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”.

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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:

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

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

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

Click here for ONLINE APPLICATION FORM

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

Time and Motion Study: Results from the CommART Baseline Assessment

“‘Cost’ is the most important component in many of evaluations used for decision making in health care”

Taniya Tembo CIDRZ Costing Research Associate said this during the CIDRZ weekly research meeting when she presented results from a study on Time and Motion Study: Results from the CommART Baseline Assessment

The study was conducted in 10 control and intervention sites selected on the basis of epidemiologic,

economic, and operational characteristics  to assess the importance of good costing during the costing of activities for the Community ART for Retention (CommART) project.

The CommART project was developed to find alternatives  to  problems in the scale-up of providing ART on an already over-stretched health care system and limited health infrastructure and decentralized ART models were found to  potentially reduce cost of HIV care due to the reduced use of providers’ time and improve patient outcomes due to increased retention.

Cost-assessment under the CommART project was based on societal perspective using micro-costing method (both bottom up and top-down), quantification of different types of resources used for the HIV, treatment and care through identification of unit costs and multiplied quantities of resource used by respective unit costs.

Further components of the cost assessment included, patient costs such as opportunity costs (including waiting time), transportation to and from clinic, provider costs( cost of ARVs, labs, personnel, equipment, supplies & administrative costs), programme costs i.e. costs to set up the monitoring and evaluation framework, technical advice, staff meetings and trainings, and facility-level costs (calculation of amounts allocated to HIV care).

Data from the study was based on ART services such as counseling, pharmacy, laboratory and clinical visits.

The key cost parameters were analysed from two dimensions: Patients and healthy systems Parameters:

From a patient’s perspective, it included issues to do with lost productivity, lost wages due to illness and seeking care, out of pocket costs for each clinic visit, including repeat visits (drugs, tests, hospitalization among others). From a health system perspective, the study looked at costs of providing clinical services per patient visit and cost of evaluation, diagnosis, treatment and hospitalization.

The results revealed that on average patient waiting time to receive all the above services were 254 minutes in urban and 215 minutes in rural clinics per day respectively. The study also found that in terms of direct patient activities, Counselors spent 978 minutes, Pharmacy Technicians 298 minutes, Clinical Officers 302 minutes and Nurses 593 minutes on average per day.

The study concluded that good costing was important in standard treatment and introduction of new health interventions.

For details, TAM-Baseline-Assessment_PP_TT.pdf (34 downloads)

Researchers Offer New Model for Uncovering True HIV Mortality Rates in Zambia: Accurate information needed to improve treatment outcomes

LUSAKA/WASHINGTON 12 Jan. 2018 A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

Survival represents the most important indicator of successful HIV treatment, according to the researchers. According to UNAIDS, mortality from HIV has fallen by 50 percent since 2004—largely due to the successes of national HIV programs, PEPFAR, and the Global Fund. Yet, because routine monitoring and evaluation fails to systematically capture most deaths, it can be challenging to accurately assess the impact of HIV services and to identify where improvement is most needed, the researchers say.

The Better Information for Health in Zambia (“BetterInfo”) study begins to examine survival rates in Zambia. Published January 12 in PLOS Medicine, the work was conducted by a team of researchers co-led by Charles Holmes, MD, MPH, faculty co-director of Georgetown University Medical Center’s Center for Global Health and Quality, and visiting associate professor at Georgetown’s School of Medicine. Holmes led the work along with Izukanji Sikazwe, MBChB, MPH, Chief Executive Officer of the Centre for Infectious Research in Zambia (CIDRZ) and Elvin Geng, MD, MPH, of the University of California, San Francisco. Holmes, who previously led CIDRZ, also serves as associate professor of international health at Johns Hopkins Bloomberg School of Public Health and associate professor of medicine at Johns Hopkins School of Medicine.

The research was conducted in Zambia through a partnership with CIDRZ and the Zambian Ministry of Health, in close collaboration with numerous local and global academic centers and researchers.

The research group set out to provide a more accurate representation of site- and regional-level mortality among people on HIV therapy in Zambia by characterizing the extent of under-reporting of mortality and the variability in data collection and use, and to assess the broader impact this might have on treatment programs and outcomes.

The group applied a multistage sampling-based approach—which they say is a novel methodology in this context—to obtain regionally representative mortality estimates in four Zambian provinces (Lusaka, Southern, Eastern, and Western). The estimates were also sufficiently precise to quantify variation in death rates among clinic sites.

