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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.

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Zambart Sensitizes Community-based Organisations on Clinical Trials and Social Research

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.

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Zambia PopART Team in Mammoth Training for Study Annual – Round 2

In April and May 2015, Zambart organised an intense re-fresher and skills-building training for the entire HPTN 071/PopART study staff cohort ahead of the start of  the second annual round of the trial.
Over 550 members of staff drawn from PopART’s intervention, population cohort, social science, data, and laboratory, administration and finance teams converged at the Fairmount Hotel in Zambia’s tourist capital Livingstone, to be prepped on how to approach various components  of the study  implementation in year two.
Staff under the two PopART sub-studies namely Case Control and Stigma studies also joined the training.
The training held in 3-phases owing to the large numbers of staff, was conducted by different study team leaders led by site Principal Investigator Dr Helen Ayles, study manger Dr Kwame Shanaube; Zambart Chief Executive Officer Dr Alwyn Mwinga, and senior management. They were joined by resource persons from HIV Prevention Trials Network (HPTN) of USA, South Africa’s Desmond Tutu TB Centre (DTTC).
The training provided the various study groups particularly the Community HIV Care Providers (CHiPs) with knowledge on how to handle the year 2 data collection and continued offering of services to the various intervention communities. Other topics included new strategies to; adherence, initiatives to improve HIV uptake, initiatives to scale up male uptake of PopART services, linkage to care, messaging, VMMC, rapid HIV testing, Tuberculosis diagnosis and treatment.
Dr Mwinga, in her meetings with various PopART field staff urged everyone to be committed to their work and maintain high standards of discipline. She took time to meet with different study teams to discuss administrative and human resources issues.
The training was run on a tightly packed schedule in which facilitators also took the training opportunity to re-orient all teams. It was also an opportunity to review the successes and challenges from the just ended first annual round of the study. However, due to limited time to adequately training such a huge staff cohort, it was realised that additional training would be required at site-level.
At the end of the training, there was an awards presentation ceremony in different categories and a number of sites walked away with trophies. The awards were meant to motivate all PopART staff to improve their output to ensure that HOPTN 071 is a success.
Meanwhile, subsequent trainings were rolled out May through June, across all sites, to provide the CHiPs with a more practical approach in capturing data for the intervention in year 2, with a focus on migration and handling of adolescents. It also emphasized HIV, TB, STI and MMC follow-ups.
Makululu site in Kabwe, conducted a one-day training for all staff with the objective of addressing some of the gaps left by the Livingstone training. “Some of these gaps were identified as key areas in the implementation of PopART in year 2,” explained Prince Mweemba, PopART district Intervention Coordinator for Kabwe.
Mr Mweemba, said field staff needed some revision and have their skills assessed in readiness for the implementation of the intervention in year two, especially that new fields to include minors, had been added in the EDCs.

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Zambart Joins National VCT Day Commemoration – 2015

On June 30th, 2015, Zambart joined the rest of the country to commemorate the annual National Voluntary and Testing and Counselling Day aimed at raising uptake of VCT services to accelerate HIV prevention in the country. National VCT Day also provides Zambia with the opportunity to increase access to and awareness on HIV information and prevention measures.
Zambart through its various research programmes collaborates extensively with the government through the ministry of health, and ministry of community development, mother and child health. Staff under Zambart’s on-going HPTN 071/PopART study, an HIV prevention trial, joined district health teams and other stakeholders in community level sensitisation and awareness creation activities.

Commemorated under the theme “Universal access to annual HIV counselling and testing”, PopART study teams, mobilised themselves and joined efforts to use this opportunity to raise community awareness on the importance of VCT and other HIV treatment and prevention efforts. The PopART team’s activities saw them distribute nearly 140,000 condoms across all sites.
In Kabwe, Zambart participated in the march past and health race from which PopART staff scooped two awards for winning the 50-meter dash. Zambart was the largest provider of VCT services at the commemoration venue in Katondo compound, outside Makululu. In a bid to raise the study’s profile among the community and statkeholders, the team also managed to get PopART study chitenge to adorn the official high table.

“Setting up the information desk table with a staff to receive clients placed outside the tent, gave us the great advantage and chance to deliver the information extensively,” said PopART District Intervention Coordinator, Prince Mweemba. He said 79 clients tested for HIV, of which 44 were males while 35 were female.

And in Livingstone, PopART study staff together with Community Advisory Board members sensitised communities satellite activities in Maramba and Dambwa, two of the PopART study sites. At the official district commemorations held at the Civic Center, PopART staff distributed fliers, male and female condoms, and offered free VCT services at the Zambart stand.  At the occasion, Livingstone District Task Force Chairperson expressed concern at the low uptake of VCT levels in the district, which has the highest HIV prevalence rate in Zambia at 23.5 per cent.

Clement Mwikamui, PopART study District Administrator for Livingstone, reported that, “Zambart participation at this year’s event was well coordinated and was appreciated by the District AIDS Task Force, the District Community Medical Officer and other stake holders and members of the public who passed through our stand to find out about our activities and undergo VCT.”

