Using Innovative means to combat HIV in Zambia

Motivational Interviewing training participants during the training in Lusaka

For over a decade, the Centre for Infectious Disease Research in Zambia (CIDRZ) has implemented HIV prevention and treatment programmes in clinics and within the communities to fight the epidemic among the general population in Zambia.

However, recent statistics show a sharp rise in new HIV infections among the adolescent population in sub-Saharan Africa. In view of this, new and innovative interventions are required to reach this population with HIV control programmes.

Responding to the challenge

With support from the University of Alabama at Birmingham Sparkman Center for Global Health, CIDRZ has introduced a new and innovative counselling technique, Motivational Interviewing, which is direct and client centred to elicit behaviour change by helping clients to explore and resolve ambivalence.

“This counselling style has been successfully used in improving adolescent behaviour in HIV programming and research. We want to enhance counselling techniques by using Motivational Interviewing for adolescents in order to improve adherence to HIV treatment,” says CIDRZ Social Behavioural Research Fellow, Jenala Chipungu.

This three-day training attracted a cohort of 50 people, drawn from clinics within Lusaka were trained in MI by a team of experts from the Behaviour Change Consulting: Dr. Sylvie Naar King and Mr. Maurice Bulls.

“The aim is to build capacity among health practitioners and technical experts in MI,” says Jenala.

Dr King and Mr Bulls during the rock interview on Motivational Interviews

Dr. King is a member of the Motivational Interviewing Network of Trainers (MINT) and has provided training locally, nationally, and internationally.

Motivational Interviewing has been demonstrated to be effective at all points of the youth HIV cascade and involves a:

  • a collaborative, goal-oriented method of communication for strengthening a person’s own (intrinsic) motivation for change
  • a systematic way of organizing a conversation to promote motivation and behavior change

Working with Communities to Promote Male Circumcision

Our close ties with the traditional leaders and communities is the bedrock of our success

CIDRZ Community team: Senior Community Advisor, Mr. Fresher Maphiri; Male Circumcision Coordinator, Bright Jere, and Western Province Community Implementation Officer, David Sitali are in Western province for community sensitization programmes on medical male circumcision.

“We want to engage stakeholders, particularly the Mongu District Commissioner, the Town clerk, the King of Barotseland – Litunga – through the KUTA and other traditional leaders in our catchment facilities on the need for male circumcision as a high impact intervention against the transmission of HIV/AIDS”, said Mr Jere.

“Our particular area of discussion is the concern on low male involvements Elimination of Mother to Child Transmission of HIV as well as low uptake of Voluntary Medical Male Circumcision (VMMC) in non-traditional circumcision seasons in the province.

We want to solicit support to drive these programmes to their successful completion,” Mr Jere added.

 

Mango Dc pledged support to interventions aimed at EMTCT and increasing the uptake of VMMC

Meanwhile, Mongu DC has pledged full support to these interventions and is particularly excited with the work CIDRZ is doing in the province.

He, however, emphasised the need for closer collaboration, coordination and pulling of limited available resources from all stakeholders to effectively and efficiently achieve program objectives.

Studies show that VMMC provides men with up to 60% protection against getting HIV from infected female sexual partners. Other health benefits include decreased risk of penis cancer, and reduced risk of infecting female sexual partners with the human papilloma virus (HPV) – the cause of cancer of the cervix.

The WHO recommends Voluntary Medical Male Circumcision (VMMC) as a long-term HIV prevention strategy for countries like Zambia with low circumcision and high HIV-infection rates.

CIDRZ, with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Centers for Disease Control and Prevention (CDC), supports the Zambian Government’s National VMMC programme and provides services or supports circumcision facilities in Western, Southern, Lusaka and Eastern provinces of Zambia through static or mobile sites.

CIDRZ gives insights on Differentiated Service Delivery Models of care at Pharmaceutical Society of Zambia Annual Scientific Conference and General Meeting

Mr Muhau Mubiana, CIDRZ Pharmacist at the PSZ AGM

Health Systems Strengthening remains a critical component of the Centre for Infectious Disease Research in Zambia (CIDRZ), as the organisation continues to supplement the Zambia Government’s effort to provide quality health care services to all Zambians.

