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.


Clinical Performance Study field visit by the Principal Investigator

Principal Investigator, for the Self-Testing Africa Project (STAR) Dr Helen Ayles, on June 8 2016, joined the Clinical Performance Study (CPS) team in M’tendere Township, in Lusaka, one of the study sites of the project. The two-year programme funded by UNITAID to provide cost-effective solutions for expanding existing HIV testing services, is being conducted in Zambia, Malawi, and Zimbabwe.

Dr Ayles, who is the Zambart Research Director, wanted to get a hands-on view of how the Clinical Performance Study is being carried out and to learn some of the field challenges staff are experiencing. She also observed how participants conduct the self-test using the provided OraQuick® HIV self-test kit, and how they read and record their own results.

The study will determine whether oral fluid HIV self-tests can be used effectively and read accurately across different populations in Zambia. The study will compare the results of oral fluid tests with a laboratory-based blood test to determine the sensitivity and specificity (ability of the test to pick out true positives as positives (Sensitivity), and to pick out only the HIV anti-bodies specifically (Specificity). Further, CPS aims at establishing the accuracy of the HIV self-test when used by intended users, who include: adolescents and adults in urban and rural Zambian settings.

Captured in the picture above, Dr Alyes, looks on as a CPS Research Assistant, Debbie Sibayuni, enters data into an Electronic Data Capturing device, collected from a study participant in Kalikiliki area, a densely populated compound on the outskirts of M’tendere community. The client is asked questions about the self-test after she performed an HIV self-test using OraQuick®.

2OraQuick® is being piloted in M’tendere and Kanakantmpa communities in Lusaka and Chongwe districts respectively, to determine the acceptability of HIV self-testing. Self-testing can help to reach those who are unable to access HCT services because of various social, cultural and geographical challenges, and encourage re-testing among those at high-risk. It can also help to reach those unlikely to use current HIV testing services because of privacy issues or lack of convenience.

Zambart has engaged with a consortium of researchers and implementers to provide research expertise in Zambia for the use of HIV self-tests in populations with the greatest need. The consortium is led by Population Services International (PSI) led collaboration, which includes the Ministry of Health, and Society for Family Health as the main distributors of the OraQuick HIV Self-Test kits. Other partners ion the STAR project are the London School of Hygiene and Tropical Medicine (LSHTM), the Liverpool School of Tropical Medicine (LSTM), University College London, and the World Health Organisation (WHO), and the Ministry of Health.


Zambart public engagement project: Nzuna lulila ya sugar

For the last few years we have been working on some research projects that have focused on how diabetes affects tuberculosis in Lusaka (The DARTZ studies). Through this work we have met many people who are living with diabetes and we have listened to their stories. We have heard story after story about the difficulties and barriers that individuals living with diabetes face in Lusaka. Stories of years of multiple visits to clinics with diabetes symptoms before a diagnosis is made. Stories of young people with severe complications because they haven’t been able to access adequate treatment. And we have seen patients die in their twenties and thirties from uncontrolled, untreated diabetes; deaths that could have been prevented with long-term adequate treatment. Tuberculosis has a structured and coordinated service for diagnosis and treatment that exists throughout the country, but diabetes lacks even basic national guidelines for its management. We therefore wanted to help to raise the profile of diabetes and decided to do this through the use of cartoons.


We invited some people living with diabetes to join a small workshop. Six participants attended. During the workshop we discussed the difficulties and challenges that result from living with diabetes. The main challenges that emerged during the workshop were accessing care at the clinic, accessing appropriate food products and accessing accurate information about diabetes. We invited a cartoonist, Kiss Brian Abraham, to observe the workshop and draw some cartoon pictures based on the discussions throughout the workshop and with the involvement of the workshop participants. We then used the cartoon pictures to inform the wider public about diabetes and raise the profile of some of the challenges facing people living with diabetes. We hope that this will help to provoke solutions to be found for these challenges and ultimately help to improve the lives of people living with diabetes in Lusaka.

The cartoon pictures can be seen in the accompanying leaflet.



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.


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.

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.


IAG Representatives Visit PopART Study Sites

HPTN 071 International Advisory Group visit Chipulukusu, Kanyama, Chawama and Chipata sites:

IMG_5508 Co-funders of the HPTN 071/PopART study and members of the International Advisory Group (IAG) visited Zambia in February, and took time to visit arm A and C sites in Chipulukusu (Ndola), Chipata and Chawama (Lusaka) to get a ground level view of how the study is progressing.

The IAG team comprised representatives from the Global Fund, World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), US National Institutes of Health,  and US National Institutes of Mental Health (NIMH), London School of Hygiene and Tropical Medicine (LSHTM).

P1010372Local site staff were on hand to receive and give the IAG members who had split into groups for the respective site tours. From head office PopART study site PI Dr Helen Ayles, PopART study manager Dr Kwame Shanaube, intervention manager Ephraim Sakala, population cohort manager Justin Bwalya, and HIV testing quality control manager Comfort Rutty Phiri, joined the site-based staff who included respective district intervention coordinators, district administrators, Community HIV Care providers (CHiPs), and community mobilisers.

The IAG members were able to observe day-to-day activities at the Kanyama, Chipata, and Chawama first level hospitals as well as Chipulukusu health clinic where their tour of the facilities were led  by the respective sister in-charges. Twinning-at-Kanyama-04.02.2015-049They met with the PopART clinical research nurses and visited the ART clinics, ART pharmacies, laboratories and Data rooms where they interacted with heads of department on the number of cases, flow and processing of patients, and investigations carried out on clients and distribution of results, and filing of clients’ record. They also visited other hospital departments like the Mother and Child Health (MCH), main Laboratory.