Meanwhile in Kitwe, Zambart took the lead role in offering HIV testing services during the main commemoration event held at Chimwemwe’s Kamunga station. The PopART team established the VCT Technical Committee comprising intervention, PC, and community engagement staff to spearhead the planning for activities for each of the study sites in Kitwe.
“Our objective was to increase testing uptake for local and external community members with a special focus on those community members that did not test during our annual round one,” explained PopART study District Administrator for Kitwe, Delgracious Chansa.

Mr Chansa, said the VCT commemoration has now opened additional doors of partnership with other stakeholders who will be part of the annual round two implementation such as Nkana College of Education, located in the heart of Chimwemwe, an Arm A site and accommodates more than 500 students who are mainly based in the community for three years.  The PopART team managed to distribute more than 36,200 condoms at the event.

In Ndola, the VCT day event was held in Mushili area, at Kaloko primary school. The Ndola PopART team distributed condoms to participants who welcomed this free condom distribution.
“The response from the members of the community was overwhelming and condoms were finished in a short while,” reported Wisdom Chansa, PopART District Intervention Coordinator (DIC) for Ndola.
CHiPs supported other stakeholders at the event with the counselling process, and gave health education talks based on the PopART study approach. A total number of 10,260 condoms were distributed by the end of the event.
In Lusaka, Chipata PopART site held satellite VCT activities from June 25 through 27th. The activities included on-site counselling and testing, condom distribution, and Voluntary Medical Male Circumcision (VMMC). The site also took time to sensitise the clients on PopART.

Meanwhile Kanyama PopART site conducted various outreach activities in various parts of Kanyama PopART catchment zones from June 26th to 30th. The team conducted sensitization on HIV Counselling and Testing, distributed condoms and flyers.
On VCT day, Chipata and Kayama sites teamed up to participate in the event held at Olympia Africa and provided on-site mobile VCT services. The team distributed nearly 50,000 condoms in their satellite activities and on VCT day.

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Kanyama Hospital Open Day

Kanyama-hospital-Open-Day-286In recent past, Kanyama Clinic, a government-run health facility in Lusaka district was elevated from being a basic health care clinic to First Level Hospital status. This led to the hospital to host a colourful Open Day event on Tuesday 26th November, 2013 at which it showcased its facilities and services to the community. Kanyama is the largest and most densely populated communities in Lusaka.Kanyama-hospital-Open-Day-132

The Open Day saw various organisations that operate at the hospital offering different health care services participating in the event. They exhibited their respective services that they offer to the public. Zambart is among the various implementing partners working with the Ministry of Health (MoH), and Ministry of Community Development, Mother and Child (MCDMCH) in disease diagnostics, treatment, prevention and control who operate from Kanyama Hospital.

Kanyama-hospital-Open-Day-342The partners comprising different health non-governmental organisations, research organisations, community-based organisations including the Neighbourhood Health Committee used the Open Day occasion as an opportunity for community engagement and awareness-raising on different health issues. The distributed flyers and information leaflets and had on display posters and banners to sensitise the community on health matters. The also hospital gave free medical check-ups to the public that included blood pressure checks and sugar-level tests.

Lusaka District Health Management (LDHMT) Team Director Dr. Masumba Masaninga, was Guest of Honour. Dr. Masaninga addressed the audience on various health and medical issues, and took time to visit all information booths for the different departments at the hospital and for the partners operating from the hospital.Kanyama-hospital-Open-Day-338

Kanyama hospital in collaboration with various implementing local and international partners provides community-based disease control programmes for Malaria, Diarrhoea, Cholera, Dysentery, TB screening and treatment, HIV prevention and treatment. Other services include the Out-Patients Department, Voluntary Country and Testing, Medical Male Circumcision, Prevention of Mother-To-Child Transmission of HIV (PMTCT), and other Safe Motherhood programmes, Dental, etc.

The Open Day was characterised with different activities that included thematic drama performances, song and cultural dances.

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Zambart, CIDRZ and AERAS Train Community TB Advocates

Zambart and its collaborating partner Centre for Infectious Diseases in Zambia (CIDRZ) in the Phase IIb trial of a new tuberculosis vaccine awaiting activation, held a two-day training for TB community advocates at Lusaka’s Cresta Golfview Hotel.

IMG_444950 community engagement advocates drawn from various community based organisations in Lusaka’s Kanyama and Kalingalinga compounds, the study sites for the vaccine trial, attended the workshop, which was aimed at strengthening community engagement and advocacy capacity on TB treatment.

The trial also called TB 018, is being jointly conducted by Aeras and GlaxoSmithkline Vaccines, S.A. (GSK), and is a double-blind, randomised placebo-controlled study. Overall, the trial will enrol more than 3500 healthy adults, with latent (asymptomatic) TB infection (LTBI), ages 18-50 in three sub-Saharan African countries namely Zambia, Kenya, and South Africa.IMG_4453

Zambart has been conducting various clinical trials in TB in Zambia and beyond, for over 2 decades now.