With support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and U.S Centers for Disease Control and Prevention (CDC), CIDRZ is among the key supporting partners at this year’s Pharmaceutical Society of Zambia Annual Scientific Conference and General Meeting held under the theme: Strong Pharmaceutical Systems Improving Public Health Outcomes in Livingstone.

The Conference has so far attracted 149 pharmacists, pharmacy technologists, exhibitors and guests from all over Zambia.

In line with the theme, CIDRZ has been working with the Ministry of Health to build capacities and strengthen pharmaceutical systems through staff mentorship, improved drug storage conditions, equipment support as well as implementation of differentiated service delivery models of care to ensure an efficient health service system.

CIDRZ Lusaka Province Pharmacist, Muhau Mubiana made a presentation on the five Differentiated Service Delivery (DSD) models that CIDRZ is implementing to address various challenges that patients encounter, and reduce the burden and strain on the local healthcare system.

Some of the AGM participants following the proceedings

These DSD models are being implemented in 49 health facilities in Lusaka, Western, Eastern and Southern Provinces and these “are Community Adherence Groups (CAGs) with  8,892enrolled patients, Urban Adherence Groups (UAGs) with 2,373 patients, Health Post/Fast track Dispensations models with 23,073 patients, Scholars’ Model  targeted at young patients aged 10-14 years has enrolled 349 patients and the Multi Month scripts model for patients receiving more than three month drug dispensations”, Mr Muhau said.

He added that there was need for a paradigm shift, where all stakeholders involved in the continuum of care especially pharmacy personnel, took ownership of public health activities and worked as a team to provide quality health services.

The Pharmaceutical Scientific Research Conference enables dissemination of current, original pharmaceutical research and practice that introduces new ideas, concepts and understanding of:

  • Pharmaceutical Technology and Innovation
  • Disease Prevention and Health Promotion
  • Rational Use of Medicines
  • Pharmaceutical Supply Chains
  • Pharmaceutical Practice and Policy

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

Zambia STEPS Survey 2017: A Surveillance of Noncommunicable Disease Risk Factors

Centre for Infectious Disease Research in Zambia (CIDRZ) continues to be an actively collaborating partner for Zambia’s Ministry of Health (MOH). Besides serving on various technical working groups, mentorship and fostering strong relationships with healthcare staff to leading-edge implementation science, qualitative research, clinical trials, health systems strengthening and capacity-building; CIDRZ has been a key partner on some of the research work that has generated high-quality evidence to inform policy aimed at strengthening local and international healthcare.

Notably so, CIDRZ collaborated with MOH, to conduct a STEPS survey of Non-Communicable Disease (NCD) risk factors in Zambia. This study was conducted from July to September 2017.

STEPS is a system for surveillance of NCD risk factors designed for implementation in low and middle income countries. It is used to gather information on risk factors to help plan programmes and interventions, collect standardized risk factor data to enable comparisons, provide an entry point for low and middle income countries to get started on NCD surveillance and build capacity in countries.

The Principal Investigator (PI) for the study was Dr Wilbroad Mutale from the University of Zambia (UNZA) while CIDRZ Chief Scientific Officer, Dr Roma Chilengi was a Co-PI of this population based survey, which target 4,302 adults aged 18 – 69.

Three steps were used in the survey to assess the different levels of risk factor:

Step One: collecting the socio-demographic and behavior information such as tobacco use, harmful alcohol consumption, unhealthy diet (low fruit and vegetable consumption and high salt intake) and physical inactivity.

Step Two: collecting physical measurements such as height, weight and blood pressure, and

Step Three: collecting biomedical measurements to assess blood glucose and cholesterol levels under.

Study results show that “currently 12.3% adults smoke tobacco, 27.7% consume alcohol, 34.7% not engaged in vigorous activity and 21% of women aged 30 to 49 years have screened for cervical cancer”.

The survey found that 24% adults were obese, 19% reporting prevalence of raised blood pressure and only 7.2% reporting having visited a dentist in 12 months.

