Integrate TB Screening, HIV testing, Antenatal Care Services: CIDRZ Study

Lusaka CIDRZ District Clinical Mentor – TB, Dora Luhanga, presenting on the study findings during the NHRA Research meeting at UTH, Lusaka, Zambia

The Centre for Infectious Disease Research in Zambia (CIDRZ) continues to be an important partner to the Ministry of Health in answering key health questions and providing evidence for decision making processes, aimed at addressing health problems for the Zambian people.

Notably so, CIDRZ in collaboration with the National Health Research Authority (NHRA) presented findings of a study on “TB Screening in Antenatal Clinics in Lusaka District” at the Quarterly Research Scientific Meeting held at the University Teaching Hospital (UTH) Paediatric Centre of Excellence.

With support from U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Center for Disease Control and Prevention (CDC), CIDRZ conducted the study from 2012 to 2013 in three Lusaka District health facilities of Chipata, Kanyama and Chawama to assess the feasibility of a routine TB symptom screening and TB sample collection as well as determining the prevalence of TB among HIV positive and negative women.

CIDRZ District Clinical Mentor – TB, Dora Luhanga (then Study Coordinator) said the study participants were pregnant women aged 18 and above who were attending antenatal clinic (ANC) for the first time.

Ms. Luhanga said “in presumptive TB cases with valid culture results, we found a prevalence of 1.50 % among HIV-positive women, 1.45 % among symptomatic HIV- negative women and in all pregnant women screened TB prevalence was 0.34%.”

Dora said the study revealed that integrating TB screening into antenatal services was feasible and acceptable going by the high rates of TB screening achieved through integration in existing PMTCT pre-test counseling sessions.

In conclusion, the study recommended that:

  • Symptom screening alone was not adequate for TB screening tool in pregnant women.
  • Pregnant women should routinely have access to more sensitive TB diagnostic & point-of-care tools to increase case detection and reduce delays in treatment initiation and loss to follow up.
  • Consideration be made to integrating routine TB screening, alongside HIV testing, into antenatal care services with strong linkages to care and treatment for those who test positive and Isonized Preventive Therapy (IPT) for those that test negative be included.
  • IPT for those that test negative could also be part of the package

The meeting provides a platform for dissemination of research information and research results which are analysed for knowledge translation, based on policy and programs relevance.

 

 

 

CIDRZ sharing shares experiences in DSD models implementation

Dr Preko during his visit Chilenje First Level Hospital

“CIDRZ is doing great and happy that CAGs are being given three month drug refills which addresses sustainability questions of these social structures among group members as well as guaranteeing drug availability”

The HIV Coverage, Quality, and Impact Network (CQUIN) Director, Dr Peter Preko said this during a tour of Chilenje Level 1 Hospital where CIDRZ is implementing two differentiated service delivery models(DSD) namely Community adherence Groups(CAG) and Fast Tract  for stable HIV patients.

Dr Preko and his team visited the health facility to draw lessons from CIDRZ on the CAG model.

CIDRZ has been implementing the CAG model since April 2015 with 288 groups formed targeting 1728 patients as a strategy to help decongest health facilities, improve service delivery and patient retention to care.

CQUIN was on a multi-country learning network dedicated to improving differentiated service delivery (DSD) for people living with HIV. The network convenes health system leaders from countries in sub-Saharan Africa to participate in joint learning and information exchange, with the goal of fostering scale-up and spread of high-quality differentiated services.

Message from the CEO – June 2018

Welcome to the first edition of the CIDRZ newsletter 2018

CIDRZ is the largest independent, non-profit healthcare research organisations in Zambia established in 2001. We have been working closely with the Government of the Republic of Zambia through the Ministry of Health and other line ministries and supporting Government’s efforts to provide high quality, complementary, and integrated healthcare services within the public health system.

In line with our mission – to improve access to quality healthcare in Zambia through innovative capacity development, exceptional implementation science and research, and impactful and sustainable public health programmes– we have been providing HIV prevention, care and treatment support to 585 health facilities in 30 districts of the four provinces we operate from i.e. Lusaka, Eastern, Western and Southern provinces.

We started the is Financial Year 2018 on high note:

  • the launch of the Lusaka Surge “Tiyende Pamodzi” Campaign on 11thDecember, 2017 by Republican President Edgar Lungu, meant we needed to align our activities to contribute to this strategy by the Ministry of Health and United States President’s Emergency Plan for AIDS Relief (PEPFAR) in Zambia to achieve HIV epidemic control in Lusaka Province over a 12 months’ period.
  • We rolled out E-First in some of our supported sites to improve patient data management. This means that we are slowly doing away with paper based filing. We are still learning lessons from this process but indicative results show that the system is working well.
  • In a bid to identify and put more people on treatment and care, we introduced Index Testing and Partner Notification. Through this strategy, we hope to break the chain of HIV transmission by offering HIV testing services to persons who have been exposed to HIV and link them to HIV treatment, if tested positive, or prevention services if negative.
  • We have also introduced differentiated service delivery models for our clients who are on ART. We believe this will address the challenges we have had with adherence to treatment and retention to care.

