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Title: Spatial analysis of logistics indicator data for health commodities.
Author: John Snow [JSI]. DELIVER
Source: Arlington, Virginia, JSI, DELIVER, 2009 Jul. 6 p.
Abstract: The USAID | DELIVER PROJECT has developed robust monitoring and evaluation tools to quantitatively and qualitatively assess the performance of logistics systems for essential health commodities. The purpose of this paper is to explore how analysis of stock indicators by location provides added value to these data sets, through a relatively minor investment in GPS devices and GIS software. Beginning with visual examination of logistics indicator data within a geographic context and progressing to network analysis, each of the spatial analysis methods presented in this paper presents its own set of strengths and weaknesses, yet they all excel in providing insights into the logistics system that might not otherwise be understood or even observed by simply looking at tabular data of stock levels for different facilities in the health system. Since a logistics system is inherently a geographically heterogeneous entity, using cartographic and spatial analysis tools may prove to be a crucial asset in assisting managers to identify key questions related to the performance of the logistics system and focus on potential causes and solutions. Moving forward, it will be useful to build off of the descriptive strengths of the spatial analysis methods described herein and begin building more robust statistical models that measure correlation between different components of the logistics system and commodity availability, while still accounting for the geographical variability of the data. (Excerpts)
Language: English
Keywords:
ZAMBIA | PARAGUAY | SUMMARY REPORT | PILOT PROJECTS | DATA COLLECTION | DATA ANALYSIS | USAID | LOGISTICS | GEOGRAPHY | INFORMATION RETRIEVAL SYSTEMS | DISTANCE | STREETS AND ROADS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | South America, Central | South America | Latin America | Americas | Studies | Research Methodology | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Management | Organization and Administration | Social Sciences | Science | Data Storage and Retrieval | Information Processing | Information | Geographic Factors | Population | Transportation | Economic Factors
Document Number: 331660

Title: Building support for orphans and vulnerable children.
Author: Population Council
Source: Momentum. 2009 Jun;:[1] p.
Abstract: We provide solid scientific evidence about programs targeting orphans and vulnerable children to help governments and communities provide better care for these children in need. The Council�s studies apply innovative research techniques to address complex issues about providing care and services to children affected by HIV. The Council�s evaluation of the RAPIDS intervention has highlighted the effectiveness of program activities and valuable lessons for program managers and providers. A mid-term evaluation in 2007 showed important progress, such as more help with school books, uniform fees, and transportation and improvements in school attendance among vulnerable children. Results from the 2009 data collection promise to provide further guidance to program managers on how to ensure the greatest impact with available resources. (Excerpts)
Language: English
Keywords:
ZAMBIA | SUMMARY REPORT | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | PROGRAM ACTIVITIES | MANAGEMENT | INFORMATION | FINANCIAL ACTIVITIES | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Economic Factors
Document Number: 331493

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Peer Reviewed

Title: Growth faltering due to breastfeeding cessation in uninfected children born to HIV-infected mothers in Zambia.
Author: Arpadi S; Fawzy A; Aldrovandi GM; Kankasa C; Sinkala M; Mwiya M; Thea DM; Kuhn L
Source: American Journal of Clinical Nutrition. 2009 Aug;90(2):344-53.
Abstract: BACKGROUND: The effect of breastfeeding on growth in HIV-exposed infants is not well described. OBJECTIVE: The objective was to evaluate the effect of early breastfeeding cessation on growth. DESIGN: In a trial conducted in Lusaka, Zambia, HIV-infected mothers were randomly assigned to exclusive breastfeeding for 4 mo followed by rapid weaning to replacement foods or exclusive breastfeeding for 6 mo followed by introduction of complementary foods and continued breastfeeding for a duration of the mother's choice. Weight-for-age z score (WAZ), length-for-age z score (LAZ), and weight-for-length z score (WLZ) and the self-reported breastfeeding practices of 593 HIV-uninfected singletons were analyzed. Generalized estimating equations were used to adjust for confounders. RESULTS: WAZ scores declined precipitously between 4.5 and 15 mo. The decline was slower in the breastfed infants. At 9, 12, and 15 mo, mean WAZs were, respectively, -0.74, -0.92, and -1.06 in infants who were reportedly breastfed and were -1.07, -1.20, and -1.31 in the weaned infants (P = 0.003, 0.007, and 0.02, respectively). No differences were observed past 15 mo. Breastfeeding practice was not associated with LAZ, which declined from -0.98 to -2.24 from 1 to 24 mo. After adjustment for birth weight, maternal viral load, body mass index, education, season, and marital and socioeconomic status, not breastfeeding was associated with a 0.28 decline in WAZ between 4.5 and 15 mo (P < 0.0001). During the rainy season, not breastfeeding was associated with a larger WAZ decline (0.33) than during the dry season (0.22; P for interaction = 0.02). CONCLUSIONS: Early growth is compromised in uninfected children born to HIV-infected Zambian mothers. Continued breastfeeding partially mitigates this effect through 15 mo. Nutritional interventions to complement breastfeeding after 6 mo are urgently needed. This trial was registered at clinicaltrials.gov as NCT00310726.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | EVALUATION | INFANT | MOTHERS | PERSONS LIVING WITH HIV/AIDS | BREASTFEEDING | CHILD DEVELOPMENT | IMPACT | NEEDS | MATERNAL NUTRITION | NUTRITION PROGRAMS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Infant Nutrition | Nutrition | Health | Biology | Communication | Economic Factors | Primary Health Care | Health Services | Delivery of Health Care
Document Number: 342426