They looked at a sample population of more than 160,000 patients who had visited government-operated HIV treatment sites in these provinces to determine: the magnitude of deaths of those who were taking antiretroviral therapy (ART); when deaths occurred; which groups are at highest risk of death; and whether these factors differ by region, facility, or other variables.

They also traced patients who were lost to follow-up to ascertain their status, and then used this information to create a corrected regional survival estimate as well as corrected site-specific mortality estimates.

The BetterInfo study concluded that mortality is substantially underreported in routine provincial program data—by as much as three- to nine-fold—among HIV-infected individuals starting ART, leading to a change in the ranking of provinces by mortality rates.

At the site-level, “corrected” mortality rates were found to be up to 23-fold higher among those on ART. The study also found unexpectedly high variability from site to site in reported mortality rates, ranging from less than 1 death per 100 person-years to up to 13.4 deaths per 100 person-years over a two-year period.

“Even as we strive to reduce new HIV infections and end the HIV pandemic as a public health threat, we must not lose sight of premature deaths occurring amongst people living with HIV who are on treatment,” Holmes says. “HIV treatment is not a ‘set it and forget it’ proposition—deaths often occur outside of the health system and are therefore ‘silent’ events that are unknown to those providing or managing care.

“We believe our scalable approach, which builds on and extends earlier sampling methods, provides actionable data to clinic, provincial and national decision-makers to ensure the HIV program in Zambia is able to become more patient-centered and impactful,” he says.

Based on the findings, certain prevailing assumptions that underlie HIV programs may need to be reexamined. For example, the researchers say it has been assumed that most patients on treatment for longer periods of time will be more stable than those just starting treatment. However, the study data suggest that time on therapy alone may not be a reliable marker of stability, a finding that will have implications for delivery strategies recommending less health system interaction for patients considered clinically stable.

In addition, approximately 50% of deaths among those newly starting ART occurred relatively shortly after a recent clinic visit, suggesting even greater need for attention to diagnostic services and clinical vigilance for potential co-existing illnesses.

Overall, the authors seek to encourage national- and global-level policy makers to investigate and address the root causes of underestimated and highly variable mortality rates so they can refocus their quality improvement efforts and strengthen HIV programs.

“These data from the BetterInfo study have provided new targets for quality improvement efforts, and we look forward to further evidence as it emerges that will enable us to support the strongest possible national HIV program in Zambia,” says CIDRZ’s Sikazwe. “We recommend that others consider the application of similar large-scale surveillance methodologies in order to better understand their program outcomes, and we are excited to facilitate broader adoption through the forthcoming release of a “BetterInfo” toolkit and other materials.”

Holmes adds, “We believe our study also highlights the critical need for investments in vital status registries and data systems to enable better visibility into patient outcomes. These investments are critical not just for the HIV response, but for broader efforts to combat chronic conditions such non-communicable diseases and achieve universal health coverage.”

Additional co-authors of the study include Kombatende Sikombe, MPH, Njekwa Mukamba, Sandra Simbeza, MSc, and Cardinal Hantuba from CIDRZ; Ingrid Eshun-Wilson, MBChB, MSc, from Stellenbosch University in Cape Town, South Africa; Nancy Czaicki, PhD, MPH, from CIDRZ and University of California, Berkeley; Laura K. Beres, MPH, from Johns Hopkins University; Carolyn Bolton Moore, MBBCh, MSc, from CIDRZ and University of Alabama at Birmingham; Peter Mwaba, MBChB, PhD, from Lusaka Apex Medical University in Lusaka, Zambia; Caroline Phiri, MD, MPH, from the Ministry of Health, Government of the Republic of Zambia; Nancy Padian, PhD, MPH, from the University of California, Berkeley; and David V. Glidden, PhD, from the University of California, San Francisco.

The study was funded by the Bill & Melinda Gates Foundation (OPP1105071). The authors report having no personal interests related to the study.

“Estimated mortality on HIV treatment among active patients and patients lost to follow-up in 4 provinces of Zambia: Findings from a multistage sampling-based survey.” https://doi.org/10.1371/journal.pmed.1002489

About Georgetown University Medical Center
Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC’s mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis — or “care of the whole person.” The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health. Connect with GUMC on Facebook (Facebook.com/GUMCUpdate), Twitter (@gumedcenter). Connect with Georgetown University School of Medicine on Facebook (Facebook.com/somgeorgetown), Twitter (gumedicine) and Instagram (@GeorgetownMedicine).

