Zambart-Publication

Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa…

Ranjeeta Thomas, Ronelle Burger, Abigail Harper, Sarah Kanema, Lawrence Mwenge, Nosivuyile Vanqa, Nomtha Bell-Mandla, Peter C Smith,
Sian Floyd, Peter Bock, Helen Ayles, Nulda Beyers, Deborah Donnell, Sarah Fidler, Richard Hayes, Katharina Hauck, on behalf of the HPTN 071 (PopART) Study Team*
Summary
Background The life expectancy of HIV-positive individuals receiving antiretroviral therapy (ART) is approaching that of HIV-negative people. However, little is known about how these populations compare in terms of health-related quality of life (HRQoL). We aimed to compare HRQoL between HIV-positive and HIV-negative people in Zambia and South Africa. Read full article.

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Zambart community health counsellors learn sign language to offer HIV treatment & prevention services to more people

International-Awareness-Week-for-the-DEAF-017It was International Awareness Week for the Deaf from September 18 through 25, 2017 and Zambart’s largest on-going study, the HPTN 071/PopART trial participated in the commemorations spearheaded by the Zambia National Association for the Deaf (ZNAD). The activities were aimed at highlighting the skills and challenges of the hearing impaired people in local communities, places of work, and public spaces.

Prior to the commemoration, a Zambart research team  in Kanyama, Lusaka, one of the study communities, decided to create more impact to assist more people access the life-saving HIV antiretroviral treatment  (ART) and prevention services, and contribute to their quality of lives.  Kanyama is one of the 12 communities for Zambart’s largest clinical trial – the HPTN 071 (PopART) study. Six members of the PopART intervention team from Kanyama site were among the 17 students that completed basic training in sign language. The Kanyama PopART lay health counsellors called Community HIV Care Providers (CHiPs) become the second group to integrate sign language into their house-to-house HIV Testing and Counselling (HTC) delivery.

International-Awareness-Week-for-the-DEAF-018Kanyama District Intervention Coordinator (DIC) Louis Mwape, said field teams were motivated to take the sign language course because they encounter hearing and speech impaired people in the community and fail to communicate with them.  “We have many cases where our CHiPs meet clients who only understand sign language, and until now we only had one counsellor who had undergone basic sign language training and she would often be called upon to help her colleagues. The hospital also called her to help with communication between medical personnel and deaf patients. This was affecting her work in her zone.”

In 2015, the PopART intervention team in Makululu, Kabwe (Central Province), also adopted a similar strategy in order to include the hearing and speech impaired people in the community with the PopART intervention package.

The skills acquired by the CHiPs will also be extended to Kanyama First Level Hospital where PoPART study clients access various HIV and TB treatment and prevention services. The CHiPs will assist hearing and speech impaired patients including those referred to the hospital through the PopART intervention. “In this way, PopART will work in line with the theme for this year “Full Inclusion with Sign Language,” said Mwape.

International-Awareness-Week-for-the-DEAF-034Mwape said the training center for the hearing impaired has requested the Zambart team in Kanyama to send CHiPs to the facility and offer HCT services and link into care clients there with speech and hearing impairment. He added that the teams’ services will now be more comprehensive as they intensify the intervention mop up.

PopART Intervention Manager of Volunteer Medical Male Circumcision and TB, Ephraim Sakala, explained that Zambart in its work and activities desired to ensure that all people receive health services regardless of their condition. “The hearing impaired people need information on HIV/AIDS and TB so that they also can make informed decision on their health.” He said the knowledge and skills acquired by CHiPs in Basic Sign Language will help PopART study reach more people who may have been neglected through dissemination of awareness raising information.

At the site where the commemorations event was held, the PopART erected a tent from where they conducted HCT services and provided health information to over 40 people.

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Community Engagement Award

The HIV Prevention Trials Network (HPTN) 2017 annual meeting brought together researchers from its clinical trials involved in HIV prevention in countries across the world. Zambart, is part of a consortium of international researchers currently conducting the world’s largest HIV prevention trial in 21 communities in Zambia and South Africa.

The Zambart Community Engagement (CE) team on the HPTN 071(PopART) Trial won the Best Community Engagement Award for outstanding performance in mobilising the biggest community randomised HIV prevention study in the world. During the course of the four year study, Zambart’s CE team has developed novel strategies to engage, sustain, and work together with other study groups to increase participants for the trial, including ancillary studies nested with the main trial.

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Zambart Commemorates National HIV testing, Counselling, and Treatment Day Activities

On August 15, 2017 Zambart joined other health stakeholders and participated in the annual HIV Testing, Counselling and Treatment (HTCT) Day event spearheaded by the Ministry of Health (MoH). National HTCT Day (previously National VCT Day) is held to raise public awareness on HIV prevention and treatment.  During this year’s event, the President of Zambia Edgar Lungu announced the government shift to routine HIV testing and treatment in all health facilities in the country.