Peer Reviewed

Title: Prevalence of tuberculosis, HIV and respiratory symptoms in two Zambian communities: implications for tuberculosis control in the era of HIV.
Author: Ayles H; Schaap A; Nota A; Sismanidis C; Tembwe R; De Haas P; Muyoyeta M; Beyers N
Author: Peter Godfrey-Faussett for the ZAMSTAR Study Team
Source: PloS One. 2009;4(5):e5602.
Abstract: BACKGROUND: The Stop TB Partnership target for tuberculosis is to have reduced the prevalence of tuberculosis by 50% comparing 2015 to 1990. This target is challenging as few prevalence surveys have been conducted, especially in high burden tuberculosis and HIV countries. Current tuberculosis control strategies in high HIV prevalent settings are therefore based on limited epidemiological evidence and more evidence is needed from community-based surveys to inform improved policy formulation. METHODS AND FINDINGS: 8044 adults were sampled from 2 sub-districts (wards) in Lusaka province, Zambia. Questionnaires were used to screen for symptoms, respiratory samples were obtained for culture and oral secretions collected for HIV testing. 79 individuals were found to have Mycobacterium tuberculosis in their sputum, giving an adjusted overall prevalence of tuberculosis of 870/100,000 (95% CI 570-1160/100,000). The adjusted overall prevalence of HIV was 28.61% (95% CI 26.04-31.19). HIV- infection was significantly associated with prevalent tuberculosis (Adj OR 2.3, 95% CI 1.42-3.74) and the population attributable fraction of HIV for prevalent tuberculosis was 36%. Symptoms such as prolonged cough (adj OR 12.72, 95% CI 7.05-22.94) and fever (Adj OR 2.04, 95%CI 1.23-3.39), were associated with prevalent tuberculosis, but 8 (10%) individuals with prevalent tuberculosis denied having any symptoms at all and only 34 (43%) would have been classified as a TB suspect by current guidelines. CONCLUSIONS: Undiagnosed tuberculosis is a challenge for tuberculosis control and new approaches are needed if we are to reach international targets. Epidemiological studies can inform screening algorithms for both detection and prevention of active tuberculosis.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | SAMPLING STUDIES | ADULTS | TUBERCULOSIS | HIV INFECTIONS | RESPIRATORY INSUFFICIENCY | PREVALENCE | SCREENING | SIGNS AND SYMPTOMS | LABORATORY EXAMINATIONS AND DIAGNOSES | PREVENTION AND CONTROL | ANTIBIOTICS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Viral Diseases | Pulmonary Effects | Physiology | Biology | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment
Document Number: 342445

7.
Peer Reviewed

Title: Antiretroviral adherence in rural Zambia: the first year of treatment availability.
Author: Birbeck GL; Chomba E; Kvalsund M; Bradbury R; Mang'ombe C; Malama K; Kaile T; Byers PA; Organek N
Author: RAAZ Study Team
Source: American Journal of Tropical Medicine and Hygiene. 2009 Apr;80(4):669-74.
Abstract: We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones' spouse (P = 0.047), knowing spouses' HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | RURAL POPULATION | PERSONS LIVING WITH HIV/AIDS | SPOUSE | SOCIAL NETWORKS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | CLINIC VISITS | PARTNER COMMUNICATION | KNOWLEDGE | SEX FACTORS | SPOUSAL SUPPORT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Friends and Relatives | HIV | Behavior | Service Statistics | Program Activities | Programs | Organization and Administration | Interpersonal Relations | Microeconomic Factors | Economic Factors
Document Number: 331277

Title: Zambia: National long term forecasting and quantification for family planning commodities, 2009-2015.
Author: Bwembya M; Mbewe RK
Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2009. 23 p. (USAID Contract No. GPO-I-01-06-00007-00)
Abstract: In December 2008, the Ministry of Health (MOH) and the Society for Family Health (SFH), with technical assistance from the USAID | DELIVER PROJECT, conducted a national long term quantification of contraceptive needs from 2009 -2015. The quantification's overall objective was to calculate the contraceptive requirements for each year of the forecast period and to use those requirements to mobilize resources for the country to support contraceptive commodity security. This report presents the findings of the quantification as well as the methodology used and assumptions made to arrive at these findings.
Language: English
Keywords:
ZAMBIA | SUMMARY REPORT | RESEARCH METHODOLOGY | TECHNICAL ASSISTANCE | USAID | NEEDS ASSESSMENT | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE SECURITY | COLD CHAIN | LOGISTICS | FUNDS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Programs | Organization and Administration | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Evaluation | Contraceptive Usage | Contraception | Family Planning | Contraceptive Availability | Management | Financial Activities | Economic Factors
Document Number: 331474

9.
Title: Increased risk for severe malaria in HIV-1-infected adults, Zambia.
Author: Chalwe V; Van geertruyden JP; Mukwamataba D; Menten J; Kamalamba J; Mulenga M; D'Alessandro U
Source: Emerging Infectious Diseases. 2009 May;15(5):749; quiz 858.
Abstract: To determine whether HIV-1 infection and HIV-1-related immunosuppression were risk factors for severe malaria in adults with some immunity to malaria, we conducted a case-control study in Luanshya, Zambia, during December 2005-March 2007. For each case-patient with severe malaria, we selected 2 matched controls (an adult with uncomplicated malaria and an adult without signs of disease). HIV-1 infection was present in 93% of case-patients, in 52% of controls with uncomplicated malaria, and in 45% of asymptomatic controls. HIV-1 infection was a highly significant risk factor for adults with severe malaria compared with controls with uncomplicated malaria (odds ratio [OR] 12.6, 95% confidence interval [CI] 2.0-78.8, p = 0.0005) and asymptomatic controls (OR 16.6, 95% CI 2.5-111.5, p = 0.0005). Persons with severe malaria were more likely to have a CD4 count <350/microL than were asymptomatic controls (OR 23.0, 95% CI 3.35-158.00, p<0.0001).
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | ADULTS | PERSONS LIVING WITH HIV/AIDS | IMMUNOLOGICAL EFFECTS | MALARIA | RISK FACTORS | ANTIMALARIAL DRUGS | SIGNS AND SYMPTOMS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology | Parasitic Diseases | Health
Document Number: 341944

10.

Peer Reviewed

Title: Early results of integrated malaria control and implications for the management of fever in under-five children at a peripheral health facility: a case study of Chongwe rural health centre in Zambia.
Author: Chanda P; Hamainza B; Mulenga S; Chalwe V; Msiska C; Chizema-Kawesha E
Source: Malaria Journal. 2009;8:49.
Abstract: BACKGROUND: Zambia has taken lead in implementing integrated malaria control so as to attain the National Health Strategic Plan goal of "reducing malaria incidence by 75% and under-five mortality due to malaria by 20% by the year 2010". The strategic interventions include the use of long-lasting insecticide-treated nets and indoor residual spraying, the use of artemisinin-based combination therapies (ACT) for the treatment of uncomplicated malaria, improving diagnostic capacity (both microscopy and rapid diagnostic tests), use of intermittent presumptive treatment for pregnant women, research, monitoring and evaluation, and behaviour change communication. Financial barriers to access have been removed by providing free malaria prevention and treatment services. METHODS: Data involving all under-five children reporting at the health facility in the first quarter of 2008 was evaluated prospectively. Malaria morbidity, causes of non-malaria fever, prescription patterns treatment patterns and referral cases were evaluated RESULTS: Malaria infection was found only in 0.7% (10/1378), 1.8% (251378) received anti-malarial treatment, no severe malaria cases and deaths occurred among the under-five children with fever during the three months of the study in the high malaria transmission season. 42.5% (586/1378) of the cases were acute respiratory infections (non-pneumonia), while 5.7% (79/1378) were pneumonia. Amoxicillin was the most prescribed antibiotic followed by septrin. CONCLUSION: Malaria related OPD visits have reduced at Chongwe rural health facility. The reduction in health facility malaria cases has led to an increase in diagnoses of respiratory infections. These findings have implications for the management of non-malaria fevers in children under the age of five years.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CASE STUDIES | MANAGEMENT | RURAL POPULATION | CHILDREN | MALARIA PREVENTION | FEVER | PRIMARY HEALTH CARE | RESPIRATORY INFECTIONS | PREVENTION AND CONTROL | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Organization and Administration | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Malaria | Parasitic Diseases | Diseases | Body Temperature | Physiology | Biology | Health Services | Delivery of Health Care | Health | Infections
Document Number: 341025

11.

