacing, group drug-pick up and distribution in the community, and peer social support to reduce the high opportunity costs of clinic visits and promote patient self-management. Although existing data suggest that retention is higher in CAGs compared to facility-based care, the overall public health impact of CAGs depends on the fraction of eligible patients who take up the model.


CIDRZ renovates Maz Hospital, Chongwe Urban Clinic Laboratories – for improved service delivery

Renovations works at Mazabuka Hospital in Southern province

Laboratories play a critical role in the continuum of care for HIV positive patients. Laboratory tests and results provide the vital information needed for health workers and patients to manage the HIV virus and keep it under control for the health of the patient and reducing chances of passing the virus to others.

However, with a population of about one million people living with HIV in Zambia, there has been an overwhelming need for Anti-Retroviral Therapy (ART) laboratory services to be provided in all health facilities providing  ART care.

Through  generous funding from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partnership of U.S Centers for Disease Control and Prevention (CDC), CIDRZ has been providing capacity building supervisory  and technical assistance aimed at accelerating government laboratory service improvements in  Lusaka, Western, Southern and Eastern provinces.

We have been identifying hospitals and clinics that need laboratories. In these facilities, we have renovated their laboratories and will procure equipment that will enhance their service provision at facility level. CIDRZ envisions a situation where ART services are provided as closer to the people as possible.

Chongwe Urban Clinic Laboratory renovations have been concluded

We recently visited Mazabuka Hospital and Chongwe Urban Clinics to inspect progress on renovations on the laboratories. We are proud that Chongwe works have been finalized while Mazabuka renovations are on course to being finalized.

This is aimed at building local capacity to provide onsite ART laboratory services, reduction in result turnaround time, full integration of operations with the Ministry of Health structures such as national forecasting, quantification, procurement, equipment maintenance plan and distribution and  as a  sustainability guarantee  of ART laboratory services.

mSpray: Spatial Data to Improve Intervention Coverage

Annie Martin, a Akros Research Associate & Programme Manager

According to UNICEF “of all people who die from malaria in Zambia, 50 percent or more are children under 5 years of age; 50 percent of under-5 hospital admissions are due to malaria; Malaria accounts for 20 percent of maternal deaths”.

The complexity of malaria, a preventable and curable disease requires several interventions to ensure an environment free of malaria. For many years prevention measures have been implemented to save lives from this disease and notable among these measures has been the indoor residual spraying (IRS) of walls with insecticides.
In order to make IRS more effective in combating malaria, Akros, an organisation whose work is mainly open platform agnostic, with projects largely focused on improving national information systems, in health, WASH and education, with an emphasis on community level surveillance has developed the mSpray tool to improve IRS operations and available tools that could facilitate that vision.

One of te spray team members showing off the cellular enabled tablets with maps that they use in the field during IRS

Annie Martin, a Research Associate and Programme Manager at Akros said during the CIDRZ weekly research meeting that “our programmers have created a tool that integrates Google’s mapping technology with intelligent overlays, putting the data in the hands of everyone, helping to drive the virtuous data cycle forward. No longer do we need to send spray teams out to the far corners of the country with instructions, hoping the spraying is happening in the right places. Now we can send them with cellular-enabled tablets with maps showing them where they are and where the next house is they need to find and spray. And thanks to GPS location tagging, we can now see each house they visited and sprayed as they file their reports, right from the field. And all of the data comes back in real-time”.

She said mSpray was associated with a significant 15% reduction in confirmed case incidence due to better targeting and achieving overall higher household coverage compared to the programme without mSpray.

Participants following the research presentation on IRS by Akros

“While reported operational coverage estimates were higher for non-mSpray areas, the ratio of structures sprayed per population achieved was higher for mSpray areas, suggesting better actual coverage was achieved in these areas leading to greater impact. The use of the mSpray electronic Monitoring & Evaluation tool appears to improve the effectiveness of the IRS programme, likely through allowing for better targeting, better coverage, and less biased estimates of coverage”.

Head Business Development

Do you have a Master’s Degree in Business Administration, Public Health, or other relevant field with at least 5 years relevant work experience in proposal development and grants pipeline analysis in the public health sector. You could just be the one we are looking for.

We are looking for someone to Head our Business Development unit. Apply now. For details, follow this link.

CIDRZ Health Fellowship Opportunity 2018 – 19 NOW OPEN!

Closing Date: 20 March 2018

This fellowship provides valuable field experience for future public health leaders in the setting of a vibrant non-governmental health research organisation in Zambia.

CIDRZ HealthCorps targets public health, medical, nursing and management graduates who are passionate about global health and wish to gain exposure. Master’s degree preparation preferred, however graduates with a Bachelor’s degree and substantial experience are welcome to apply. Previous work experience is highly regarded, but not required.

