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.”

President Lungu Launches one year ‘Tiyende Pamodzi’ Campaign: reaching out to Everyone with HIV Information and treatment

CIDRZ staff participating in the World AIDS Day commemoration activities today

President Edgar Lungu today, 11 December 32017, launched the Lusaka Anti Retroviral Therapy Saturation Surge Campaign. He launched the campaign during the commemoration of the World AIDS Day celebrations, whose theme is Ënding AIDS Starts with ME!”.

President Lungu during the launch of the campaign at Nkoloma Stadium in Lusaka today

 “This is the first ever surge campaign in Africa and I would urge everyone to support this campaign by getting tested now. If you are found negative, live responsibly and if found positive start treatment now immediately,” President Lungu said.

In his launch speech, President Lungu said “the commemoration of World AIDS Day this year coincides with the launch of the Lusaka Ant-retroviral Therapy Surge Campaign dubbed ‘Tiyende Pamodzi’’ . This campaign is aimed at Achieving HIV epidemic control, within one year, in Lusaka which currently carries 25 percent of the national HIV burden.”

President Lungu said, though Zambia has witnessed the decline of HIV cases, more work need to be done to sustain the gains achieved so far.

What is Lusaka ART Saturation Surge campaign?

How are we fairing on 90:90:90 strategy in Lusaka

Lusaka ART Saturation Surge Campaign is a strategy by the Ministry of Health and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in Zambia to achieve HIV epidemic control in Lusaka Province over 12 months, whereby 90% of People Living with HIV(PLHIV) 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 nationwide 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.

CIDRZ, being the main GRZ partner in Lusaka will take a lead in ensuring that the objects, 90:90:90 are reached for Lusaka.

 

CIDRZ is ready for the challenge

The Surge Strategies

The campaign will implement strategies such as increasing targeted case identification through index testing of family and other sexual partners (Partner Notification Services), different linkage strategies tailored for health facilities and communities, Implement the WHO recommendation to retest for verification HIV positive individuals prior to ART initiation and HIV self-testing to reach adolescents, men, and key populations.

Another strategy will be to increase physical infrastructure and staffing to provide ART for increased number of patients by procuring and erecting pre-fabricated structures and hiring additional staff at selected clinics. Convert selected health posts to ART sites by providing the required staff, ARVs and other health commodities, equipment and furniture for service delivery.

Expanding Differentiated Service Delivery (DSD) is another strategy that will be used to better serve the needs of patients on ART and reduce the workload of healthcare workers. This will be achieved through transfer of all stable patients into DSD programs to reduce the time and effort that they need to spend to receive care and treatment, which in turn should improve retention. Provide multiple months prescriptions of ARVs and 6-monthly clinical consultations for all stable patients in Lusaka to reduce the number of clinic visits.

In order to achieve the 3rd 90, viral load testing will be increased to assure that there is capacity to determine the viral load for all patients on ART. Lusaka Province, currently has three viral load testing labs namely the University Teaching Hospital, Pediatric Center of Excellence, and CIDRZ Central Lab with a collective capacity to process 100,000 viral load tests annually.

Lastly, the storage space for ARVs at the district and site levels will be increased to assure adequate supply for the increased number of patients and multiple months prescription, carefully forecast the supply needs at the site level and inform central medical stores to ensure timely drug distribution and ensure adequate supplies of HIV test kits, ARVs, EDTA test tubes, and viral load consumables at all times.

Dr Kenneth Kaunda being honoured by President Lungu for his support to end HIV in Zambia

… and First Repoublican President, Dr Kenneth Kaunda was honoured by President Lungu for his efforts in fighting HIV in Zambia. President Kaunda will be one of the Ambassadors for the campaign. Others include Innocent Kalaluka a.k.a Smooth IK; award winning musician, B’Flow; and Keembe Member of Parliament, Hon. Princess Kasune Zulu.

CIDRZ Joins Zambia Correctional Service to commemorate World AIDS Day

ZCS Commissioner General, Percy Chato

“As we celebrate this day and in an effort of not leaving inmates behind by 2030, the following statistics are worth noting though not conclusive, 2451 inmates are on antiretroviral therapy, 166 inmates are on TB treatment and 90% reduction in morbidity. We thank our cooperating partners such as CIDRZ for supporting this event and call upon all cooperating partners to continue with this collaboration if we are to end HIV/AIDS by 2030 without leaving the correctional community behind,” said Zambia Correctional Service (ZCS) Commissioner General Percy Chato.

