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Zambia-South Africa PopART Study CHiPs Twinned for Field Visit

Zambia – South Africa HPTN 071/PopART Study Community HIV Care Providers conduct joint field visits:

HPTN 071/PopART study Community HIV Care Providers (CHiPs) got a chance to work side-by-side in delivering the study intervention package in Kanyama and Chipata PopART sites during the recently held HPTN 071 annual workshop held in Lusaka. Other workshop delegates also braved heavy rains to visit some PopART sites in Zambia.

P1010354The field teams comprised from the Zambart and Desmond Tutu TB center (DTTC) comprised CHiP teams, District Administrators, CHiP supervisors, community mobilisers, social science research assistants, population cohort research assistants, district intervention coordinators, and Human Resources manager from DTTC also accompanied the teams.

The teams were twinned according to their respective work in the field. This allowed the Zambian team to share experiences and lessons, and also interact with their South African counterparts on the work they do. It also gave the South African team a direct glimpse of the Zambian field situation.P1010359

The teams drew more similarities in the PopART study implementation in both countries than differences, but noted some differences in the roles. In Zambia for example, the DICs have mixed professional backgrounds, while in South Africa DICs are nurses. It was also observed that under population cohort, quality control is done on site by the PC nurse in Zambia, while in South Africa, QC is done by the PC research assistant and where the PC nurses and research assistant’s daily targets are half of those for their Zambian counterparts. However, the number of clients an intervention team is expected to recruit per day was less for Zambia 8-9, than their South African colleagues recruit at 11 clients per day.

However, notable differences included a violent work environment for South Africa, particularly for their research assistants who because of violence have to move in a vehicle, than Zambia. In addition, it was learned that social science research assistants in in South Africa do not attend community meetings unlike their Zambian counterparts.

South African and Zambian CHiPs

The South African field teams reported that houses in South African study communities were very close together than in Zambia, making it easier for the intervention and PC to reach more people in a smaller catchment area. However, PopART zones in Zambia are much larger than those in South Africa and the large distances enabled the Zambian CHiPs to be more thorough and spend more time with clients.

Zambart communications caught a group of the South African field staff upon their return from the site and they had this to say:

“It was a great experience, they do exactly the same consent forms as us. What is interesting is that the PopART staff here escort a sick client to the clinic, in South Africa we don’t, we refer them to other community health workers,” said Babalwa Solinjani, a South African CHiP among those paired with their Zambian colleagues at Chipata site.

Phindiswa Malangeni, another Arm “A” CHiP noted the different ethical considerations. “In South Africa, we write a referral letter and indicate the client’s HIV status, in Zambia they give the client a referral slip to take to the clinic.”

P1010340Another CHiP Siziwe Makonza, noted that the relation between Zambart PopART and staff at the government clinic is good. “But the stigma experiences and most of the problems our Zambian counterparts face in the field, we are also encountering the same challenges,” she said.

Chipata PopART site District Intervention Coordination Rosemary Zulu described the CHiPs twinning was a good initiative that should be encouraged as it helped field staff to interact with their counterparts. “This interaction made it possible for the field staff to share lessons learned from their respective countries,” she said.

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Zambart Commemorates International Condom Day 2015

Zambart joins LOVE Condoms Campaign

Zambart joined local HIV stakeholders to mark the global 2015 International Condom Day which was held under the theme ‘Condoms are Cool’. The event held annually on February 13 on the eve of Valentine’s Day – February 14, is organised by the AIDS Health Care Foundation (AHF) to promote safe sex through widespread access, usage and acceptance of condoms as a vital component of the global fight against the AIDS pandemic.

In Zambia, the event attracted participation from the National AIDS Council (NAC), Ministry of Community Development, Mother and Child Health (MCDMCH), local HIV non-governmental organisations, students from higher learning institutions such as the University of Zambia, National Institute of Public administration (NIPA) and Evelyn Hone College.

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International Condom Day

MCDMCH minister Emerine Kabanshi, the Guest of Honour at the event and said government planned to double the procurement of antiretroviral drugs and improve service delivery infrastructure.  AIDS awareness activities characterised the event, which included live performances by local performing artists. Rapid HIV testing, accompanied by condom distribution and other HIV prevention services were also offered on-site by various organisations at the event.

Zambart teams from Kanyama and Chipata sites who included PopART intervention manager, district intervention coordinator, social science research assistants, Community HIV Care Providers (CHiPS) and their supervisors, took the opportunity to do some outreach work for the on-going HPTN 071/PopART study which is testing the impact of a combined package of several HIV prevention interventions at the community level on HIV transmission.  Condom distribution to households and the community in intervention sites is part of the PopART study intervention package.

Created in 2008, International Condom Day is a campaign that seeks to put an estimated 20 million HIV positive people on ART by 2020. AHF wants sexually active people to consistently use condoms to help reduce the risk of new HIV infections.

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Zambart Signs MOU with School of Medicine

IMG_4322---CopyZambart signed a Memorandum of Understanding with the University of Zambia’s School of Medicine on 13 February 2015, which would see the organisation support capacity building for the utilisation of routinely collected HIV data for strengthening services and provide transparency about the benefits and equity in delivering services to people living with HIV in the Ministry of Health (MoH), and the Ministry of Community Development, Mother and Child Health (MCDMCH).

The MoU signed under SEARCH (Sustainable Evaluation through analysis of Routinely Collected HIV Data) project is aIMG_4306 collaboration with the London School of Hygiene and Tropical Medicine (LSHTM), MoH, and MCDMCH.

As one of the project outputs, Zambart, will use its research capacity to support PhD training for Fellows in the MoH and MCDMCH. The PhDs are being offered by the School of Medicine and will be supervised by staff from Zambart and the Department of Health, further strengthening links between the two institutions as well as the training program of the department of Health.

IMG_4311Zambart CEO and SEARCH project coordinator Dr Alwyn Mwinga said the MoU underscores Zambart commitment to research capacity building to strengthen the public health response in Zambia. “The project is one that will strengthen the capacity for routine data analysis and use of data for decision making.”

SEARCH aims to among other things, provide transparency about the benefits and equity in delivering services to people living with HIV. It is being carried out in Tanzania, with Zambia being the second country to get involved.

IMG_4317---CopyZambart statistician and Head of the Data department, Ab Schapp, said Zambia has a huge HIV programme whose data was not utilised. “HIV care is being outsourced; the implementation of HIV care is being done by implementing partners. Building local capacity will help government to utilise its own data to improve service delivery,” he said.

SEARCH project is mainly funded by the Bill and Melinda gates Foundation and the Principal Investigator Jim Todd, is based at the LSHTM.

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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.