The survey recommends among other things:

  • an increase of excise taxes and prices on tobacco products,
  • consistence of the Policy on alcohol with a commitment to general increase excise taxes on alcoholic beverages in Zambia and
  • the introduction and enforcement of laws to control salt amounts in food products being sold to the public.

In addition, the survey recommends wide public education and awareness for physical activity which supports physical activity champions targeted at encouraging women to increase physical exercises, cervical cancer awareness and community based awareness programmes, quick enactment of the Mental Health Bill to provide a legal framework for mental health interventions.

A repeat of the survey is planned to be conducted in 2022.

Read here for study design and results

CIDRZ  trains private Pharmacy Personnel on HIV Management and Differentiated Service Delivery

CIDRZ Pharmacist, Mubiana Muhau during the training

Health care system must support the planned increase of ART clients, due to the rising number of HIV patients in the community. This calls for collaboration among all stakeholders involved in the management of HIV cases.

With on-going support from the United States President’s Relief (PEPFAR), and Centre for Disease Control and Prevention (CDC), CIDRZ  in collaboration with the Ministry of Health conducted a 2 day training workshop for private pharmacy personnel on HIV management with  focus on patients enrolled on the Differentiated Service Delivery (DSD) model. The workshop was aimed at imparting pharmacy personnel with knowledge on how to handle HIV patients referred to their respective pharmacies through the DSD model.

This training was conducted following a series of consultative meetings with the DSD National Task Force and  private pharmacy owners.

The training, a first of its kind for CIDRZ was targeted at private pharmacies that are  fully registered with Zambia Medicines Regulatory Authority (ZAMRA), a statutory national medicines regulatory body for Zambia established under an Act of Parliament, the Medicines and Allied Substances Act No. 3 of 2013 of the Laws of Zambia. The Pharmacy’s involved in the training will be required to sign a Memorandum of Understanding and adhere to Ministry of Health (MOH) regulations.

Dr. Shula a clinical care representative from MOH said “CIDRZ has been an all-weather partner and I want to say thank you very much for facilitating such. I know we may not be in this meeting throughout, but we are very happy for the togetherness as we continue combating AIDS”.

Some of the training participants following the proceedings of the training

Meanwhile, Mulenga Ezra a Pharmacy Technologist from BERTY Pharmacy in Kabwata said “ I am grateful to CIDRZ for giving me this opportunity to attend this training. I feel my work will now be made simple when it comes to drug delivery. This will reduce the cost and distance a patient is required to travel to pick up drugs, and patients with competing work schedule can easily access their drugs at a convenient time and place of their choice”.

 

 

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.

PEPFAR/CDC awards CIDRZ USD25m “Lab Innovation for Excellence (LIFE)” Grant

We are proud to announce that following a highly competitive process, CIDRZ emerged successful and was recently awarded a new co-operative agreement to implement the “Scaling Up Lab Services for Viral Load and Early Infant Diagnosis Testing to Meet the 90/90/90 Goals” project otherwise known as Lab Innovation for Excellence (LIFE).

It is a great honor for our organization that the United States Government, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and Centers for Disease Control and Prevention (CDC), has once again called on CIDRZ. Our selection demonstrates the central importance of CIDRZ within the health landscape in Zambia, and that we are considered a trusted and capable partner by all stakeholders.

LIFE is a USD 25 million five-year project that aims at improving lab hubs in four provinces – Eastern, Lusaka, Southern and Western Provinces. This grant will enable CIDRZ to further strengthen our model partnership with the Ministry of Health through which we work to build a strong and sustainable health system for the delivery of quality healthcare to Zambians and control of the HIV epidemic.

This project will work in the third 90: monitoring of clients on anti-retroviral therapy and this will be scaled up to ensure clients’ needs are met.

LIFE will work towards strengthening the health systems by:

  • improving sample courier networks
  • providing equipment and personnel
  • improving quality management systems and
  • providing stable power (green energy among them) at pre-analytical level
  • improving data flow from facility, to testing

We have received this grant due to the excellence of the CIDRZ Central Laboratory team which has made us competitive. Dr Ranjit Warrier is the Principal Investigator for this project

 

Dr Izukanji Sikazwe

CEO and Director