This was during the ZCS commemoration of World AIDS Day at the Lusaka Central Correctional Facility.

“I wish to thank partners such as CIDRZ and those not mentioned here for supporting this event. our casual observation is that there is a decrease of HIV/AIDS among inmates and staff. However, we cannot rely on observations only. Therefore there is need for another scientific survey to determine the current prevalence rate in prisons as data from the 2013 survey could have been overtaken by time. We call upon all cooperating partners to conduct a survey in correctional facilities to depict a true picture of what is happening on the ground.”

Since its inception in 2001, CIDRZ has implemented 6 different projects in correctional facilities in partnership with the Government of the Republic of Zambia. These include:

  1. TB REACH 1 that was an implementations science programme that had both research and provision of TB/HIV interventions;
  2. Zambia Prisons Health Systems Strengthening (ZaPHSS) project whose goal was developing and building capacity of the prison health system that is able to plan, manage and implement improved health services in Zambian correctional facilities; This was with support from the European Union
  3. Placement of equipment such as GeneXpert and refurbishment of Mazabuka prisons health facility under the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and Centers for Disease Control CDC supported under the HIV Integration into Local Ownership (HILO) project;
  4. Treatment as Prevention (TasP);
  5. CONTINUUM study and
  6. The US government support Achieving HIV Epidemic Control (ACHIEVE) which is a five year project support by PEPFAR through the CDC partnership.

CIDRZ provided support for sustained TB diagnosis through support of back-up lab supplies, support of X-ray services and on-going training and mentorship of prison health centres.

Some inmates during the march past to commemorate the day

CIDRZ Project Manager, Clement Moonga said “we value our relationship with ZCS and together we have been able to raise the standard of health care, particularly for HIV and TB, for inmates in Zambia. As a major technical partner to ZCS under projects such as TB REACH and the Zambia Prisons Health Systems Strengthening (ZaPHSS), we have been able to jointly establish policies and systems to improve access to healthcare in correctional facilities and structures for communication, coordination, and planning”.

Breaking the taboo surrounding menstrual hygiene management in schools, a case of David Kaunda Technical School in Lusaka

Mapalo. M. Chungu getting instructions from the Matron at David Kaunda National Technical School, Mrs Ikowa Ida

Mapalo Chungu, a 14-year-old grade 9 pupil from David Kaunda Secondary School, was gripped with fears of menstruation when she first attended boarding school. There was basic knowledge of maintaining good menstrual hygiene practices at the school, and this always sent chills in her.

However, having the confidence to attend school all the time can make the difference between succeeding and dropping out for many adolescent girls. Thus, CIDRZ came up with a Menstrual Hygiene Management course and toolkit for teachers which is being used to educate pupils, both boys and girls.

While some people treated this opportunity with derision and opted out, curiosity got the better of Mapalo and she decided to attend. Today, she is an inspiration to many at her school.

MHM Crisis due to Lack of Knowledge

Mapalo confessed that at first, she was not comfortable going to school during her menstrual period days. Though she attended class despite the distress, many girls who lack knowledge of how to manage their menstruation are reported with recurrent absenteeism in school every month which subsequently affects their studies.

For, they would not even take part in extra-curricular activities, stay away from the playgrounds and never take part in outdoor activities during their menstrual days due to the possible embarrassment and the pain it brings.

The school matron in charge of the sick bay, Ms. Ikowa Ida, says,

“Previously, when the girls would stain themselves the boys would laugh at them. I used to find sanitary pads in the shower, on the soap racks, sometimes they would try to flush them down the toilets. It used to block somewhere then open on the other side of the fence. As a result, there would be infections that came because someone could not change the pad or dispose it in the right way.”

This poor sanitary condition contributed to dysentery, at some point in time, at David Kaunda National Technical School in Lusaka.