Zambart’s objective of participating in this event was to support HIV prevention and treatment, and showcase some of the organisation’s innovative activities aimed at enhancing uptake of HIV testing and treatment.

Across all its research sites on the Copperbelt, Central, Lusaka, and Southern provinces, Zambart field teams mobilised and conducted various community engagement and sensitisation activities in different zones, and participated in the district-level commemorations held under the theme: “HIV Test and Treat: Towards Ending AIDS”. The activities were also aimed to increase awareness about HTCT Day.

Zambart conducted satellite outreach activities in the communities prior to HTCT Day. The activities included offering free HIV Counselling and Testing, linkage to care, screening for Tuberculosis  and Sexually Transmitted Infections, distribution of lubricants, condoms and  information and education materials, and providing HIV health talks and counselling to adolescents in Youth Friendly Corners in Zambart supported clinics.

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PopART Study Staff Reflections, Challenges, and Experiences

Reflections on 2017 PopART Study all-staff training & retreat

During the last PopART study all-staff training the various teams had an opportunity to share their personal experiences and reflects about the trial. The field teams, on whom the successful implementation of the study relies heavily, had some great feedback about PopART. Equally the supervisors and technical leaders who support the field teams and enable them to boldly carry out their work had a few things to say.

Here are just a few examples of some of the PopART staff reflections from the field and head office alike:

“When you change a life, you change a life forever,” – Steve Belemu, Zambart Community Engagement Team

“The HPTN 071 is an extraordinary study, and we did it, each and every one of you.” – Dr Helen Ayles, PopART Site Principal Investigator: Z Director of Research- Zambart

“PopART has been an amazing study. It has successfully managed to mobilise efforts of different people, organisations and communities towards the dream of achieving an HIV free Zambia. Yes, it is possible to get rid of HIV if we replicate PopART at country level.” – Dr Musonda Simwinga, Zambart Community Engagement Lead & Social Scientist

“I first became involved in HIV research in 1985. The lab I was in was among those conducting the initial trials of AZT, which became the first drug approved for treatment of individuals infected with HIV. Three decades later, PopART is demonstrating the efficacy of treatment as prevention at the population level. It’s gratifying to be a part of the PopART team and the remarkable advances that have been made in HIV treatment.” – Barry Kosloff, Head of Zambart Laboratories

“One day we went in the field and enrolled a female participant whose husband had died some years before. She wanted to know her HIV status. The research assistant consenting the woman and I was called to collect the sample. After the test was done, she was found to be reactive and we linked her to care. She then asked if I could also test her daughter who was not looking too healthy and she also tested reactive. We linked her to care too. From that time to date, this family is like my family to me. I feel happy when I pass by their home and see how happy they are and getting on with their life.” (PopART CHiP)

“I tested a man in a household that I had been visiting in my zone, he tested HIV positive but it was very difficult to link him to care. When he fell very ill, that is when he started the treatment and he is now doing fine. And after that, his mother disclosed that she was also taking care of a child who lost its mother at a very young age. I probed more and asked if I could test the child. The test was positive and I managed to link the child to care. The child looks good and feels good now. She doesn’t get sick like before. This makes me happy and am proud of myself at least I have saved a life.” (CHiP)

In other bizarre experiences shared by the PopART intervention team staff: A female CHiP reflected how a client insisted to the PopART team visiting his household that he was born naturally circumcised and attempted to show them. And in another instance, a client attempted to remove all his clothes off to show the CHiP team during a household visit a skin rash that had spread all over his body.  Some of the CHiPs narrated how at the beginning of the study they would sometimes be mistaken for political cadres. Another CHiP recalled a field encounter when instead of conducting HCT they found themselves as first responders to an expectant woman’s call for help and helped to conduct a home delivery, after which they assisted the woman to the health facility for onward care.

“In year one we tested the wife in absence of the husband and the results were negative. Shortly afterward, the husband came and the wife asked the husband to also test but with a warning that if her results came out positive that would be the end of their marriage. Later, the wife left the house to go to the market and the husband asked to be tested in the absence of the wife and he tested HIV positive.

