Community ART for Retention in Zambia Study

CIDRZ has been awarded a USD 4.49 million Bill & Melinda Gates Foundation grant in support of the Community ART for Retention in Zambia Study, or ‘Community ART’. The study will be conducted in close collaboration with the Government of the Republic of Zambia and aims to develop and evaluate the effectiveness of innovative models of care delivery designed to reduce health systems barriers to care, and leverage community support to improve retention in HIV care and treatment (ART) programs. Dr Charles Holmes, CIDRZ Chief Executive Officer and Johns Hopkins faculty member, and CIDRZ Deputy CEO, Dr Izukanji Sikazwe are co-Principal Investigators, and are joined by Dr Crispin Moyo (Ministry of Health), Dr Bushimbwa Tambatamba (Ministry of Community Development, Mother and Child Health), Dr Elvin Geng (University of California, San Francisco), Dr Willbroad Mutale (University of Zambia), and Dr Carolyn Bolton (CIDRZ) along with numerous other co-investigators and local trainees.

The scale-up of HIV care and treatment services in Zambia over the last 10 years has resulted in vastly increased access to HIV care and treatment services for adults and children. However, this scale-up has taken place in the context of a health care system with overstretched human resources and physical infrastructure, and has required individual patients to regularly travel long distances to fixed clinics and endure long wait times with minimal community support. These challenges have resulted in suboptimal patient outcomes including high rates of disengagement from care and death, not just in Zambia, but in other regions hard hit by the HIV pandemic. It is therefore critical to identify models of care that can more effectively and efficiently provide care to patients with varied healthcare intensity needs in order to improve the ability of the health system to meet patient needs and ensure patient motivation to remain in lifelong, life-saving ART care.

The ‘Community ART’ Study was conceived of during discussions with the Government of the Republic of Zambia, along with local community groups of individuals living with HIV, PEPFAR, and the U.S. Centers for Disease Control and Prevention (CDC). The study will pursue two strategies simultaneously in order to obtain both broad-based insights into the demand and preferences for differentiated care in Zambia, as well as practical insights about implementation and outcomes of leading models of differentiated care that are already under consideration in Zambia.  The mixed-methods approach of survey research, discrete choice experiments, interviews and focus group discussions complemented by concurrent implementation of four differentiated care models incorporating innovative systems approaches to information technology, community support, real-time monitoring and quality framed by rigorous impact evaluation will yield insights into these models’ overall quality, feasibility, cost, cost-effectiveness and fit within the Zambian health system. In addition, the study will inform the creation of a “methodologic” tool kit that could be used by other countries in the region to identify models of differentiated care appropriate to their particular needs and resources. The study will be conducted in urban, semi-urban and rural settings in Lusaka, Southern and Eastern Provinces, over 24 months.

Ministry of Health Clinical Care Specialist and co-Investigator Dr Crispin Moyo remarked that “The Ministry of Health is looking forward to working with CIDRZ on yet another landmark intervention to improve access to ART services by further decentralizing care and treatment services to the community. The Community ART study of various care provision models will provide insights on program level impact and will shed light on the whether the intervention can be taken to scale in a sustainable manner”.

Through this work, the Zambian Government and key community and care and treatment partners will gain access to a detailed understanding of the preferences for differentiated care within Zambian society as well as more focused data from model implementation, and therefore will be better poised to work with a range of funders to move forward with scale-up of well-conceived and effective models of ART care across the country. This close partnership between CIDRZ and the Zambian Government ensures relevance and gives the study the greatest opportunity to dramatically and favorably transform the future course of the Zambian national HIV care and treatment program.

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