Introduction of MHM Toolkit brings revival

During the training, the facilitator taught on what menstruation is, the different cycles, what you use when you are undergoing this process and most important part of all was breaking the silent taboo of discussing the topic between boys and girls.

Mapalo M. Chungu demonstrating what she had learnt through the training

Mapalo recalls,

“They taught us how to be more open and free about the topic without having any feeling of regret, doubt or fear. I shared the information with my roommates and they were like, ‘Ah! The boys didn’t laugh and start making jokes when you were done?’ When I reassured them that was not the case, the next day I came with one, the next day another one, then the last day everyone came. They also appreciated the programme.”

Matron Ikowa also recalls,

“What we found very interesting and what was not there before is the involvement of boys. We found the teaching useful for everyone! The boys said they were going to help their sisters at home. The MHM toolkit has helped keep our environment clean. It has helped the first-time girls be aware of what is happening to them. The course has helped the big girls manage their menstrual cycle whether they have light or heavy flows. Apart from that, it has helped us know that when girls are on their menstrual they should not just rely on the sanitary pads that they buy in the shops. That they can also improvise using the washable pads that they were taught to make and use.”

The girls were also advised on precautionary measures to take the pain away such as taking warm water and painkillers that came along with the MHM toolkit supplies.

“I realised that there are people in boarding in similar situations who also go through menstruation and still manage to have a normal life. It shouldn’t be something that drags you down or affects other school programs. It prepares me for adult life and some other intense circumstances,” says Mapalo.

At the hostels, there has been a lot of change. There has been an improvement in the disposal of sanitary pads and general hygiene. Now the girls change their pads regularly and infections have reduced.

Preparing for a Hygienic Generation

Matron Ikowa says,

“I now freely talk about menstrual hygiene management regardless of who is there. I would recommend that it should be implemented in the school curriculum so that the children can grow up with it and the next generation can be better than ours.”

Today, Mapalo serves as an example to rest of the students. They started taking interest in maintaining the sanitary blocks and making the students aware of the best hygiene practices.

Dr Craig Wilson visits CIDRZ

(l-r) Dr Chileshe Mabula and Mbaita Shawa both UAB Sparkman Center – CIDRZ HealthCorps Fellows; Dr Craig Wilson; Dr Roma Chilengi, CIDRZ Chief Scientific Officer; and Dr Izukanji Sikazwe, CIDRZ CEO

CIDRZ is pleased to have hosted Dr. Craig Wilson, Director of University of Alabama at Birmingham (UAB) Sparkman Centre for Global Health. Dr. Wilson a Professor of Epidemiology Pediatrics and Microbiology  made a presentation on “Community mobilization for HIV prevention and impact on the Continuum of Care in 15 cities in the US” at the CIDRZ research meeting.

Notable from Dr Wilson’ presentation were lessons and experiences leading to the formation of an Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) in the United States of America, a network funded primarily by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) with Office of AIDS Research funds and supplemented by National Institute of Mental Health (NIMH), National Institute on Drug Abuse (NIDA) and the National Institute on Minority Health and Health Disparities (NIMHD) focusing on youth aged 12-24 years.

The ATN community initiatives were implemented from 2002 to 2016 through a model, Connect to Protect (C2P): Mobilizing Communities for Structural Change to Impact HIV/AIDS conceptualized In 2001, when half of all new HIV infections were among people 25 years and younger, HIV determinants were viewed through a narrow lens, individual-level interventions were primary focus and limited collaboration with stakeholders outside of traditional HIV prevention and care..

Dr Craig Wilson

The C2P model is based on the “Community Empowerment Framework” that emphasizes seven factors for successful coalition development and function namely, defining a clear vision and mission, strategic planning, coalition leadership, providing resources to mobilizers, documentation of coalition efforts and feedback on progress, technical assistance and making outcomes matter.

The  central focus of C2P was the identification of local social and structural factors that impede HIV prevention and treatment in youth and utilized the power of community stakeholders to bring about structural level changes that would be difficult for any single organization to achieve independently.

Dr. Wilson has nearly 15 years of experience in Zambia working predominantly on capacity building programs supported by PEPFAR and working  with CIDRZ, Ministry of Health and UNZA SOM.