In year two, we went back to the household and tested the wife again. She tested positive. But she could not understand how she could be positive when her husband was negative (the husband had told her that he tested negative when in actual fact he was positive). The wife refused to start treatment fearing the husband who thought she was negative. The husband-had refused to start treatment for fear of being divorced by the wife who he believes was negative.”-  (CHiP)

“In annual round two, I went to a household where I tested a seven (7) year old girl and she was reactive. Unfortunately, she was not linked to care because her father’s family said that she was too young to be HIV positive, and the girl’s mother’s relatives insisted her mother died of witchcraft and not HIV. In annual round three, I learned that they had not yet linked her to care because of the misunderstanding and beliefs from the two families. This matter was reported to the supervisor and the youth counsellor but to no avail. Eventually the girl got very ill and that is when they cousin decided to take her to the clinic. The file was opened for the girl. As I.mm writing, the girl’s condition has improved.”(CHiP)

“A 13 year old client told me that he was denied condoms, so he only picks the used condoms, washes them and then use them. The CHiP advised him not to pick used condoms because they are contaminated. He was counselled on abstinence ad tested for HIV and condoms were given to him.”- (CHiP)

In delivering the house-to-house PopART HIV prevention package in the various study communities, the field teams comprised of Community HIV Care Providers (CHiPs); Research  Assistants; Research Nurses; Community Mobilisers; worked in collaboration with community leaders and health facilities. Over the course of the four years of study implementation, PopART staff forged great friendships and further strengthened the nearly 3 decade old partnership Zambart has had with the communities.

Thanks to everyone for their support, dedication, and teamwork that continues to make Zambart a solid community-focused local research organization working to improve health for all Zambians.

 

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World TB Day 2016

On March 24, 2016, Zambart joined the rest of the country in commemorating World TB Day. Across different study sites in Lusaka, Copperbelt and Southern provinces, Zambart staff under the on-going HPTN 071 (PopART) study engaged in different awareness – raising activities in the local communities.

PopART-ART-Interevntion-ManagerPopART study Community HIV Care Providers (CHiPs) distributed condoms, conducted TB screening and sputum collection, community HIV Counselling and Testing (HCT) mostly targeted at adolescents and men.  They also sensitised the communities on TB stigma, TB management, infection control and prevention.

Tents were mounted in select areas where CHiPs were positioned to specifically target the youth and adolescents.

TB Corner staff and Community Advisory Board Members (CAB), PopART study implementing partners and district health staff in some study sties, joined the CHiPs in the community awareness-rising campaigns.

Zambart staff took the lead and screened for TB first as well breaking down barriers by submitting sputum for examination.

Communities in all the PopART study intervention sites were involved in the World TB day commemorative activities. These include: Chimwemwe and Ndeke in Kitwe; Chifubu in Ndola; Makululu in Kabwe, Kanyama and Chipata in Lusaka, and Maramba and Dambwa in Livingstone.

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Adolescents in the PopART Trial

Uptake and acceptability of a combination HIV prevention package among young people in Zambia and South Africa:

A new ancillary study to be nested in the HPTN 071/PopART trial, and whose aim is to evaluate the acceptability and uptake of a community-level combination HIV prevention package that includes Universal HIV Testing and Treatment (UTT) among adolescents has started.
The inclusion of adolescents in the HPTN071/PopART study was approved by the ethics committee on 14th September 2015 and study started end of October, 2015. The study, mostly funded by the United Kingdom government’s Department for International Development (DFID), Norwegian Agency for Development (NORAD), and Sweden, will be a community randomized comparison of a combination prevention approach, combined with youth targeted interventions.
The Adolescents in PopART study will provide process data on the uptake of HIV testing and linkage to HIV prevention and care by adolescents aged 15-20 years old, and is expected to provide evidence on the acceptability and uptake of HIV combination prevention packages including Universal Test and Treat in young people. It also provides an opportunity to add and evaluate youth specific interventions for prevention and care.
sam_9428Previously, there was no specific adolescent focus in the PopART trial, and all impact measures occurred in adults aged 18-44 years only. However, the Adolescents in PopART study, will address the unique needs of this key population as it presents an opportunity to assess whether a population-level strategy of combination HIV prevention including universal HIV testing and treatment is effective in reaching adolescents. The findings from the study are expected to have policy and practice implications within the Southern Africa region and beyond.
The Adolescents in PopART study is being carried out by a consortium of partners: Zambart; Desmond Tutu TB Centre, Stellenbosch University, South Africa; London School of Hygiene and Tropical Medicine; and Imperial College, London. The study will be nested within all the 21 PopART study communities in Zambia (12 sites) and South Africa (9 sites).
Following regulatory approval of the study, re-orientation was rolled out in October 2015 across all intervention sites, in addition to prior training of all study staff in May 2015, in Livingstone on how adolescents will be incorporated into the intervention activities of the trial.  Dr Joseph Chaila, the study manager explained that the adolescent study has since been activated in all the sites and will run for 26 months.
Kelvin Phiri, a CHiP from Kabwe said-“Adolescents have been disadvantaged in terms of access to HTC in the past and the door- to door approach may be one way to offer this service although our counselling skills are already been “challenged” in a positive way”.
“Adolescent inclusion in the study is good because in the first year we were just referring children to the facility for counselling and testing and parents were reluctant to take children, especially when the child was not sick; this time the service is delivered at their door step” said Osborn Mashawira CHiP supervisor from Kabwe.

