Health workers attitudes, key to HIV linkage to care

Tila Mainga presented on “Results from the Stigma Ancillary Study” during CIDRZ Research Meeting

Health Care Workers, like all other community members are affected by HIV stigma. But Health Workers have a special role in providing services to clients and so addressing stigma is especially important.

These were some of the conclusions made by Tila Mainga, Study Manager at ZAMBART, when she presented on “Results from the Stigma Ancillary Study” during the CIDRZ weekly research meeting.

The study’s objectives were to ascertain how stigma among health care workers impacted on linkage to care with specific focus on health care workers attitude towards key populations and clients living with HIV, their perceptions of  experiences of clients living with HIV in the health facility physical spaces and internalized stigma among health care workers living with HIV.

On  attitudes towards key populations, the study found that health Care Workers  talk badly to pregnant adolescent girl as they believe that  pregnant  adolescents are promiscuous and engage in high risk sexual behaviors.

The study also revealed that sex workers face a lot of stigma in the clinic and in the community and lose  interest in accessing health care services due to long queues and waiting times is perceived as a risk of  them being identified.

Tila explained  “however, there is a contrast in the nature of the relationship between People Living with HIV and Health Care Workers. On one hand some described it as friendly and supportive while on the other, it was described it as rude and unaccommodating”.

She pointed out that “some health facilities have no privacy ,as a result there is information leakage as to who is HIV positive and who is not. Some communication materials found in health facilities are too obvious that they are symbols of an HIV positive person, hence chances of being stigmatized are high”

The study concluded that there was still more that could be done to reduce stigma levels by health care workers especially towards populations at high risk of HIV.

 

President Edgar Lungu thumbs up CIDRZ

President Lungu listening to CIDRZ TB Clinical Care Specialist, Dr Mary Kagujje during the official launch of the National Health Week at OYDC

In line with our mandate to ensure equitable access to health services in Zambia, the Centre for Infectious Disease Research in Zambia (CIDRZ) is participating in this year’s National Health Week.

The Health Week, whose theme is “Healthy for All, Leaving No One Behind” was officially opened by the Republican President, Edgar Lungu on Tuesday at the Olympic Youth Development Centre (OYDC).

CIDRZ is providing services at the OYDC which include: HIV Testing, ART clinic, cervical cancer screening, TB screening using Gen Xpert Machine, adolescent HIV Testing and information dissemination, and recruitment of study participants for the HIV Vaccine Trials.

CIDRZ provided a range of services at OYDC during the National Health Week

All this is with support from the United States (U.S.) President’s Emergency Plan for AIDS Relief (PEPFAR), and it’s partnership with the U.S. Centers for Disease Control and Prevention (CDC); Stop TB Partnership | TB REACH; MAC AIDS Fund; and the U.S. National Institutes of Health.

During the launch, President Lungu commended CIDRZ for offering mobile TB screening services and urged the ministry to procure such digital X-Ray machines for outreach purposes.

People lining up at the CIDRZ X-Ray truck

“It’s impressive to see a mobile X-Ray truck and I am happy that you are going in the community to screen people for TB. It will be a good idea for the Ministry of Health to purchase such mobile X-Ray machines for all our communities,” President Lungu said.

CIDRZ TB Clinical Care Specialist, Dr Mary Kagujje was on hand to give insights to the President on the services offered by CIDRZ.

CIDRZ, partners hold first media science café on clinical trials

Media cafe participants actively following the discussions around ethical conduct of clinical trials and the role of the media in report on health in general, and clinical trials in particular

Despite education and treatment advances towards HIV e.g. provision of Anti-Retroviral Therapy (ARV’s), male circumcision, prevention of mother to child transmission of HIV, the rates have not dropped as much as they should have.

While ARV’s have been very helpful in fighting the epidemic, they are expensive and depend on continuous supply hence the need to find a long lasting cost effective method of addressing this challenge.

To address this, CIDRZ is part of the HIV Vaccine Clinical Trials (HVTN) that seek to develop a Safe and Effective Vaccine for Prevention of HIV Infections Globally.

