HIV prevention messages don’t always reach deep into rural areas like Sinazongwe District located on the north shore of Lake Kariba in the far south-east corner of Zambia’s Southern province. In fact HIV prevention programmes in remote areas are the most neglected and the least evaluated in Zambia. The Sinazongwe Combination Prevention Evaluation (SCOPE) study, funded by the U.S. Centers for Disease Control and Prevention (CDC) through ICAP at Columbia University, aims to evaluate population-level changes in HIV incidence, prevalence, and disease progression as well as knowledge, perceptions and attitudes in Sinazongwe District before and after implementation of a Development Aid from People-to-People (DAPP) integrated HIV programme called “Total Control of the Epidemic” in conjunction with a GRZ Southern Provincial Health Office and Sinazongwe District Medical Office scale-up of health services.
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As part of SCOPE the over 50-member local CIDRZ team is conducting two community-based household surveys before and after the implementation of the DAPP HIV programme and GRZ services scale-up, three healthcare facility clinic record reviews, as well as interviews of up to 40 healthcare workers. It is estimated that up to 9,325 people from 24 Census Supervisory Areas (CSA) in Sinazongwe District will be reached per round during the evaluation exercise that started in July 2014.
– First round Facility survey data collected from 18 District health facilities
– Interviews with 29 health care staff members
– First round Community survey enrolled over 9,000 people from 24 CSAs
– Ongoing data entry, cleaning and analysis
Sensitisation and Community Relations Create Trust
Undertaking such a large community evaluation cannot take place without the support and approval of local leadership; and the SCOPE study team has always valued interaction with Traditional Chiefs and Village Headmen. During a SCOPE study sensitisation meeting, a Chief requested that testing for malaria be included in the protocol as it was such a big health problem for his people. After discussions with the Southern Province Health Office – a key study partner – malaria testing and treatment was written into the protocol with the majority of test kits and all treatment being provided by the government.
Before study start local Community Health Workers (CHW) were identified by health facility leadership and were briefed on SCOPE by the Community Liaison Officer. The CHW plays an instrumental role by assisting the study team meet local leadership and accompanying them in the field on data collection days. By introducing the CIDRZ SCOPE staff to the community through a known and respected member, the community is assured that the survey team is genuine and working with the full knowledge and partnership of government. In addition, prior to a survey team starting activity in an area they are preceded by a trained Sinazongwe-based drama troupe that informs the audience about the survey and explains that the Ministry of Health is a key partner in this evaluation exercise. Providing regular updates to local stakeholders is also very important during the conduct of a study. SCOPE study coordinator, Henry Muloongo makes quarterly presentations to the Southern Provincial Health Office.
The SCOPE evaluation is planned to be completed by 2017. SCOPE data will be shared with key stakeholders and used to inform government health programming to enhance HIV prevention, treatment and support programmes targeting whole communities as it will provide important information about changes in new HIV cases over time at the population level. It is hoped that SCOPE data will contribute to Zambia, other country governments, and donors benefitting as they decide on the best allocation of resources to achieve reduction in new HIV infections.
It Takes Multiple Partners
A large evaluation such as the SCOPE study requires collaboration of multiple partners. Key entities involved in this study are the: Zambian Ministry of Health, Southern Provincial Health Office, Sinazongwe District Health Management Team, University Teaching Hospital, Centers for Disease Control and Prevention (Zambia and Atlanta U.S. offices), International Center for AIDS Care and Treatment Programs, FHI360, Development Aid People-to-People, University of North Carolina at Chapel Hill, and CIDRZ.