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HPTN 071/PopART Site Monitoring Visit

An HPTN 071 team was in Zambia recently to conduct a site monitoring visit of some of the PopART study sites. Sara Fidley of the London School of Hygiene and Tropical Medicine (LSHTM), and Sam Griffith and Ayana Moore of FHI 360 in the United States, arrived in Zambia on November 2-6, 2015. Accompanying them were Zambart Research Director and PopART Site Principal Investigator Dr Helen Ayles, and Study manager Dr Kwame Shanaube.

The monitors’ first port of call was the tourist capital Livingstone where for the next two days they would meet with the intervention teams, conduct field visits and on-site inspections at the Dambwa and Maramba PopART site offices.

The team proceeded to the capital Lusaka where they split into two groups with Mr Griffith going to visit Kanyama site, and Ayana and Sara going to Chipata site. Here they were accompanied by the site study leadership, managers, and site supervisors. In Chipata their focus was on the Population Cohort, but had time to interact with the medical staff at Chipata first level hospital who included the Medical doctor in charge of the hospital, and the ART-sister in Charge, in addition to the rest of the PopART staff. The team also managed to accompany the PC nurses in the field.

Sam Griffith accompanied by the Intervention team from head office, toured Kanyama site. In addition to accompanying the CHiPs in the field, he also received an update from site staff on various activities carried out including inspection of registers at the PopART Information Desk. Implementing partners from CIDRZ were also available to provide additional updates.

Their last visit was Makululu site in Kabwe where they noted a marked improvement in the various intervention activities, particularly in HIV, Counselling and Testing (HCT), and that CHiPs were paying more attention to detail.

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University Teaching Hospital Conducts QA in HIV testing in PopART Study

Zambart, contracted the University Teaching Hospital (UTH) Virology Laboratory, under Ministry of Health to conduct external Quality Assurance (QA) in HIV proficiency testing for all the 459 HIV counselors under the on-going HPTN 071/PopART study.
The UTH’s virology department is the only HIV rapid testing certifying institution under Ministry of Health and was contracted to give an independent assessment on HIV proficiency testing. Of the 459 PopART counselors, 444 were tested out of which 94 percent scored a 100 percent mark — the required pass mark, while 6 percent failed the test.

“The main objective of this activity was to have an independent and credible institution cross examine the counsellors in HIV proficiency testing, assessing if HIV rapid testing is correctly done and results are accurately interpreted,” said Comfort Phiri Musonda, the PopART study HTC QA/QC manager.
This was the first time Community HIV Care Providers (CHiPs) and other counsellors under the study were tested for HIV proficiency externally. The activity was conducted in third quarter of 2015.
Ms Musonda reported that, “97 percent of all HIV testing counselors in PopART study were tested, and overall they performed well especially that this was the first time to perform this type of test.”

However, annual HIV proficiency testing is conducted internally using liquid plasma. Ms Musonda said, “This exercise helps to assess the ability of an HIV testing counsellor to perform the test correctly as per outlines or SOP and interpret results accurately.”

Counselors that failed the proficiency testing QA will not be permitted to perform any client testing until they are re-trained and pass the second external QA.  Ms Musonda explained that all the counselors that failed the external QA HIV Proficiency testing would have to undergo additional training.

In the re-training, individual attention will be paid to, “Determine HIV rapid test outline; Unigold HIV rapid test outline; use of national HIV testing algorithm; interpreting HIV test results; and finger prick HIV rapid testing procedure, after which they will be re-assessed in external QA HIV proficiency,” she said.

Ms Musonda, said she would continue to discuss HIV testing procedures with the PopART District Intervention Coordinators and CHiP supervisors during her quarterly site visits, while the DIC and CHiP supervisors will include HIV rapid testing procedure to their agenda items during monthly intervention meetings.

PopART Enrolls Populations With Disabilities

Makululu Enrols Special Population Groups in PopART Study

In a bid to scale up linkage to care and Universal Test and Treat, the Kabwe PopART intervention team at Makululu site have begun to enrol individuals from special population groups.

As the Community HIV Care Providers (CHiPs) go about their intensified field activities to engage more men and strengthen linkage to care of clients, they have increasingly encountered people with physical disabilities, particularly the hearing and speech impaired in need of the PopART intervention services.

While this initially presented a new challenge for the teams, they quickly overcame it and have since mobilised themselves, partnered with a qualified sign-language interpreter and are constantly on the lookout for special population groups within Makululu community.

Because the numbers of individuals from special populations groups have been steadily increasing, the PopART team, working with the interpreter, has been prompted to conduct special orientation sessions for the members of groups they have encountered on basic HIV transmission, prevention and treatment methods.

Over 10 couples have so far been enrolled, and all of them on ART.