His first  Zambian visit was in 1998 before CIDRZ was operational to establish HIVNET 025 study and returned in 2004 to support CIDRZ scale up efforts and trainings. He facilitated technical aspects of Kalingalinga laboratory remodeling and establishment  from 2004 to 2006 and did clinical trainings (pediatric and adult) in Lusaka, Southern and Eastern Provinces.

CIDRZ holds research symposium

CIDRZ CEO Dr Izukanji Sikazwe

Since inception, CIDRZ has been committed to answering research questions relevant to improving health in Zambia. The work, ranging from pharmacokinetic, behavioural studies, individual and cluster-randomized trials to large multi-country programme evaluations, aims at identifying locally-relevant, culturally-acceptable, resource-appropriate, evidence-based interventions that will influence policy and thus raise healthcare service delivery in the public health sector.

CIDRZ research teams are supported by a research and regulatory infrastructure with dedicated staff skilled in regulatory affairs, human subjects protections, Good Clinical Practices, quality control and assurance, data management, analysis, and research pharmacy and laboratory. The findings are disseminated at local, regional and international meetings after sharing with the Ministry of Health.

CIDRZ Chief Scientific Officer, Dr Roma Chilengi

In all its work CIDRZ strives to contribute to the Zambian healthcare system through innovation in programming and as part of achieving the above, a one-day scientific symposium centred around diversifying research funding was held on the 6th of November 2017.

The symposium brought together CIDRZ researchers, Principal Investigators (PIs) and Board members to showcase current CIDRZ research activities and see how best to build a vibrant research practice at CIDRZ.

CIDRZ Grants and Contracts Consultant, Jill Morse said

“a more targeted strategy for financial diversification among our grants will be developed, department-level business plans will be created to identify key types and potential areas for funding, and business development at the departmental level will be tied to key strategic plan targets for revenue concentration”.

CIDRZ Head of Community, Musonda Musonda, talking about the adolescent programme during the symposium

CIDRZ Chief Scientific Officer Dr Roma Chilengi said CIDRZ had a lot of opportunities in its training programs.

“Our HealthCorps Fellowship program has produced critical -thinking scholars in the areas of clinical trials, implementation science, health systems strengthening, laboratory science, HIV/AIDS, Tuberculosis, Hepatitis and Enteric Disease, Non-Communicable Diseases, Women’s cancer control, Reproductive & Maternal Health, Newborn & Child Health, Water, Sanitation & Hygiene and data analysis.

The quality of fellows we produce at CIDRZ could contribute immensely to research work in the organisation. And being the largest healthcare related non-governmental organisation in Zambia, our laboratory would compete favorably in sub-Sahara Africa”.

CIDRZ Board Member, Dr Mike Saag of UAB during the Symposium

Some of the research presentations included:

  • Hepatitis B by Dr Michael Vinikoor, which looked at the growing global recognition of Hepatitis B by stakeholders and what CIDRZ has accomplished around HBV since 2003. CIDRZ work in this area has the potential to make the organisation the leading African implementer of HBV research and programmes.
  • Factors associated with Rotavirus vaccine failure in Zambiainfantsts by CIDRZ PhD candidates, Michelo Simuyandi, Natasha Labana and Katayi Kazimbaya.
  • The aetiology of diarrheoa among Zambia infants presenting with moderate and severe diarrhoea in Zambian health facilities byCarol Chisenga, John Mwaba and Neha Buddhdev.

Deputy Director Health Systems Strengthening and Primary Care, Cheryl Rudd-Mallaghan presenting on Finding Efficiencies in Zambia’s Immunisation Supply Chain

Other presentations were on studies and programs: Better Information for Health in Zambia; Community ART for Retention in Zambia; ART Readiness in HIV-infected Pregnant Women; Finding Efficiencies in Zambia’s Immunisation Supply Chain;  and Reaching At-Risk Adolescents through Facility-Based Youth-Friendly Services.

And CIDRZ Board Member, Mr. Charles Mpundu, said “listening to the different presentations gives an idea of not only the skill-set CIDRZ has, but also the amount of work and dedication that goes into the various programs.

The insights the Board Members have received here today would not have any impact had we just read about it. Given the amount of work done, there is need to package the information in a simplified way for more people to understand and eventually attract more financial support.”