Prevention of HIV transmission, is the long term global solution for the HIV pandemic. Current methods are working but Protection by these interventions is limited by

  • Need for long-term continuous adherence
  • Continuous uninterrupted access to products and
  • Sustainable donor and public funding.

“Ultimately, we believe, the only guarantee of a sustained end of the AIDS pandemic lies in a combination of non-vaccine prevention methods and the development of a safe and effective HIV vaccine.”

A vaccine able to prevent HIV infection would have a significant impact on the health, social and economic burden of HIV/AIDS and recent modelling studies showed that introducing a partially effective (30%) with limited coverage in Southern Africa could result in an significant reduction in HIV incidence compared to a non-vaccine scenario.

We took a media tour with journalists to the CIDRZ HVTN Site at Matero referral Hospital and CIDRZ Central Lab in order to showcase the state of the art equipment that CIDRZ uses for its services and clinical trial

CIDRZ, Zambia Emory HIV Research Project (ZEHRP) and Zambia Institute of Mass Communication Education Trust (ZAMCOM) held a media café to raise awareness among journalists and the community on HIV vaccines, ethical conduct and the role of the media in the process.

In addressing journalists, ZEHRP Director Dr William Kilembe explained that “the rationale behind the vaccine trials is to find an intervention that has significant effect on reducing new HIV infections.”

The media science café, was attended by more than 25 journalists from different media houses to acquaint them on their role in health reporting and HIV vaccine trials in particular with a specific focus on HIV prevention research updates, current HIV vaccine trials in the region and globally as well as clinical research concepts.

Former Times of Zambia News Editor, Enock Ngoma said “the media are a key stakeholder that has to be involved in the entire process of any clinical trial. People believe what they read in the media and therefore the media will play a critical role in making people understand the objectives, processes and procedures of clinical trials. This is a step in the right direction for journalists to develop interest and gather prior knowledge about the trials, design process, participants and duration. I must commend CIDRZ and partners for bringing journalists together in this manner”.

Another participant, Nicholas Bwalya of Metro FM added that “journalists need more of such platforms to interact with researchers and inculcate the interest of health reporting in them. This is the only way we can understand the jargon that always has always posed a challenge to report on health research and outcomes”.

CIDRZ Communications Manager, Daniel Banda, making a presentation on the role of the media in reporting on clinical trials

Meanwhile, CIDRZ Communications Manager Daniel Banda pointed out that “media is one of the most important stakeholders in every community. The media has influence on funders, policymakers, & even ethics review committees, hence the reason of our meeting here. Health affects everyone and almost no other news or specialist topic has such a universal audience in all media like health”.

And ZAMCOM Director, Oliver Kanene said “we are happy to partner with CIDRZ especially that the inaugural  media science café was at CIDRZ years ago. The goal for this platform is simply to bring science to a level where everyone understands. Science is worthless if it is not shared with people but sharing can only happen if the media first understand the processes involved”.

CIDRZ strengthening health systems through internship programmes

Interns in one of the health facilities

CIDRZ continues to provide Health systems strengthening and capacity-building through partnerships with both local and international learning institutions by offering internship and fellowship opportunities.

This year like every other year the Pharmaceutical Services Department supported five Pharmacy students attached to the unit from Evelyn Hone college, the students were mentored and exposed to HIV Prevention and Treatment Services in the MoH CIDRZ supported facilities.

Emmanuel Kalangwa, 3rd year pharmacy student at Evelyn Hone College said “the one month I spent at CIDRZ was educative. I have learnt a lot, for example how drugs are supposed to be stored at the right temperature to preserve drug potency. Besides acquiring more knowledge about HIV treatment regimes, I also learnt more other diseases such TB.”