Title: An assessment of the effectiveness of growth monitoring and promotion practices in the Lusaka district of Zambia.
Author: Charlton KE; Kawana BM; Hendricks MK
Source: Nutrition. 2009 Oct;25(10):1035-46.
Abstract: OBJECTIVE: We evaluated the effectiveness of the growth monitoring and promotion (GMP) program in Zambia. METHODS: A 3-mo prospective study of growth outcomes was undertaken at randomly selected health facilities and community posts within the Lusaka district. Children <2 y old (n=698) were purposively sampled from three health facilities (n=459) and four community posts (n=77) where health workers had undergone training in GMP and three health facilities where staff had not received training (n=162). Qualitative data on knowledge, attitudes, and practices of GMP were collected from health facility managers (n=6), health workers (n=35), and mothers whose children attended all follow-up visits (n=27). RESULTS: Anthropometric status of children in all groups deteriorated, with children at community posts having the worst outcomes (change in weight-for-age Z-score -0.8+/-0.7), followed by trained (-0.5+/-0.6) and untrained (-0.3+/-0.47; P<0.05) health facilities. A similar trend was seen for weight for length. The overall dropout rate was 74.1%. Weight-for-age Z-scores were higher at 1- and 2-mo follow-up visits for children who did not complete the study at trained health facilities and community posts compared with those who remained in the study. Mothers/caregivers identified GMP as important in attending the under-five clinic, associated their child's weight with overall health status, and expressed a willingness to comply with health workers' advice. However, health care providers were poorly motivated, inadequately supervised, and demonstrated poor practices. CONCLUSIONS: The GMP program in Lusaka is functioning suboptimally, even in facilities with trained staff.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | MONITORING | CHILDREN | GROWTH | CHILD DEVELOPMENT | BODY WEIGHT | ANTHROPOMETRY | PROMOTION | PROGRAM EFFECTIVENESS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Biology | Physiology | Measurement | Research Methodology | Marketing | Economic Factors | Program Evaluation | Programs | Organization and Administration
Document Number: 342875

12.

Title: Evaluating the impact of community-based interventions on schooling outcomes among orphans and vulnerable children in Lusaka, Zambia.
Author: Chatterji M; Hutchinson P; Murray N; Buek K; Mulenga Y
Source: Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center [CPC], MEASURE Evaluation, 2009 Apr. 34 p. (MEASURE Evaluation Working Paper Series WP-09-110USAID Cooperative Agreement No. GPO-A-00-03-00003-00USAID Task Order GHS-I-00-07-00002-00)
Abstract: This paper evaluates the impact of a community-based program implemented by a Zambian nongovernmental agency (NGO) on educational outcomes among orphans and vulnerable children (OVC) in Lusaka, Zambia. These outcomes included school enrollment and being at the correct age-for-grade. The study design included two rounds of post-intervention data collection, in 2003 and 2006. There were 2,302 children, ages 6-19, interviewed in 2003; and 3,105 children or young adults, ages 8-22, interviewed in 2006. A sub-sample of 2,922 orphans and vulnerable children, ages 8-19, was used. The effectiveness of Bwafwano Community Home-Based Care Organization, an NGO working in Lusaka, was evaluated, first using the individual cross-sectional samples and then using a differences-in-differences model on the pooled sample. Both cross-sectional analyses found positive and statistically significant effects of the intervention on school enrollment, with marginal effects of 0.104 and 0.168 respectively. The differences-in-differences estimates for school enrollment were positive, but small and not statistically significant. For the estimations of the effects of Bwafwano on the outcome of appropriate age-for-grade, only the difference-in-difference models showed positive program effect, with participation in the program being associated with a 15.7 percentage point increase in appropriate age-for-grade for intervention children, relative to control children. This study suggests that the Bwafwano program is a promising approach to improving educational outcomes among orphans and vulnerable children in urban Zambia.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | ORPHANS AND VULNERABLE CHILDREN | EDUCATIONAL STATUS | PRIMARY SCHOOLS | INTERVENTIONS | HIV PREVENTION | HOME CARE | PROGRAM EVALUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Family and Household | Sociocultural Factors | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Schools | Education | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Care and Support | Health Services | Delivery of Health Care | Health
Document Number: 339995

13.

Peer Reviewed

Title: Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia.
Author: Chi BH; Cantrell RA; Zulu I; Mulenga LB; Levy JW; Tambatamba BC; Reid S; Mwango A; Mwinga A; Bulterys M; Saag MS; Stringer JS
Source: International Journal of Epidemiology. 2009 Jun;38(3):746-56.
Abstract: BACKGROUND: High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. METHODS: We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months: optimal (> or =95%), suboptimal (80-94%) and poor (<80%). RESULTS: Overall, 27 115 treatment-naive adults initiated and continued ART for > or =12 months: 17 060 (62.9%) demonstrated optimal adherence, 7682 (28.3%) had suboptimal adherence and 2373 (8.8%) had poor adherence. When compared with those with optimal adherence, post-12-month mortality risk was similar among patients with sub-optimal adherence [adjusted hazard ratio (AHR) = 1.0; 95% CI: 0.9-1.2] but higher in patients with poor adherence (AHR = 1.7; 95% CI: 1.4-2.2). Those <80% MPR also appeared to have an attenuated CD4 response at 18 months (185 cells/microl vs 217 cells/microl; P < 0.001), 24 months (213 cells/microl vs 246 cells/microl; P < 0.001), 30 months (226 cells/microl vs 261 cells/microl; P < 0.001) and 36 months (245 cells/microl vs 275 cells/microl; P < 0.01) when compared with those above this threshold. CONCLUSIONS: MPR was predictive of clinical outcomes and immunologic response in this large public sector antiretroviral treatment program. This marker may have a role in guiding programmatic monitoring and clinical care in resource-constrained settings.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | CLIENTS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | IMMUNOLOGICAL EFFECTS | PHARMACY DISTRIBUTION | MORTALITY | HEMOGLOBIN LEVEL | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | HIV | Behavior | Immunity | Immune System | Physiology | Biology | Nonclinical Distribution | Distributional Activities | Population Dynamics | Demographic Factors | Population | Hemic System
Document Number: 342460

14.

