Study staff as they writing down their reflections on their challenges encountered during their course of duty, successes, lessons learned, and their experiences
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.
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.
All 618 study staff shared their reflections and experiences and contributed to building of this PopART study reflection tree from their day to day work implementing study.
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 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.
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.
Previously, 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.
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.
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.
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.
The HPTN 071/ PopART community engagement team in collaboration with other Zambart units conducted a two-day research literacy workshop for civil society and community-based organisations at Zambart House from 2-3 September, 2015.
The purpose of the CPP workshop was to orient the members about research, and in particular clinical trials and social research. The workshop was aimed at raising awareness among civil society and community-based advocacy organisations working in HIV prevention and treatment on the importance of research in generating evidence for advocacy and influencing policy.
The workshop also emphasised the importance of using a systematic approach to data collection and analysis for research findings to be credible.
As a health research organisation, Zambart has established the Community Partners Platform (CPP), a vehicle through which it engages with various civil society stakeholders and advocacy groups in the research activities the organisation undertakes.
CPP comprises 7 main organisations representing People Living with HIV such as the Network of Zambian People living with HIV (NZP+), Treatment Advocacy and Literacy Campaign (TALC), Zambia Network of ARV users (ZNARVs), and International Community of Women living with HIV (ICW).
Some of the topics discussed during the workshop included the important contents of a study protocol; principles of social and clinical research; and the role of ethics and Good Clinical Practice (GCP) in ensuring that research participants are respected and data collected from them is treated with utmost confidentiality.
Musonda Simwinga, the PopART study community engagement lead said the CPP participants found the workshop useful and applicable to their work, with some expressing concern for instance, that government had not taken seriously findings of their survey on patient experiences with frequent treatment regime changes because their surveys had not been systematic.
Mr Simwinga said, the CPP members requested for more skills building activities with some expressing interest in protocol writing and capacity building in data collection and analysis, particularly the use of qualitative data analysis software, Atlas ti.