Meanwhile in the field where they had been paired to accompany the CHiPs in the community, the advisors got to observe CHIPs offering the intervention Twinning-at-Kanyama-04.02.2015-058package including conducting the HIV rapid tests. However, not all IAG teams were able to go out in the field because of rainy weather, for example in Chawama. .

The IAG  team noteda marked improvement in the delivery of the PopART intervention in the community and at the sites, and expressed satisfaction. Specifically, they noted the amount of work put in by the CHiPS when offering health education about the various PoPART interventions, and the fact that clients were not pressured into consenting to be enrolled in the study. The advisors were also able to directly the various field teams.



HPTN 071 Case Control Studies

Evaluation of universal HIV testing in PopART study underway:

IMG_3868A third sub-study of the on-going HPTN 071/PopART study has started in the Zambia PopART sites. The Case Control Studies will seek to evaluate the home-based PopART intervention delivered house-to-house by the Community HIV Care Providers (CHiPs). The studies will specifically examine the HIV testing, a key component of the PopART intervention package, and will be progressively rolled out in arms A and B sites in Zambia. In March, the case Control studies will be extended to a further 6 intervention sites in South Africa.

IMG_3877Clinical epidemiologist, Dr Kalpana Sabapathy working on the PopART trial and manager of the Case Control studies explained that the cases are randomly selected to represent the wider community to help PopART researchers understand the features and factors associated with the uptake and non-uptake of the PopART services in the first year of the PopART trial, and adapt the intervention accordingly.

“It was always anticipated that not everybody would accept the testing intervention, which is key in Universal Test and Treat approach. We planned this study as part of the main design of the trial to evaluate acceptability of the testing in the intervention after the 1st year to facilitate improvements which may be introduced in the 2nd and 3rd years,” Dr Sabapathy explained.

IMG_3869She said that by looking at differences between 2 groups of cases, researchers will get insight into sub-sets of the community not accepting the PopART intervention and allow them to adapt it in a bid to get those people not accepting the intervention to accept it eventually: “To achieve overall PopART goal of universal home-based testing,” Dr Sabapathy said.

The Case Control studies will run over a period of 2 months and involve 500 people in Zambia, and 300 in South Africa.


HPTN 071/PopART Study Annual Workshop – 2015

HPTN 071/PopART study staff and implementing partners from all over the world gathered from 2nd-5th February 2015 in Lusaka, for their annual workshop to review progress in the on-going HIV prevention trial being conducted in Zambia and South Africa, and chart the way forward as the trial enters its second year.

IMG_4032The Populations Effects of Antiretroviral Therapy to Reduce HIV Transmission study is a two country cluster-randomised trial of the impact of a combination prevention package on population-level HIV incidence. It is the single largest HIV prevention trial ever to be conducted involving over 1 million people, and is being carried out in 21 communities across Zambia and South Africa.

Study leadership and partners had an opportunity to hear directly from country staff who shared their experiences and challenges in the main plenary sessions and through working groups. Zambart Communications caught up with the study leadership to get their views on the study progress.

PopART is a realisation of combination prevention centred on maximising the use of antiretroviral therapy to see how far we can get in stopping new HIV infections. This is a big undertaking – HPTN principle investigator Dr Myron Cohen on the side lines of the workshop.

IMG_3999Dr Cohen said through several of the implementation activities, PopART was benefitting individuals and communities. “In the treatment communities, you see that everyone with HIV who needs treatment is receiving treatment. For every new case of HIV we prevent, there is a dramatic benefit to the families and to the individuals who avoid infection to their communities.”

Dr Cohen said PopART put together all the tools to prevent new cases of HIV. “HIV is the pandemic of the 20th century. We’ve spent 35 years getting ready to put these tools together and if we can maximise our prevention strategies and deploy them more generally, it will be a terrific advance.”

HPTN 071 Principal Investigator Dr Richard Hayes, said the study had made tremendous progress in the first year, whose main focus was getting people to test and know their HIV status. He said the Population Cohort had visited over 30,000 households with the intervention arm providing services to a large number of people.IMG_4018

“Overall, the achievement has been enormous. We’ve already got a lot of information that we did not have before on what are the challenges on delivering universal test and treat,” said Dr Hayes adding that the possibilities of delivering ART within the communities was now being considered. “We’re looking at how our Community HIV Care Providers can best support the process,” he said.

The PopART intervention main objectives in year two will be addressing major problem areas such as access to care, adherence and retention, and increasing the uptake of medical male circumcision.  “We found that we have much higher uptake of our services among women. This is something we need to work on very hard. It’s our number one challenge and we are looking at various strategies,” Dr Hayes said.

IMG_4085He expressed concern that unless those testing HIV positive  can get to the clinics and start accessing clinical services, the intervention would not work.  “We’ve been very good at getting people to test and finding out their status, but the next step is to get people into care and on to treatment and suppress the virus, and making sure we keep it suppressed all the time for years to come. This is critical,” he said.

Dr Hayes said despite the change in national ART guideline in Zambia and South Africa, PopART study will still be able to answer the main questions.

I am confident that as long as we can deliver the intervention to a high quality and achieve that high coverage that we are looking for, we will be able to answer the question whether this can reduce the number of new HIV infections substantially in these severely affected communities – Dr Hayes.