Muhau Mubiana of CIDRZ explained that our department in collaboration with training institutions hosts a team of five (5) students from Evelyn Hone College every year and mentors them in pharmaceutical care. The skills attained became useful as they get deployed to various health facilities within the country. This year’s internship was unique in the sense that the interns came at a time when our activities had evolved from the traditional supply chain to differentiated service delivery (DSD), Pre-exposure prophylaxis (PrEP) and Isoniazid Prevention Therapy (IPT)”.

Mentorship programme in progres

Having been with them for one month, these five are going out there as Pharmacy Technologist with a difference (Ambassadors and Champions) of DSD and PrEP services.

This years’ interns worked with Chipata 1st Level Hospital team to strength the Ministry of Health Standard Operating procedure (SOPs) manual for the management of the National ARVs Logistic system. The SOPs provide storage guidelines that should be followed at all facilities to ensure that drugs maintain their shelf life and maintain drug potency up to the time they are dispensed to the patients and in turn achieve viral suppression (third 90 among the 90:90:90 UNAIDS strategy).

The 90–90–90 is an ambitious treatment target to help end the AIDS epidemic by 2020. It aims:

  • By 2020, 90% of all people living with HIV will know their HIV status
  • By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy
  • By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

CIDRZ Publishes A Toolkit for a Sampling-Based Approach to Understand HIV Treatment Results

The global HIV response has grown far beyond early expectations but continues to face formidable and evolving challenges at policy, organisational, individual healthcare worker (HCW), and patient levels. As HIV programs transition to country ownership to ensure sustainability, gaps in capacity and resource commitments emerge. Meanwhile, the volume of individuals seeking chronic HIV care, especially in countries with the highest burdens of disease, has posed a challenge to the health delivery system. In Zambia, for instance, the current HIV prevalence rate is estimated at 12.9% [2017] with about 1.2 million persons living with HIV, many now entering a phase of long-term follow-up. However, losses-to-follow-up from HIV Care and Treatment programs exceed 25-50% in many African settings, therefore leading to an under-estimation of patient mortality and retention in care. This gap represents a form of selection bias in epidemiologic studies which seek to understand the effects of predictors on patient outcomes. An understanding of the true patient outcomes allows for a better assessment of public health systems and their program efficiencies.

 

The CIDRZ BetterInfo Study Toolkit was designed for decision-makers and implementers of HIV programs who would like to apply the same sampling-based approach to track patients lost from HIV Care services. Herein, we identify our measurement strategy, provide the basic tools for our sampling-based approach, detail the methods and minimum package to track patients considered lost from care, and discuss our study results.

 

The measurement strategy employed by the BetterInfo study has the potential to improve evidence-based global delivery of care and treatment for patients with HIV infection. With the more accurate revised information obtained by tracking patients considered lost from the HIV care program, a better estimation of the true mortality and retention rates in this population was obtained. This knowledge can help to guide in-depth assessment to understand care delivery in and across facilities and to identify best practices to improve patient care. Therefore, understanding levels of true disengagement and addressing the facilitators and barriers to HIV care which are unique to clinics is needed to improve ART patient retention.

Read more

 

CIDRZ awards 40 members of staff for distinguished service

The Lusaka based awardees with CIDRZ Board member, Mr Charles Mpundu, CIDRZ CEO Dr Izukanji Sikazwe and other senior Leadership Team members at CIDRZ

CIDRZ has awarded 40 members of staff for their outstanding contribution towards the organisation’s goals and objectives.

The  awardees,  27 from Lusaka and 13 from Southern, Eastern and Western provinces were recognized in five categories namely; Most Hardworking, Most Cost Efficient, Most Innovative, Most Outstanding and Most Improved Employee.

CIDRZ CEO Dr Izukanji Sikazwe said “we have  partnered with different stakeholders in carrying out our work and among them are community volunteers who have been instrumental in ensuring that we meet our goals. At the national level, we have worked closely with government and notably so has been during the launch of the Lusaka Surge campaign by President Edgar Chagwa Lungu. The campaign is the drive by the Ministry of Health towards the 90:90:90 targets for Lusaka District. What this means for us as CIDRZ is to continue working hard as we have always done to ensure that we contribute effectively towards the campaign.”

