Community based ART delivery models have been shown to reduce the burden and strain on the local health system. These models have shown improved outcomes that include better patient retention in care, reduced clinic congestion, and patient satisfaction.
Nessia Tembo of Matero was one of the over 400 participants who took part in the CIDRZ Fast Track Model, one of the four differentiated models of care implemented during the Community ART for Retention in Zambia study through funding from the Bill and Melinda Gates Foundation. The other three were Community Adherence Group(CAG), Urban Adherence Group (UAG) and Streamlined ART Initiation (START).
Nessia shared her experience, “I was working part time and usually getting leave from work to go the health facility would be a challenge and for fear of losing my job, I would default going for my clinical appointment just to keep my job. The hours I would spend from having my file pulled to collecting my drugs were long. When the Fast Track model was introduced, I spent less time at the health facility during my ART visits giving me enough time to go back to work and even attend to other family engagements.”.
“It is sad that the study has come to an end. If only those of us that took part in the study could be trained and mentored, we would form groups to ensure continuity of the model”.
The Zambian Ministry of Health had authorised implementing partners to pilot different models of community-based ART service delivery to determine best models of dealing with retention into care of HIV positive clients.
This was in response to the challenges that the health sector was facing. Under the Community ART Study (CommART), CIDRZ conducted a study whose objectives were:
- To determine the acceptability, appropriateness, and feasibility of a differentiated care system in Zambia.
- To evaluate the effectiveness, efficiency, and health care quality of a differentiated care system that includes targeted models of care.
- To develop a “methodologic” toolkit for assessment of local needs and preferences and for implementation during scale-up of differentiated care models in this and in other contexts.
Four models were piloted: one Community model and three facility models. These were the Community Adherence Groups (community model), and the Urban Adherence Groups, FastTrack and Streamlined ART Initiation (facility models).
According to researchers, because of a shortage of global stockpile of cholera vaccines, an outbreak in Lusaka, Zambia, in February 2016 necessitated a need for single-dose vaccination.
An emergency single-dose oral vaccination campaign was implemented in April 2016, around Lusaka, targeting more than 500,000 people in the city’s overcrowded township areas.
Francisco Luquero, a co-author of the study and an expert in preventable diseases at the France-based Epicentre, the research arm of the Médecins Sans Frontières (MSF) or Doctors without Borders, says that studies have already proved that one oral cholera vaccine dose works, but they were conducted in countries that had recently experienced cholera.
The 2016 outbreak happened when Zambia had not reported a case of cholera in four years.
“Our results show that people vaccinated can be protected against cholera a few days after receiving one dose.”
Francisco Luquero, Médecins Sans Frontières (MSF)
Between 25 April 2016 and 15 June 2016, researchers enrolled 66 patients with confirmed cholera and 330 people without the disease but who were neighbours of the patients, and determined the effectiveness of the single-dose cholera vaccine.
According to the study published last month (8 February) in the New England Journal of Medicine, the effectiveness of the single dose vaccination was about 90 per cent.
“Our results show that people vaccinated can be protected against cholera a few days after receiving one dose, which is important in outbreaks because we need to protect people quickly, Luquero says.
Oral cholera vaccines are emerging as a new tool for cholera control and have been used in past years to successfully prevent outbreaks in complex emergencies, to curb cholera epidemics or to reduce burden in countries which are endemic but there is a current global shortage, MSF says.
The Lusaka outbreak ended quickly after the implementation of the vaccination campaign, thus limiting the number of cases recruited, Luquero explains.
The Ministry of Health offered a second vaccine eight months later in December 2016.
The WHO estimates that globally cholera infects one to four million people a year, resulting in 21 000 to 143 000 deaths, with countries in Sub-Saharan Africa at increased risk.
“This is an important study because it suggests that the world could face the challenges of cholera outbreak with a single dose,” says Roma Chilengi, chief scientific officer, Centre for Infectious Disease Research in Zambia, adding a single-dose vaccine is cheaper and could help countries with limited financial ability to control the disease.
But Chilengi tells SciDev.Net, “It would be helpful to be clear about the potential duration of the protection the single dose offers.”
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.
Eva Ferreras and others Single-dose cholera vaccine in response to an outbreak in Zambia(New England Journal of Medicine, 8 February 2018)
To ensure that quality health care reaches to as many as possible in all the sites where CIDRZ has presence, working with the local leadership has been one of the strategies the organisation uses to reach out to many people with health information.
We engage with traditional leaders to discuss health issues that concern their people and we take advantage of every opportunity to do so. We talk about cervical cancer, Voluntary Medical Male Circumcision, Prevention of Mother to Child Transmission of HIV, Tuberculosis and best ways to link HIV positive people to care.
And we have always found positive attitude with our traditional leaders and have received support for our work.
This is why during this year’s Nc’wala ceremony, CIDRZ with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partnership from the U.S Centers for Disease Control and Prevention (CDC) During this year’s ceremony, sensitised a total number of 2131 people voluntary male medical circumcision, condom use, Prevention of Mother to Child Transmission of HIV (PMTCT) and cervical cancer.
Messages on the importance of HIV testing, male circumcision for HIV negative partners and cervical cancer prevention and management were disseminated to individuals as well as groups of people. We conducted two onsite circumcision procedures.
CIDRZ also provided HIV testing services of which 578 people got tested with six people found HIV positive were linked to care.
Nc’wala Traditional Ceremony is an annual event of the Ngoni-Speaking People of Eastern Province and takes at Mtenguleni in Chipata District, Eastern Province to celebrate the first harvests of the year.