Fellowship areas offered this intake are:

  • Enteric Diseases
  • Tuberculosis
  • Hepatitis
  • Child Health
  • Vaccine Research
  • Lab Science
  • Detailed Analysis
  • Social Qualitative Research
  • Primary Care & Health Systems Strengthening

10-12 months placement with a Lusaka-based mandatory orientation the first week of August 2018; fellowship activities start soon thereafter.

Modest monthly bursary to cover basic living expenses, local medical services membership, and emergency evacuation insurance.


Completed applications must be received by CLOSING DATE: 20 MARCH 2018

Oral cholera vaccine (OCV) can save lives: Intensified efforts to eliminate cholera in Zambia

Prof David Sack, Dr Roma Chilengi, CIDRZ Chief Scientific Officer and other study staff with Volunteers from Lukanga Swamp who help with tracking DOVE study participants in the swamps and lagoons

Zambia is currently grappling with the fight against cholera. More than 3000 cases have been reported since the 2017/18 rain season begun and more than 70 deaths recorded. A multisectoral approach to combat the outbreak has been implemented including the use of security personnel to maintain public order and more than ZMW100 million (USD10m) has been spent so far.


The first outbreak of cholera in the country was recorded between 1977 followed by another outbreak in 1982; and since then, there has been outbreaks though, not on an annual basis. These outbreaks, once they occur, put the country under serious economic and health stress.

Several strategies on the prevention of cholera such as providing clean water and proper sanitation, health education and good food hygiene have been promoted as long term measures to prevent such outbreaks, however, the need to integrate oral cholera vaccines (OCV) to these strategies continues to be emphasised.

Professor David Sack, from the Department of International Health at Johns Hopkins Bloomberg School of Public Health shade more light on OCV during the CIDRZ research meeting when he made a presentation on ‘How can CIDRZ contribute to elimination of cholera in Zambia?’.

The World Health Organization (WHO) agrees “given the current availability of killed whole-cell OCVs and data on their safety, efficacy, field effectiveness, feasibility, impact and acceptability in cholera-affected populations, these vaccines should be used in areas with endemic cholera, in humanitarian crises with high risk of cholera, and during cholera outbreaks. The vaccines should always be used in conjunction with other cholera prevention and control strategies”.

Prof Sack reiterates that “sanitation is the long term solution; but vaccine will provide results more quickly. The first round of OCV in Zambia in April 2016 showed 89% effectiveness from 423,774 doses administered to a target population of 543,755 people. OCV reduces the risk for persons to receive vaccine, if coverage is high, OCV also reduces the risk for persons who do not receive vaccine and further reduces the risk for persons who receive the vaccine. Clearly vaccine is not an alternative to safe water; however, vaccine and improved water/sanitation actually work together—each reinforces the benefit of the other”.

He added that critical elements towards cholera elimination included understanding the disease burden (epidemiology, transmission, surveillance, seasonality, hotspots), an integrated national plan to focus efforts on Hotspots as well as resources and leadership.

Study participants fulfing their appointments with study staff from CIDRZ

CIDRZ is currently implementing the Delivering Oral Vaccine Effectively (DOVE) Project in collaboration with Johns Hopkins Bloomberg School of Public Health, a cholera vaccine study in the Lukanga Swamps. The goal of the DOVE project is to ensure that populations at risk of cholera will benefit from receiving OCV in an appropriate and effective manner.


The project provides tools and resources to countries and agencies who are dealing with the threat of cholera in order to assist them in making evidence-based decisions regarding when and how to use OCV.

HIV self-testing acceptable and accessible among female sex workers Zambian transit towns

Mbaita Shawa, during the Research Meeting at CIDRZ

HIV testing is essential for realizing the first step of UNAIDS 90:90:90 target by 2020 and its introduction was as an alternative to traditional testing to reach the UN target.

In Zambia, a study conducted by CIDRZ showed that HIV Self Testing was accepted in the general population but, little is known about its acceptability among female sex workers.
Mbaita Shawa, a CIDRZ HealthCorp Fellow conducted a review on article on “HIV self-testing among female sex workers in Zambia : a cluster randomized controlled trial” a study conducted to evaluate the effect of two different health system mechanisms for HIV self-test delivery compared to referral to standard HIV testing among transit town based female sex workers of Chirundu, Kapiri Mposhi and Livingstone.

Results from the study revealed that of the 965 participants, 885 (91.7%) returned to follow up at 1 month and 898 (93.1%) returned at 4 months, 92.3% and 89.5% reported use of HIV self -test in one (1) month and four (4) months respectively, and linkage to HIV services.

In her review, Mbaita concluded that in the short term, direct delivery self- testing may be more effective as it removed confidentiality and logistical barriers to accessing HIV services and that the modality was acceptable to female sex workers and can lead to uptake of HIV self- testing just as high as direct delivery.
“This study indicates that HIV testing interventions, delivered by peer educators may have a large effect on HIV testing”

She recommends that future long term studies consider linkage to care and Anti Retroviral Therapy interventions following HIV self -testing, the role of peer educators in facilitating HIV care cascade progression