Peer Reviewed

Title: CD4+ response and subsequent risk of death among patients on antiretroviral therapy in Lusaka, Zambia.
Author: Chi BH; Giganti M; Mulenga PL; Limbada M; Reid SE; Mutale W; Stringer JS
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):125-31.
Abstract: INTRODUCTION: Where virologic monitoring is not routinely available, immunologic criteria are commonly used to determine treatment failure while on antiretroviral therapy (ART). However, few have studied CD4+ response and its relationship to subsequent clinical outcomes in a programmatic setting. METHODS: We analyzed cohort data from Zambia to investigate whether 6- and 12-month CD4+ response after ART initiation was associated with later mortality. We used Cox proportional hazards models that accounted for different strata of baseline CD4 counts and adjusted for age, sex, clinical stage, tuberculosis coinfection, baseline hemoglobin, initial ART regimen, and adherence behavior. RESULTS: We analyzed data from 2 cohorts, from 6 months onward (n = 24,366; median follow-up = 467 days, interquartile range 222-791) and from 12 months onward (n = 17,920; median follow-up = 423 days, interquartile range 191-689). In the post-6-month analysis, hazard for death was significantly higher when absolute CD4+ response was <100 cells per microliter [adjusted hazard ratio (AHR) = 2.25, 95% confidence interval (CI): 1.91 to 2.64], relative response was <10% above baseline (AHR = 2.60, 95% CI: 2.12 to 3.19), and absolute CD4+ count was <100 per microliter (AHR = 2.79, 95% CI: 2.26 to 3.45). In the post-12 month analysis, mortality was associated with rise in absolute CD4+ cell count <200 per microliter (AHR = 2.41, 95% CI: 1.83 to 3.17), relative rise in CD4+ cell count of <10% above baseline (AHR = 3.41, 95% CI: 2.51 to 4.64), and absolute CD4+ count at 12 months <100 per microliter (AHR = 4.11, 95% CI: 2.96 to 5.68). CONCLUSION: Commonly used definitions for immunologic treatment failure are associated with elevated mortality risk among patients on ART.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | COHORT ANALYSIS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | DEATH RATE | HIV | MORTALITY | TREATMENT | ANTIRETROVIRAL THERAPY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Population Dynamics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342891

15.

Peer Reviewed

Title: Mental distress in the general population in Zambia: impact of HIV and social factors.
Author: Chipimo PJ; Fylkesnes KM
Source: BMC Public Health. 2009 Aug 18;9(1):298.
Abstract: ABSTRACT: BACKGROUND: Population level data on mental health from Africa are limited, but available data indicate mental problems to represent a substantial public health problem. The negative impact of HIV on mental health suggests that this could particularly be the case in high prevalence populations. We examined the prevalence of mental distress, distribution patterns and the ways HIV might influence mental health among men and women in a general population. METHODS: The relationship between HIV infection and mental distress was explored using a sample of 4466 participants in a population-based HIV survey conducted in selected rural and urban communities in Zambia in 2003. The Self-reporting questionnaire-10 (SRQ-10) was used to assess global mental distress. Weights were assigned to the SRQ-10 responses based on DSM IV criteria for depression and a cut off point set at 7/20 for probable cases of mental distress. A structural equation modeling (SEM) was established to assess the structural relationship between HIV infection and mental distress in the model, with maximum likelihood ratio as the method of estimation. RESULTS: The HIV prevalence was 13.6% vs. 18% in the rural and urban populations, respectively. The prevalence of mental distress was substantially higher among women than men and among groups with low educational attainment vs. high. The results of the SEM showed a close fit with the data. The final model revealed that self-rated health and self perceived HIV risk and worry of being HIV infected were important mediators between underlying factors, HIV infection and mental distress. The effect of HIV infection on mental distress was both direct and indirect, but was particularly strong through the indirect effects of health ratings and self perceived risk and worry of HIV infection. CONCLUSION: These findings suggest a strong effect of HIV infection on mental distress. In this population where few knew their HIV status, this effect was mediated through self-perceptions of health status, found to capture changes in health perceptions related to HIV, and self-perceived risk and worry of actually being HIV infected.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | MENTAL HEALTH | HIV INFECTIONS | EDUCATIONAL STATUS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Viral Diseases | Diseases | Health | Socioeconomic Status | Socioeconomic Factors | Economic Factors
Document Number: 342549

16.

Peer Reviewed

Title: HIV testing among adolescents in Ndola, Zambia: how individual, relational, and environmental factors relate to demand.
Author: Denison JA; McCauley AP; Dunnett-Dagg WA; Lungu N; Sweat MD
Source: AIDS Education and Prevention. 2009 Aug;21(4):314-24.
Abstract: A cross-sectional survey among randomly selected 16- to 19-year-olds in Ndola, Zambia, covered individual (e.g., HIV knowledge), environmental (e.g., distance), and relational factors (e.g., discussed voluntary counseling and testing [VCT] with family) that relate to demand for HIV testing. Multivariate regression analysis compared 98 respondents who planned to test for HIV within the year with 341 respondents who did not. Discussing HIV testing with family members was strongly associated with planning to test. Discussions with sex partners and friends about VCT were also associated with HIV testing plans. Significant individual factors were having ever had sex and HIV risk perception. Relational and individual factors strongly correlated with VCT demand, supporting the need to examine these factors when implementing and evaluating adolescent VCT strategies.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | ADOLESCENTS | HIV TESTING | VOLUNTARY COUNSELING AND TESTING | IMPLEMENTATION | YOUTH PROGRAMS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration
Document Number: 342726

17.