CIDRZ Awards Bauleni Compound Landlords for Improving Sanitary Conditions in their Housing Units

CIDRZ has awarded 12 landlords for improving their toilets in Bauleni Compound under the organisation’s behavioural change meetings dubbed ‘Indaba Yama Landlords’ (meeting of landlords).

This is under the CIDRZ, in collaboration with the London School of Hygiene and Tropical Medicine project which is aimed at ‘Sanitation Demand: Creating Demand for Sanitation in Peri-urban Areas or SanDem.’

A total of 508 Landlords participated in Bauleni Compound and each of them was asked to make four improvements to their toilets:

  • Initiate the ‘pamodzi’ cleaning rota for the toilets which would involve the participation of all households within a housing unit;
  • Provide an inside lock to ensure privacy in the toilet;
  • Provide an external lock to the toilet to ensure that toilets are kept clean all the times and used responsibly; and
  • Provide a cover pan to reduce the smell.

One of the Landlord recipients being rewarded for taking sanitation seriously on her plot during the prize-giving ceremony in Bauleni Compound.

Meetings were held with landlords to sensitise them on the key issues including the building of improved toilets. Within a period of four weeks, we saw great improvement as some landlords worked on all the four requirements and some went further and bought modern fittings including cisterns, while others even started the process of constructing new toilets. This elated the CIDRZ SanDem project who decided to award the outstanding landlords with various prizes.

The SanDem project is funded by the U.K. Department for International Development (DFID) under the Sanitation and Hygiene Supply for Equity (SHARE) project.

The project is designed to create demand for sanitation in peri-urban areas of Lusaka such as Bauleni Compound through formative research, innovation, and intervention. The aim is to determine how far a state-of-the-art communication approach to behaviour change can enhance demand for and acquisition of improved toilets in urban Zambia.

Simple improvements made to pit latrine toilets

Evidence shows that poor sanitation and exposure to human excreta have been implicated in the transmission of many infectious diseases including diarrhoea, cholera, typhoid, intestinal worms, infectious hepatitis, trachoma among many others.

Globally, diseases related to water and sanitation are one of the major causes of death in children under five years old. About 4 billion cases of diarrhoea occur per year, causing 1.8 million deaths among children under five. Therefore improving sanitation is an effective and sustainable means to reduce the risk of infection,  the severity of infection, and ultimately, morbidity and mortality.

The United Nations Children’s Fund and the World Health Organization report that about 2.5 billion people have inadequate toilets globally, and almost one billion defecate in the open.

In Zambia, out of a population of ≈15 million, 5.6 million have no safe toilets and 2.3 million defecate in the open.

 

CIDRZ Holds First Lusaka District Medical Doctors Clinical Meeting

Dr Monde Muyoyeta, CIDRZ Director of TB Programmes

CIDRZ organised the first ever Medical Doctors Clinical Meeting for Lusaka District to, among other things, give an update on the cholera situation in Lusaka and discuss ways in which the organisation can better work and coordinate with the Lusaka District Medical Office to bring health services as closer to the people as possible.

 
CIDRZ works with the government of Zambia, in ensuring equitable access to quality healthy services to all, as closer to the community as possible.
 
CIDRZ took this opportunity to share with the medical staff on its overall work which centres around its mission: “To improve access to quality healthcare in Zambia through innovative capacity development, exceptional implementation science and research, and impactful and sustainable public health programs” as per mission.
 

Lusaka District Health Director, Dr Namani Monze

Some of the presentations during the Meeting included the “Intensified TB Case-Finding” by CIDRZ Clinical Care Specialist, Dr Mary Kagujje, Isoniazid Preventive Therapy and TB in Children by Dr Monde Muyoyeta, Director of TB Programmes. These presentations aimed at strengthening ways of identifying cases of TB infections with the aim of ensuring that we achieve not only HIV epidemic control but TV as well.

 
It was an interactive forum that brought together 33 medical doctors working under different hospitals and health centres within Lusaka District.
 
In closing the meeting, CIDRZ Lusaka Province Coordinator, Dr Daniel Mwamba said the meetings would be held quarterly and will be an opportunity for different medical personnel to present on their areas of work in the facilities.