You will read about all these issues in this edition, including the impact of our work: both at the national and international levels, and how this is transforming the lives of communities we are supporting.

With this, our newsletter provides an insight of how we have collaborated with our donors, key partners and other stakeholders to provide quality health care services to the Zambian people and I hope that you find it an interesting read.

 

Thank you,

Izukanji Sikazwe, MBChB, MPH

Director and CEO

Exploring the Acceptability and Consumer Demand for Sanitation Products and Services in Lusaka Peri-Urban Areas

Jenala Chipungu making a presentation during the CIDRZ Research meeting

ABOUT half of Zambia’s population rely on basic sanitation services for excreta of human waste. However, 90% of those living in the peri-urban areas of Lusaka rely on unimproved sanitation characterized by poorly built pit latrines that do not safely separate waste from human contact.

CIDRZ with support from UNILEVER and in collaboration with the London School of Hygiene and Tropical Medicine conducted a study to map out  the sanitation landscape with respect to sanitation goods and services and  identify potential niches and business models for sanitation products in Lusaka’s peri-urban compound.

The  study  sought to explore the market for improving domestic latrine quality, emptying services and faecal sludge re-use products along the faecal sludge management chain. The objectives involved understanding perceptions about emptying services, exploring the demand for the service by potential consumers, consumer demand and willingness to pay for toilet pan technology (SATO Pan) and to assess consumer demand for faecal sludge fuel briquettes.

When  presenting the findings of the study during the CIDRZ weekly research meeting, CIDRZ Jenala Chipungu said “50% of participants reported previous latrine filled up, 5% reported current latrines had filled up before and of these 67% were emptied. Due to safety concerns, 41% of participants in George Compound planned to replace their latrines when full as opposed to emptying compared to 20% of participants in Kanyama where they already had existing emptying services”.

On use of SATO toilet pan technology,  the study found that 80% of respondents preferred the stool pan (mainly because it allows one to sit) as compared to 50% in favour of the squat pan. In terms of gender, 83% women  preferred  the stool pan compared to 71% men with participants over 55 years disliking both pans. The majority of participants were willing to pay up to 60 ZMW and 70 ZMW for the stool and squat SATO pans respectively. However, concerns  by participants included skepticism around durability and user unfriendliness especially for the elderly.

Jenala added that though the majority of the participants had heard of faecal sludge briquettes,  “approximately 74% of participants  would not use it even if it was cheaper than charcoal or if the community was using it”. The study revealed that reasons for participants unwillingness to use faecal sludge briquettes were that it was unhygienic, the  burning capacity might not be strong and that the smell would be unpleasant.

The study concluded that given widespread onsite pit latrine usage and relative lack of space in peri-urban areas, pit emptying was inevitable as well as requirement for appropriate pit construction standards for the safe containment of waste and eventual ease of emptying. Furthermore, payment initiatives for those who cannot afford the SATO pans needed to be explored including raising awareness for faecal sludge briquettes  prior to introducing them in the market.

160 Volunteers trained in Index Testing

When the UNAIDS declared the 90-90-90 targets: 90% of people knowing their HIV status, 90% of people with HIV initiated on treatment, and 90% of people achieving viral suppression by 2020, national governments and organisations have come with different strategies towards achieving these targets.

With support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR), U.S. Centers for Disease Control and Prevention (CDC) and the University of Maryland partnership, CIDRZ is implementing index testing and partner notification, a strategy aimed at closing the gap to achieving the first 90%.

As a key partner for the Zambian Ministry of Health, CIDRZ has been supplementing government’s efforts towards attaining these goals through capacity building and health system strengthening activities.

CIDRZ trained 160 volunteers from various health facilities in Lusaka, in communications skills needed to conduct index testing.

During the training, CDC Public Health Specialist, Kennedy Nkwemu said “Index Testing focuses on improving the wellbeing of people living with HIV (PLHIV). The strategy is one of the priorities for PEPFAR in order for Zambia to achieve the 90-90-90 goals. Zambia is doing well with the second 90, but there is need to improve on the first 90, and this is where index testing comes in.”

Mary Mwapa, a Volunteer from Matero clinic said, “The skills and information I have acquired from this training vital and useful to my work. I am Grateful to CIDRZ and its partners for this opportunity.”