Title: Outcomes of a remote, decentralized health center-based HIV/AIDS antiretroviral program in Zambia, 2003 to 2007.
Author: Elema R; Mills C; Yun O; Lokuge K; Ssonko C
Source: Journal of the International Association of Physicians in AIDS Care. 2009 Jan-Feb;8(1):60-67.
Abstract: A cross-sectional study of patients living with HIV/AIDS treated during 2003 to 2007 in decentralized, rural health centers in Zambia was performed to measure virological outcomes after 12 months of antiretroviral therapy and identify factors associated with virological failure. Data from 228 patients who started antiretroviral therapy > 12 months prior were analyzed. In all, 93% received stavudine + lamivudine + nevirapine regimens, and median antiretroviral therapy duration was 23.5 months (interquartile range 20-28). Of the 205 patients tested for viral load, 177 (86%) had viral load <1000 copies/mL. Probability of developing virological failure (viral load >1000copies/ml) was 8.9% at 24 months and 19.6% at 32 months. Predictors for virological failure were <100% adherence, body mass index < 18.5 kg/m�, and women <40 years old. Of those with virological failure who underwent 3 to 6 months of intensive adherence counseling, 45% obtained virological success. In a remote, resource-limited setting in decentralized health centers, virological and immunological assessments of patients on antiretroviral therapy > 12 months showed that positive health outcomes are achievable.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | RURAL AREAS | PERSONS LIVING WITH HIV/AIDS | DECENTRALIZATION | HEALTH SERVICES | HEALTH FACILITIES | ANTIRETROVIRAL THERAPY | TREATMENT | LABORATORY PROCEDURES | ADMINISTRATION AND DOSAGE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Geographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Political Factors | Sociocultural Factors | Delivery of Health Care | Health | HIV | Medical Procedures | Medicine | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Drugs
Document Number: 331331

18.

Title: Knowledge, Use, and Concerns about Contraceptive Methods among Sero-Discordant Couples in Rwanda and Zambia.
Author: Grabbe K; Stephenson R; Vwalika B; Ahmed Y; Vwalika C; Chomba E; Karita E; Kayitenkore K; Tichacek A; Allen S
Source: Journal of Women's Health. 2009 Aug 26;
Abstract: Abstract Objective: The unique needs of sero-discordant couples are largely missing from many current family planning efforts, which focus on the prevention of pregnancies in absence of the reduction of the risk of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Conversely, HIV testing and programs focus exclusively on condom use without discussion of more effective contraceptive methods. In order to provide information to inform the development of family planning services tailored to the unique needs of sero-discordant couples, this study examined the contraceptive knowledge, use, and concerns among sero-discordant couples in urban Rwanda and Zambia. Methods: This article presents a comparison of family planning knowledge, use, and concerns about contraception among two cohorts of HIV sero-discordant study participants in Rwanda and Zambia. Results: The results reveal an interesting profile of contraceptive knowledge and use among sero-discordant couples; in both settings, despite high levels of knowledge of contraception, use of contraceptive methods remains relatively low. There is a clear gender difference in both the reporting of knowledge and use of contraceptive methods, and there is evidence of clandestine contraceptive use by women. Conclusions: Including information on family planning in voluntary counseling and testing (VCT) services in addition to tailoring the delivery of family planning information to meet to needs and concerns of HIV-positive women or those with HIV positive partners is an essential step in the delivery of services and prevention efforts to reduce the transmission of HIV. Family planning and HIV prevention programs should integrate counseling on "dual method use," combining condoms for HIV/STI prevention with a long-acting contraceptive for added protection against unplanned pregnancy.
Language: English
Keywords:
ZAMBIA | RWANDA | RESEARCH REPORT | COHORT ANALYSIS | COUPLES | KNOWLEDGE | CONTRACEPTIVE METHODS | FAMILY PLANNING | REPRODUCTIVE BEHAVIOR | CONTRACEPTIVE METHODS CHOSEN | PROGRAM EVALUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Africa, Central | Research Methodology | Family Characteristics | Family and Household | Sociocultural Factors | Contraception | Fertility | Population Dynamics | Demographic Factors | Population | Contraceptive Usage | Programs | Organization and Administration
Document Number: 342591

19.

Title: Heterosexual transmission of human immunodeficiency virus type 1 subtype C: Macrophage tropism, alternative coreceptor use, and the molecular anatomy of CCR5 utilization.
Author: Isaacman-Beck J; Hermann EA; Yi Y; Ratcliffe SJ; Mulenga J; Allen S; Hunter E; Derdeyn CA; Collman RG
Source: Journal of Virology. 2009 Aug;83(16):8208-20.
Abstract: Human immunodeficiency virus type 1 transmission selects for virus variants with genetic characteristics distinct from those of donor quasispecies, but the biological factors favoring their transmission or establishment in new hosts are poorly understood. We compared primary target cell tropisms and entry coreceptor utilizations of donor and recipient subtype C Envs obtained near the time of acute infection from Zambian heterosexual transmission pairs. Both donor and recipient Envs demonstrated only modest macrophage tropism, and there was no overall difference between groups in macrophage or CD4 T-cell infection efficiency. Several individual pairs showed donor/recipient differences in primary cell infection, but these were not consistent between pairs. Envs had surprisingly broad uses of GPR15, CXCR6, and APJ, but little or no use of CCR2b, CCR3, CCR8, GPR1, and CXCR4. Donors overall used GPR15 better than did recipients. However, while several individual pairs showed donor/recipient differences for GPR15 and/or other coreceptors, the direction of the differences was inconsistent, and several pairs had unique alternative coreceptor patterns that were conserved across the transmission barrier. CCR5/CCR2b chimeras revealed that recipients as a group were more sensitive than were donors to replacement of the CCR5 extracellular loops with corresponding regions of CCR2b, but significant differences in this direction were not consistent within pairs. These data show that sexual transmission does not select for enhanced macrophage tropism, nor for preferential use of any alternative coreceptor. Recipient Envs are somewhat more constrained than are donors in flexibility of CCR5 use, but this pattern is not universal for all pairs, indicating that it is not an absolute requirement.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | HIV TRANSMISSION | HETEROSEXUALS | GENETICS | HIV | LABORATORY PROCEDURES | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | HIV Infections | Viral Diseases | Diseases | Sex Behavior | Behavior | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342733