CIDRZ staff during this years Labour Day celebrations

Dr Sikazwe said it was gratifying to note how CIDRZ work is being recognized by the different stakeholders at various levels and urged all CIDRZ departments to complement each other to ensure that set targets are met and delivered according to partners’ expectations.

And CIDRZ Board member Charles Mpundu said, “on behalf of the Board, I wish to salute all CIDRZ members of staff and congratulate you on the achievements. The Board therefore, urges you to use the milestones as a foundation to further transform the organisation. We have seen how seen the credibility of CIDRZ has continued to grow and the impact has been felt within the communities we serve. In all this, we realise that employees are an important tenant of any organisation and therefore, continue developing positive attitudes towards work”.

CIDRZ Deputy CEO, Emmanuel Qua-Enoo joined our Southern Province team in commemorating this years Labour Day Celebrations

And in Mazabuka, CIDRZ Deputy CEO Emmanuel Qua Enoo  commended staff for their effort during the transition of  CIDRZ activities to two new districts of Monze and Pemba and pointed out that “as challenging  the transition might have been, allow me to commend you for the robust implementation of key activities such as weekend Anti Retroviral Therapy (ART) services, ART-OPD integration and Index Testing and Partner Notification in the two districts”.

CIDRZ donates 31 fridges to Lusaka Province health facilities

Storage of drugs in a fridge that does not function efficiently in a clinic can be a challenge. It is for this reason that CIDRZ, with support from the U.S. President’s Emergency Plan For AIDS Relief (PEPFAR) and its partnership with the U.S. Centers for Disease Control and Prevention (CDC) donated 31 fridges to selected ART pharmacies in Lusaka province .

Dr Consity Mwale, Lusaka Province Medical Director

Lusaka Provincial Medical Director Dr Consity Mwale said

“this donation has come at the right time when we have been working on our budgets to find resources to buy fridges for our health facilities. It will help reduce costs and improve on drug potency for paediatric formulations. As you maybe aware, the province is implementing the Lusaka Surge Campaign that was launched in December 2017 by President Edgar Chagwa Lungu and its important that drugs are stored properly if we are to meet targets for the campaigns”.

 

“Thank you to CIDRZ for your continued support to government as we know that this donation is not the only support you have rendered. CIDRZ has also been instrument in building capacities of our health providers in all health facilities you are carrying out your work and that is commendable”.

Ng’ombe Sister-In-Charge

Ng’ombe and Garden clinics are among the health facilities to have benefited from the donation. The Sister-In-Charge at Ng’ombe Clinic Mrs. Banda said

“the coming of the fridge will not only be beneficial to ART patients but even other patients whose drugs need to be stored in the fridge like diabetes patients. The community at large will greatly benefit because this facility is for the community”.

Meanwhile, Garden Clinic Sister-In-Charge Mrs. Sikazwe said she had a challenge of mixing other drugs in one fridge before the new fridge came along, thanks to CIDRZ for coming to their aid.

CIDRZ enrolls 14,376 patients on Health Post, FastTrack DSD models for ART dispensation

Drugs being transport from Matero Referral Hospital to Chimwemwe Health Post

With the scale up of Antiretroviral therapy (ART), most district health facilities in Zambia began experiencing increased congestion. Patients face significant challenges to retention including transportation costs, time away from work, long clinic waiting times, and competing life priorities with greater need to develop strategies to cater for the different needs and situations of ART patients.

In July 2017, CIDRZ through its Pharmaceutical Services Department with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partnership of U.S Centers for Disease Control and Prevention (CDC) developed differentiated service delivery models (DSD) of care among others, namely Health Post and Fast Track (Static) for ART dispensation.

The models which are in line with WHO and 2016 Ministry of Health (MoH) ‘Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection are being implemented in 16 main facilities ,21 Health posts and 7 static sites with a total of 14, 376 patients enrolled between October 2017 and February 2018.