Index testing is a voluntary process where counsellors or health care workers ask a newly diagnosed HIV positive individual or an HIV positive individual already accessing HIV treatment to list all of their sexual or injecting drug partners, and children. With consent from the individual who is HIV positive, each listed partner and child is contacted, informed that they have been exposed to HIV, and offered voluntary HIV testing services. Index testing is consensual, confidential, and includes counselling, correct test results and connection to treatment or prevention services.

Emmanuel Appiah Qua-Enoo

Emmanuel Appiah Qua-Enoo, BComm (Hons), MComm (SA&Intl Taxation, CA(SA) Deputy Chief Executive Officer

Mr. Emmanuel Appiah Qua-Enoo is a Chartered Accountant and a registered member of the South African Institute of Chartered Accountants. He holds a Bachelor of Commerce (Hons) Degree from the University of Natal, and a Master’s Degree in International Taxation from the University of Johannesburg, and an alumnus of the United States Venture Capital Institute.

Mr. Qua-Enoo worked at PricewaterhouseCoopers in their Johannesburg Practice where he specialized in Financial Services and Management of Internationally Funded Institutions. He has consulted widely for numerous international donors and their recipients across Africa.  He has worked at USAID’s Office of the Regional Inspector General in Pretoria where he was responsible for the management of all Non-Federal Audits in Eastern and Southern Africa, covering 21 countries. He was also the Chief Financial Officer of the Southern Africa Enterprise Development Fund, a USAID sponsored Private Equity and Venture Capital Fund that invested in Southern Africa.

Michael Herce MD, MPH, MSc

Dr. Michael Herce is the Director of Implementation Science at CIDRZ, an Honorary Lecturer at the University of Zambia, and an Assistant Professor of Medicine in the Division of Infectious Diseases at the University of North Carolina (UNC), USA. As a US-trained infectious disease specialist, Dr. Herce’s work focuses on understanding and ameliorating health inequities in HIV and TB prevention, treatment, and care for key and vulnerable populations in sub-Saharan Africa through patient-oriented and implementation science research. His research and service delivery projects have been funded by the US NIH, UNICEF, USAID, PEPFAR/CDC, and DFID/UKAID. Before joining CIDRZ in 2014, he served as Clinical Director for Partners In Health—Malawi and Chief of Party for TB CARE II. Dr. Herce completed his residency in Global Health Equity and Internal Medicine at Brigham & Women’s Hospital/ Harvard Medical School and his Infectious Disease fellowship training at UNC. He received his MD cum laude from Yale, his MSc in Clinical Research from UNC, and his MPH in Global Health from Harvard.

David Ojok MSc, MPH

David has worked with CIDRZ Central Laboratory for the last four years as Head of Laboratory QA/QC and has been central in establishing, coordinating, and monitoring lab Quality Management Systems (QMS) programmes at the Central Laboratory. He has 15 years’ experience in the operations and QMS of clinical and research laboratories. Before moving to CIDRZ Central laboratory, he worked as Lab Shift Leader at Makerere University and Johns Hopkins University Core Lab (MU-JHU Core Lab) at Makerere University. He has vast experience implementing and monitoring of both College of American Pathologists (CAP) and ISO 15189 QMS. He is a vetted nominated representative for accreditation, ISO 15189 Lab Technical Assessor, and an advisory committee member on the Medical Laboratories Accreditation Programme for SADCAS. He has experience working with Division of AIDS National Institutes of Health (DAIDS/NIH) clinical trial Networks including HIV Vaccine Trials Network (HVTN), International Maternal Paediatric Adolescent AIDS Clinical Trials Network (IMPAACT), PROMISE, Microbicides Trial Network (MTN), and AIDS Clinical Trial Group (ACTG).
He is currently pursuing his PhD studies in International Public Health.

CIDRZ sharing shares experiences in Differentiated Service Delivery models implementation

“CIDRZ is doing great and happy that CAGs are being given three month drug refills which addresses sustainability questions of these social structures among group members as well as guaranteeing drug availability,” says Dr Peter Preko, HIV Coverage, Quality, and Impact Network (CQUIN) Director

Dr. Preko said this during a tour of Chilenje Level 1 Hospital, where CIDRZ is implementing two differentiated service delivery models (DSD) namely Community Adherence Groups (CAG) and FastTrack  for stable HIV patients.

Dr. Preko and his team visited the health facility from Swaziland to draw lessons from CIDRZ on the CAG model.

CIDRZ has been implementing the CAG model since April 2015 with 288 groups formed targeting 1728 patients as a strategy to help decongest health facilities, improve service delivery and patient retention to care.

CQUIN is a multi-country learning network dedicated to improving differentiated service delivery (DSD) for people living with HIV. The network convenes health system leaders from countries in sub-Saharan Africa to participate in joint learning and information exchange, with the goal of fostering scale-up and spread of high-quality differentiated services.

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.