20.
Peer Reviewed

Title: Routine offering of HIV testing to hospitalized pediatric patients at university teaching hospital, Lusaka, Zambia: acceptability and feasibility.
Author: Kankasa C; Carter RJ; Briggs N; Bulterys M; Chama E; Cooper ER; Costa C; Spielman E; Katepa-Bwalya M; M'soka T; Ou CY; Abrams EJ
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jun 1;51(2):202-8.
Abstract: OBJECTIVES: The difficulties diagnosing infants and children with HIV infection have been cited as barriers to increasing the number of children receiving antiretroviral therapy worldwide. Design: We implemented routine HIV antibody counseling and testing for pediatric patients hospitalized at the University Teaching Hospital, a national reference center, in Lusaka, Zambia. We also introduced HIV DNA polymerase chain reaction (PCR) testing for early infant diagnosis. METHODS: Caregivers/parents of children admitted to the hospital wards were routinely offered HIV counseling and testing for their children. HIV antibody positive (HIV+) children <18 months of age were tested with PCR for HIV DNA. RESULTS: From January 1, 2006, to June 30, 2007, among 15,670 children with unknown HIV status, 13,239 (84.5%) received counseling and 11,571 (87.4%) of those counseled were tested. Overall, 3373 (29.2%) of those tested were seropositive. Seropositivity was associated with younger age: 69.6% of those testing HIV antibody positive were <18 months of age. The proportion of counseled children who were tested increased each quarter from 76.0% in January to March 2006 to 88.2% in April to June 2007 (P < 0.001). From April 2006 to June 2007, 1276 PCR tests were done; 806 (63.2%) were positive. The rate of PCR positivity increased with age from 22% in children <6 weeks of age to 61% at 3-6 months and to 85% at 12-18 months (P < 0.001). CONCLUSIONS: Routine counseling and antibody testing of pediatric inpatients can identify large numbers of HIV-seropositive children in high prevalence settings. The high rate of HIV infection in hospitalized infants and young children also underscores the urgent need for early infant diagnostic capacity in high prevalence settings.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | INFANT | CLIENTS | HIV TESTING | COUNSELING | HOSPITALS | CHILD HEALTH SERVICES | LABORATORY EXAMINATIONS AND DIAGNOSES | IMPLEMENTATION | PROGRAM ACCEPTABILITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | Health Facilities | Maternal-Child Health Services | Primary Health Care | Program Evaluation
Document Number: 341754

21.

Peer Reviewed

Title: HIV Incidence Rates and Risk Factors for Urban Women in Zambia: Preparing for a Microbicide Clinical Trial.
Author: Kapina M; Reid C; Roman K; Cyrus-Cameron E; Kwiecien A; Weiss S; Vermund SH
Source: Sexually Transmitted Diseases. 2009 Feb 9;
Abstract: OBJECTIVES:: A preparedness study was conducted to evaluate the suitability of sites and populations following the same study procedures intended for a larger scale microbicide efficacy trial. In the process the study evaluated human immunodeficiency virus (HIV) incidence, prevalence, and risk profiles for HIV-acquisition among young women in urban Zambia. METHODS:: Women aged 16 to 49 years were screened for participation in the study that involved HIV/sexually transmitted infection testing and the assessment of sexual behavioral characteristics. Two hundred thirty-nine eligible women were enrolled and followed up for 12 months. RESULTS:: Baseline HIV prevalence at screening was 38.7% (95% CI: 34.2%-43.3%). The highest age-specific prevalence of HIV was 54.1% (95% CI: 46.3%-61.8%) seen in women aged 26 to 34 years. HIV incidence was 2.6% per 100 woman years. Pregnancy rates were high at 17.4 per 100 woman years (95% CI: 12.2-24.1). CONCLUSION:: It was concluded that our general population sample, characterized by high HIV prevalence and ongoing incidence rates despite receiving regular risk reduction counseling and free condoms qualifies for future microbicide studies.A microbicide preparedness study conducted in Lusaka, Zambia found high HIV prevalence and appreciable HIV incidence in a population of women in an urban setting.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL TRIALS | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | URBAN POPULATION | PREVALENCE | RISK FACTORS | MICROBICIDES | HIV PREVENTION | HIV INFECTIONS | INCIDENCE | CONDOMS | COUNSELING | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Measurement | Health | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Viral Diseases | Diseases | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 341501

22.

Peer Reviewed

Title: Effects of neighbourhood-level educational attainment on HIV prevalence among young women in Zambia.
Author: Kayeyi N; Sandoy IF; Fylkesnes K
Source: BMC Public Health. 2009 Aug 25;9(310):1-11.
Abstract: This study reanalyzed data from a cross-sectional population survey conducted in Zambia in 2003. The analyses were restricted to women ages 15�24 years (n=1,295). Stratified random cluster sampling was used to select 10 urban and 10 rural clusters. A measure for neighborhood-level educational attainment was constructed by aggregating individual-level years-in-school. Multi-level mixed effects regression models were run to examine the neighborhood-level educational effect on HIV prevalence after adjusting for individual-level underlying variables (education, currently a student, marital status) and selected proximate determinants (ever given birth, sexual activity, lifetime sexual partners). HIV prevalence among young women ages 15�24 years was 12.5% in the urban and 6.8% in the rural clusters. Neighborhood educational attainment was found to be a strong determinant of HIV infection in both urban and rural populations. HIV prevalence decreased substantially by increasing level of neighborhood education. The likelihood of infection in low educational attainment areas was 3.4 times higher among rural women and 1.8 times higher among the urban women after adjusting for age and other individual-level underlying variables, including education. However, the association was not significant for urban young women after this adjustment. After adjusting for level of education in the neighborhood, the effect of the individual-level education differed by residence: there was a strong protective effect among urban women whereas it tended to be a risk factor among rural women.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | DATA ANALYSIS | YOUTH | WOMEN | HIV INFECTIONS | PREVALENCE | EDUCATIONAL STATUS | GEOGRAPHIC FACTORS | SEX BEHAVIOR | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Measurement | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Behavior
Document Number: 339907

23.

Peer Reviewed

Title: Mortality and virologic outcomes after access to antiretroviral therapy among a cohort of HIV-infected women who received single-dose nevirapine in Lusaka, Zambia.
Author: Kuhn L; Semrau K; Ramachandran S; Sinkala M; Scott N; Kasonde P; Mwiya M; Kankasa C; Decker D; Thea DM; Aldrovandi GM
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):132-6.
Abstract: OBJECTIVES: Single-dose nevirapine (SDNVP) for prevention of mother-to-child HIV transmission selects mutations conferring resistance to nonnucleoside reverse transcriptase inhibitor (NNRTI)-based therapy. We investigated mortality and virologic and clinical outcomes after introduction of antiretroviral treatment (ART) among a cohort of women given SDNVP. METHODS: When ART programs were introduced in 2004 in Lusaka, Zambia, we were completing a trial of infant feeding, which involved following HIV-infected women who received SDNVP between 2001 and 2005. Women still in follow-up or who could be contacted were evaluated for eligibility for ART (CD4 count <200 or <350 and World Health Organization stage >or=3) and started on NNRTI-based therapy if eligible. We compared mortality in the cohort of women before and after ART access, and examined, among women initiating ART, whether virologic response was better allowing a longer time to elapse between SDNVP and treatment initiation. RESULTS: In the cohort of 872 women, mortality more than halved after ART became available (relative hazard = 0.46, 95% confidence interval: 0.23 to 0.91, P = 0.03). Of 161 SDNVP-exposed women followed on NNRTI-based ART, 70.8% suppressed (viral load <400 copies/mL). Only 3 of 8 SDNVP-exposed women (37.5%) <6 months of starting therapy suppressed compared with 13 of 22 (59.1%) who started 6-12 months, 44 of 61 (72.1%) 12-24 months, and 54 of 70 (77.1%) >24 months after exposure (chi2 trend P = 0.01). CONCLUSIONS: Most SDNVP-exposed women respond well to NNRTI-based therapy, but there was an attenuation of therapy efficacy that persisted to 12 months after exposure. Women should be screened for ART eligibility during pregnancy and started on effective regimens before delivery.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | COHORT ANALYSIS | WOMEN | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTIRETROVIRAL DRUGS | MORTALITY | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | HIV | Disease Transmission Control | Prevention and Control | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics
Document Number: 342901