Sr Masupa Chimwemwe Health Post

The objectives of the models are to decongest main facilities by aligning bi-annual medicine refills with clinical visits, reduce the cost and distance a patient is required to travel to pick up drugs and reduce pharmacy waiting time for patients at the facility. The models target stable patients with CD4 >=200/µl and viral load suppression of <1000 copies/ml.

Three months’ supply of drugs for patients on the Health Post model are delivered weekly to health posts closer to their homes to ensure a steady and uninterrupted supply of drugs. Drugs for patients on the Fast Track model are delivered to a separate dispensing location within the facility where stable patients pick up their three months’ supply of drugs.

Matero Reference clinic is among the facilities where the two models have been highly accepted by both patients and the facility staff. Enrollment at the health facility started on 26th October 2017 and to date 6,014 stable patients have been enrolled into both Health Post and Fast Track Models.

Grace Pumulo collecting her drugs from CIDRZ Treatment Supporter, Sabrina at Chimwemwe Health Post

Grace Pumulo, a beneficiary of the Fast Track model is elated with the model;

 “I have been on ART since 2007.In all these years before enrolment on the model, I spent long hours queuing up to receive ART services such as clinician appointments, laboratory tests and even getting drugs. With this model, I just walk in here and within a short time, I am attended to and go back home to do other things”.

Pharmacy Technologist at Matero Reference Clinic, Tinda Mbewe shared her experience;

“Before the introduction of the DSD program, we used to attend to 300 stable and unstable patients in a day. With two pharmacists working on that number of patients’ files and dispensing drugs, one would only imagine the amount of stress that comes with it. However, after the introduction of Fast Track, there is reduced workload as we only see 100 patients a day”.

Sabrina Sakala, a Treatment Supporter at Matero Reference clinic said;

“Matero Ref alone has enrolled 6,014 stable patients on Fast Track. On average, we attend to 150 patients per day with each patient spending about 10 minutes. What this means for the client is that they spend less time here at the facility and are able to go back to attend to their daily activities. Some patients say that the model guarantees them more confidentiality as they do not have to queue up just to receive their drugs.”

Sr Masupa Chimwemwe Health Post

Another Treatment Supporter, Estella Ngowani had this to say;

“What we are now experiencing are overwhelming requests from patients once we go to the main pharmacy at Matero to sensitize them about the program. This simply shows that patients have understood the aims differentiated service delivery models want to achieve”.

Helen Bwalya Mulenga, Head of Pharmacy at CIDRZ explains;

 “I am excited to lead and drive the team in the implementation of Differentiated Service Delivery for ART, these models will provide improved patient adherence and retention and enable us to positively contribute to decongesting ART clinics, reducing patient wait times and reducing patient costs by offering them an opportunity to collect drugs near their homes”.

CIDRZ shares research results at first 2018 MoH Scientific Research Meeting

Research in any country is vital especially in finding lasting solutions to health needs and more so is it more effective if its done in close partnership with the government and the communities as addressing health challenges becomes much easier and faster.

Through continued generous support from funders such as the United States (U.S) National Institutes of Health (NIH), Division of AIDS (DAIDS), Centers for Disease Control and Prevention (CDC), and other partners that include Bill & Melinda Gates Foundation, Aeras, TB REACH, Global Alliance for TB Drug Development; CIDRZ has been conducting locally relevant research aimed at improving the quality of health care in Zambia.

By working in close collaboration the Zambian Ministry of Health, CIDRZ aims to be a permanent resource to the government by answering locally relevant health questions using latest methodologies to generate high quality evidence to inform policy.

It in this regard that CIDRZ participates in the National Health Research Authority (NHRA) organized scientific research meetings, a national platform for dissemination of research information and research results.