CIDRZ hosts first Lusaka ART Saturation Planning meeting with over 90 participants

Dr Mary Boyd, U.S. CDC Zambia Associate Deputy Director Programmes addressing the meeting

CIDRZ today hosted the planning meeting for the Lusaka Art Saturation Surge Campaign – dubbed Tiyende Pamodzi. The meeting has seen the participation of about 40 health facilities and hospitals, and more than 90 people.

This was made possible with support from With support from the US Presidents Emergency Plan for AIDS Relief and Centers for Disease Control and Prevention (CDC.

The planning meeting is meant to operationalize the Lusaka Surge Strategy which the Republican President, Edgar Lungu, launched on 11 December 2017, during the World AIDS Day Commemoration.

The meeting drew participants from other United States government supported implementing partners that include: University of Maryland, FHI, Catholic Relief Services (CRS), Zambia Community HIV Prevention Project Z-CHPP, and Expanded Church Response (ECR).

Addressing the participants, the United States Centers for disease Control and Prevention, Zambia Associate Deputy Director of Programmes, Dr. Mary Boyd emphasized the need for partners to be committed to the objectives of the Lusaka ART Saturation Surge Campaign.

Part of the participants drawn from all the healthy facilities in Lusaka

Tiyende Pamodzi campaign is a strategy by the Ministry of Health and PEPFAR in Zambia to achieve HIV epidemic control in Lusaka Province over 12 months, whereby 90% of People Living with HIV are identified, 90% of identified PLHIV are placed on ART, 90% of PLHIV on ART become virally suppressed and use the information learned from achieving epidemic control in Lusaka Province to assure achieving 90-90-90 efficiently in Zambia by or before December 2020.

Currently, Lusaka province statistics indicate that out of an estimated population of 326,535 people living with HIV, only 71% of people are aware of their HIV status, while 88% are on treatment and 89% are virally suppressed.

The meeting sought to assess the readiness and current status of the health facilities in terms of responding to the needs of the Lusaka Surge campaign. The goals assessed included: 1) Case finding 2) Linkages to care and treatment 3) Retention to care 4) Viral Load testing and 5) Systems issues

CIDRZ shares best practices and experiences at 11th Annual HIV Technical Conference

 

Dr Mubiana-Mbewe

In its quest to be a permanent resource to the Government of the Republic Zambia, CIDRZ actively collaborates with the Ministry of Health and serves on Technical Working Groups. Through mentorship and technical assistance, CIDRZ builds strong relationships with Zambian healthcare staff from facility to national levels as well as presenting at local and international meetings and provide regular dissemination to the Ministry of Health Research Directorate and other key stakeholders.

“In this regard, CIDRZ participated at this year’s 11th Annual National HIV Technical Conference held in Lusaka under the theme “fast- tracking Towards HIV Epidemic Control while Maintaining Quality Health Care”

Dr Mwangelwa Mubiana-Mbewe presented research findings on stigma under a session aimed at highlighting challenges and share best practices in case identification and linkage to treatment for adults, pregnant women and key populations towards achieving the first 90.

Musonda Musonda shared best practices in case identification and linkage to treatment for adolescents from a Comprehensive PMTCT for At-Risk Teens project supported by the M.A.C AIDS Fund. The “one-stop shop” pilot service implementation project aims to increase the awareness of adolescent health services within targeted communities as well as amongst health providers. The goal is to increase HIV testing amongst teens and prevent new HIV infections in HIV-negative teens, prevent unintended pregnancies, improve adherence to Option B+, increase treatment initiation and retention, increase the awareness of adolescent health services within the community.

CIDRZ Chief Medical Officer Dr Carolyn Bolton co-chaired a session on differentiated service delivery models and lost to follow up where Mpande Mwenechanya presented on CIDRZ Community Adherence Groups (CAGS), Urban Adherence Groups (UAG) models.

“The meeting was officially opened by the Minister of Health, Hon. Dr Chitalu Chilufya who also stated that the Zambian government is in the process of introducing a bill in parliament to help strengthen the National AIDS Council (NAC) in order for the organisation to effectively respond to the emerging challenges that come with control of the HIV epidemic.”