24.
Peer Reviewed

Title: Closing gaps in antiretroviral therapy access: human immunodeficiency virus-associated dementia screening instruments for non-physician healthcare workers.
Author: Kvalsund MP; Haworth A; Murman DL; Velie E; Birbeck GL
Source: American Journal of Tropical Medicine and Hygiene. 2009 Jun;80(6):1054-9.
Abstract: Human immunodeficiency virus-associated dementia (HIV-D) is an indication for antiretroviral therapy (ART), but HIV-D is not routinely screened for in ART clinics in sub-Saharan Africa. Given the dearth of physicians in sub-Saharan Africa, enabling non-physician healthcare workers to identify HIV-D is crucial for early treatment initiation and preventing chronic neurologic disability. Non-physician healthcare workers administered locally adapted screening instruments to 48 persons living with acquired immunodeficiency syndrome (PLWAs), and 15 healthy comparison persons provided normative data. Stage IV PLWAs performed worse than the comparison group on all tests. Overall, 24 (50%) of 48 PLWAs had significant cognitive impairment. Among HIV staging categories, 1 stage II (33%), 6 stage III (42%), and 17 stage IV (55%) patients were identified as cognitively impaired. Our pilot study indicates that screening instruments used by non-physician healthcare workers can identify cognitive impairment in PLWAs and may facilitate appropriate initiation of ART in resource-poor settings.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | PILOT PROJECTS | PERSONS LIVING WITH HIV/AIDS | HEALTH PERSONNEL | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | MENTAL DISORDERS | SCREENING | TRAINING ACTIVITIES | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Viral Diseases | Diseases | Delivery of Health Care | Health | HIV | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Training Programs | Education
Document Number: 341761

25.

Peer Reviewed

Title: Fitting the HIV epidemic in Zambia: a two-sex micro-simulation model.
Author: Leclerc PM; Matthews AP; Garenne ML
Source: PloS One. 2009;4(5):e5439.
Abstract: BACKGROUND: In describing and understanding how the HIV epidemic spreads in African countries, previous studies have not taken into account the detailed periods at risk. This study is based on a micro-simulation model (individual-based) of the spread of the HIV epidemic in the population of Zambia, where women tend to marry early and where divorces are not frequent. The main target of the model was to fit the HIV seroprevalence profiles by age and sex observed at the Demographic and Health Survey conducted in 2001. METHODS AND FINDINGS: A two-sex micro-simulation model of HIV transmission was developed. Particular attention was paid to precise age-specific estimates of exposure to risk through the modelling of the formation and dissolution of relationships: marriage (stable union), casual partnership, and commercial sex. HIV transmission was exclusively heterosexual for adults or vertical (mother-to-child) for children. Three stages of HIV infection were taken into account. All parameters were derived from empirical population-based data. Results show that basic parameters could not explain the dynamics of the HIV epidemic in Zambia. In order to fit the age and sex patterns, several assumptions were made: differential susceptibility of young women to HIV infection, differential susceptibility or larger number of encounters for male clients of commercial sex workers, and higher transmission rate. The model allowed to quantify the role of each type of relationship in HIV transmission, the proportion of infections occurring at each stage of disease progression, and the net reproduction rate of the epidemic (R(0) = 1.95). CONCLUSIONS: The simulation model reproduced the dynamics of the HIV epidemic in Zambia, and fitted the age and sex pattern of HIV seroprevalence in 2001. The same model could be used to measure the effect of changing behaviour in the future.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | THEORETICAL MODELS | DEMOGRAPHIC AND HEALTH SURVEYS | HETEROSEXUALS | SEX WORKERS | HIV INFECTIONS | EPIDEMICS | AGE FACTORS | SEX FACTORS | EPIDEMIOLOGY | MARRIAGE | SEX BEHAVIOR | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Behavior | Viral Diseases | Diseases | Population Characteristics | Public Health | Health | Nuptiality
Document Number: 341943

26.

Peer Reviewed

Title: Population immunity to measles virus and the effect of HIV-1 infection after a mass measles vaccination campaign in Lusaka, Zambia: a cross-sectional survey.
Author: Lowther SA; Curriero FC; Kalish BT; Shields TM; Monze M; Moss WJ
Source: Lancet. 2009 Mar 21;373(9668):1025-32.
Abstract: BACKGROUND: Measles control efforts are hindered by challenges in sustaining high vaccination coverage, waning immunity in HIV-1-infected children, and clustering of susceptible individuals. Our aim was to assess population immunity to measles virus after a mass vaccination campaign in a region with high HIV prevalence. METHODS: 3 years after a measles supplemental immunisation activity (SIA), we undertook a cross-sectional survey in Lusaka, Zambia. Households were randomly selected from a satellite image. Children aged 9 months to 5 years from selected households were eligible for enrolment. A questionnaire was administered to the children's caregivers to obtain information about measles vaccination history and history of measles. Oral fluid samples were obtained from children and tested for antibodies to measles virus and HIV-1 by EIA. FINDINGS: 1015 children from 668 residences provided adequate specimens. 853 (84%) children had a history of measles vaccination according to either caregiver report or immunisation card. 679 children (67%) had antibodies to measles virus, and 64 (6%) children had antibodies to HIV-1. Children with antibodies to HIV-1 were as likely to have no history of measles vaccination as those without antibodies to HIV-1 (odds ratio [OR] 1.17, 95% CI 0.57-2.41). Children without measles antibodies were more likely to have never received measles vaccine than those with antibodies (adjusted OR 2.50, 1.69-3.71). In vaccinated children, 33 (61%) of 54 children with antibodies to HIV-1 also had antibodies to measles virus, compared with 568 (71%) of 796 children without antibodies to HIV-1 (p=0.1). INTERPRETATION: 3 years after an SIA, population immunity to measles was insufficient to interrupt measles virus transmission. The use of oral fluid and satellite images for sampling are potential methods to assess population immunity and the timing of SIAs.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | URBAN POPULATION | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | IMMUNIZATION | HIV INFECTIONS | COMPLICATIONS | SEROCONVERSION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Measurement | Primary Health Care | Health Services | Delivery of Health Care | Health | Immunity | Immune System | Physiology | Biology
Document Number: 330988

27.