The first 2018 scientific meeting was held at the UTH Paediatric Center of Excellence where CIDRZ shared research results from three projects namely:

  • A Rapid Qualitative Assessment Before, During and After the 2nd-dose OCV Campaign in Bauleni, Chawama and Kanyama compounds in Lusaka;
  • Costing and Cost Effectiveness Analysis of the Oral Cholera Vaccine (OCV) Campaign in Lusaka, Zambia in 2016, and
  • Recounting the numbers: Policy proposal to Reinforce Routine HIV Testing and Treatment among children in Zambia

 “There is need for all stakeholders involved in research to support research work if we are to improve the quality of health care in Zambia. We as CIDRZ look forward to listening to research work being done by other researchers as this meeting provides a platform to learn from each other,” CIDRZ CEO Dr Izukanji Sikazwe said.

Dr Sikazwe further added “The presentations CIDRZ is making today on cholera is driven by past outbreaks and through support from donors, we are looking at possibilities of how future outbreaks could be averted. One particular such study CIDRZ is carrying out is a cholera vaccine trial in the Lukanga Swamps. Another presentation will look at HIV in children and how to improve HIV interventions among children”.

Dr Anjali Sharma presented research findings on A rapid qualitative assessment before, during and after
the second-dose OCV campaign in Bauleni, Chawama and Kanyama compounds in Lusaka, a project that was aimed at  understanding community and healthcare worker perspectives and experience regarding both the reactive and preemptive OCV campaigns.

Taniya Tembo, presented on Costing Cholera Illness, Vaccine Delivery and Vaccination Campaigns in Zambia while Dr Mwanza Wa Mwanza presented on Routine HIV Testing and Treatment for Children and how the intervention can increase testing update for children.

 

CIDRZ screens 741, Initiates 15 on TB treatment during TB week in George Compound

CIDRZ staff screening at during the community drive campaign

CIDRZ with support from the Stop TB Partnerships/TB REACH and working with the Ministry of Health through the Lusaka District Health screened patients for TB treatment during the TB week.

With current statistics indicating that Zambia ranks 7th among 30 highest tuberculosis (TB) burden countries in the world, a lot of effort needs to be channeled towards ending the spread of TB.

As the world commemorated World TB Day this year, under the theme; Wanted: Leaders for a TB-Free World. You can make history. End TB, CIDRZ celebrated this year’s event with a TB screening drive in Lusaka’s George compound where close to 300 people were screened for TB as well as tested for HIV on a daily basis.

Matero Sub District TB Coordinator, Mercy Mwale said “in 2017, of 1693 patients on TB treatment,1451 are male and 242 female and from our observations men are at high risk of TB due to poor diet and excessive alcohol intake”.

Matero Sub District TB Coordinator Mercy Mwale during the commemoration

“CIDRZ has supported us with a mobile X- Ray machine and an X-pert machine, resulting in quick turnaround time for results of all TB tests we conduct and detection of 10 MDR (Multi Drug Resistant) TB cases. This has elated the community going by the demand for TB screening services. Through TB drives such as this one, we are able to reach out to as many as 300 people in a day and this is all through CIDRZ support”.

Catherine Nalumbwe, a former TB patient shared her experience, “through the TB services offered by CIDRZ, I was quickly linked to care after being screened and found with TB. Throughout the six months I was on medication, I received support from the health care providers and today I stand before you to tell you that early TB detection saves lives. I wish to thank Stop TB Partnership and TB REACH because without their support, a lot of lives could have been lost to TB”.

Ag Lusaka District Health Director, Dr. Khozya Zyambo

And acting Lusaka District Health Director Kozya Zyambo says “all stakeholders need to come on board and participate towards ending TB. The community needs to be informed about the symptoms of TB and engage with health facilities to access treatment. Early detection and screening is the surest way to prevent TB.”

CIDRZ Director of TB Programmes, Dr Monde Muyoyeta emphasized the importance of community involvement in the fight against TB.

Dr. Monde Muyoyeta, CIDRZ Director of TB Programmes

“Without the collaboration of the Community Volunteers, this work would not have been possible. Working with them and equipping them with knowledge about TB has resulted in increased case detection. We need to continue sensitizing people and encouraging them to screen for TB. Lastly I wish to thank our funders Stop TB Partnership/ TB REACH for their continued support in this drive to end TB”