Peer Reviewed

Title: Intersectoral debate on social research strengthens alliances, advocacy and action for maternal survival in Zambia.
Author: Manandhar M; Maimbolwa M; Muulu E; Mulenga MM; O'Donovan D
Source: Health Promotion International. 2009 Mar;24(1):58-67.
Abstract: The Health Promotion Research Centre of the National University of Ireland, Galway and the University of Zambia's School of Medicine conducted operational research to understand and address the socio-cultural and gender contexts of maternal survival. Together with an analytical policy and programming review and qualitative research, the project process also involved the convening of 'Interest Group' meetings involving intersectoral stakeholders at Central (Lusaka) and Provincial (Kasama) levels. These meetings aimed to catalyse debate and stimulate advocacy on the project theme by using discussion of qualitative research as entry point. Participants came from government departments, civil society groups, the indigenous health system, academia, technical provider associations, and media, advocacy and human rights organisations. We found that engagement in Interest Groups was successful at Provincial level with lively participation from civil society, media and advocacy stakeholders and strong engagement by the health system. The process was welcomed as an opportunity to fill gaps in understanding about underlying social determinants of health and jointly explore intervention approaches. Overburdened government staff at central level faced with disease-focused interventions rather than underlying contextual determinants, and a weak culture of health sector engagement with civil society, academics and activists, contributed to less successful functioning in Lusaka. Final Dissemination and Discussion Events incorporated material from Interest Group Meetings to stimulate wider discussion and make recommendations. This project highlights the potential value of intersectoral stakeholder discussions from the inception stage of research to stimulate intersectoral exchange and alliance building, inform advocacy, and catalyse the process of research into action.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | ACTION RESEARCH | MATERNAL HEALTH | ADVOCACY | INTEGRATED PROGRAMS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Health | Communication | Programs | Organization and Administration
Document Number: 330828

28.

Title: The prevalence of the use of 'dry sex' traditional medicines, among Zambian women, and the profile of the users.
Author: Mbikusita-Lewanika M; Stephen H; Thomas J
Source: Psychology, Health and Medicine. 2009 Mar;14(2):227-38.
Abstract: Concern has been voiced about the 'dry sex' practice in Southern and Central Africa, and its possible role in the transmission of the Human Immuno-deficiency Virus (HIV). Despite this concern, there has been little information about the practice. Most of the available information has been anecdotal, speculative or inadequate mainly because of cultural reluctance to discuss or investigate personal sexual issues. This article provides information about the prevalence of the practice in Zambia and the profile of its practitioners. A cross-sectional study involving 812 Zambian women was undertaken in Lusaka, the capital city of Zambia. Quantitative and qualitative data was obtained through self-administered questionnaires, interviews, in-depth interviews and focus group discussions. The quantitative data was analysed using SPSS, and the qualitative data was used to complement and clarify the quantitative data. Awareness of the 'dry sex' practice was almost universal among Zambian women. About two-thirds had used 'dry sex' traditional medicines (DSTM) at some point in their lives, and about half were using them. Those who were most likely to have been using, or to have used DSTM, were those who were older, married, with little or no formal education, mainstream Christians, from the lower socio-economic levels, homemakers, manual workers (p < 0.001), originally from the Eastern province of Zambia (p < 0.002) and those who had spent most of their formative years in rural areas (p < 0.006).The study showed that the knowledge and use of DSTM is widespread among Zambian women, especially among those who were most likely to adhere to traditional views and beliefs about womanhood and marriage, and perhaps those likely to have a poor sense of self-worth or less confidence. In view of the concern about the possible role of 'dry sex' in HIV transmission, these findings would be useful in Health education strategies.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | QUALITATIVE RESEARCH | WOMEN | TRADITIONAL MEDICINE | SEX BEHAVIOR | WOMEN'S HEALTH | BELIEFS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Behavior | Culture | Sociocultural Factors
Document Number: 341836

29.

Peer Reviewed

Title: Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia.
Author: Morris MB; Chapula BT; Chi BH; Mwango A; Chi HF; Mwanza J; Manda H; Bolton C; Pankratz DS; Stringer JS; Reid SE
Source: BMC Health Services Research. 2009;9:5.
Abstract: The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART) have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | HEALTH PERSONNEL | ADMINISTRATIVE PERSONNEL | URBAN POPULATION | CAPACITY BUILDING | ANTIRETROVIRAL THERAPY | AIDS PREVENTION | ORGANIZATION AND ADMINISTRATION | MANAGEMENT | COUNSELING | USER COMPLIANCE | CLINIC ACTIVITIES | ON-THE-JOB TRAINING | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Delivery of Health Care | Health | Population Characteristics | Demographic Factors | Population | Program Sustainability | Programs | HIV | HIV Infections | Viral Diseases | Diseases | AIDS | Program Activities | Behavior | Training Programs | Education
Document Number: 331094

30.

Peer Reviewed

Title: Barriers to acceptance and adherence of antiretroviral therapy in urban Zambian women: a qualitative study.
Author: Murray LK; Semrau K; McCurley E; Thea DM; Scott N; Mwiya M; Kankasa C; Bass J; Bolton P
Source: AIDS Care. 2009 Jan;21(1):78-86.
Abstract: Sub-Saharan Africa contains over 60% of the world's HIV infections and Zambia is among the most severely affected countries in the region. As antiretroviral programs have been rapidly expanding, the long-term success of these programs depends on a good understanding of the behavioral determinants of acceptance and adherence to antiretroviral therapy (ART). The study used qualitative methods to gain local insight into potentially important factors affecting HIV-infected women's decision to accept or continue with ART. Some of the barriers identified by this study are consistent with factors cited in the existing adherence literature from both developed and developing nations such as side effects, hunger and stigma; other factors have not been previously reported. One major theme was unfamiliarity with the implications of having a chronic, potentially deadly disease. Other emerging themes from this study include the complicated effect of ART on interpersonal relationship, particularly between husbands and wives, the presence of depression and hopelessness, and lack of accurate information. The results suggest that the reasons for non-uptake of treatment include issues related to local cultural frameworks (e.g., illness ideology), mental and behavioral health (e.g., depression and/or interpersonal challenges), stigma, and motivating factors (e.g., values of church or marriage) of different cultures that affect the ability and willingness to take life-saving medicine for a long period of time. Qualitative studies are critical to better understand why ART eligible individuals are choosing not to initiate or continue treatment to achieve needed adherence levels.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | QUALITATIVE RESEARCH | URBAN POPULATION | WOMEN | PERSONS LIVING WITH HIV/AIDS | USER COMPLIANCE | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Behavior | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 331210


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