1
|
Scopazzini MS, Chansa P, Majonga ED, Bual N, Schaap A, Mateyo KJ, Musukuma R, Mweemba V, Cheeba M, Mwila CC, Sigande L, Banda I, Ngulube J, Shanaube K, Zenner D, Ayles H, Shah ASV. The burden and natural history of cardiac pathology at TB diagnosis in a high-HIV prevalence district in Zambia: protocol for the TB-Heart study. BMC Cardiovasc Disord 2024; 24:205. [PMID: 38600454 PMCID: PMC11007960 DOI: 10.1186/s12872-024-03877-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) continues to be a major cause of death across sub-Saharan Africa (SSA). In parallel, non-communicable disease and especially cardiovascular disease (CVD) burden has increased substantially in the region. Cardiac manifestations of TB are well-recognised but the extent to which they co-exist with pulmonary TB (PTB) has not been systematically evaluated. The aim of this study is to improve understanding of the burden of cardiac pathology in PTB in those living with and without HIV in a high-burden setting. METHODS This is a cross-sectional and natural history study to evaluate the burden and natural history of cardiac pathology in participants with PTB in Lusaka, Zambia, a high burden setting for TB and HIV. Participants with PTB, with and without HIV will be consecutively recruited alongside age- and sex-matched TB-uninfected comparators on a 2:1 basis. Participants will undergo baseline assessments to collect clinical, socio-demographic, functional, laboratory and TB disease impact data followed by point-of-care and standard echocardiography. Participants with PTB will undergo further repeat clinical and functional examination at two- and six months follow-up. Those with cardiac pathology at baseline will undergo repeat echocardiography at six months. DISCUSSION The outcomes of the study are to a) determine the burden of cardiac pathology at TB diagnosis, b) describe its association with patient-defining risk factors and biochemical markers of cardiac injury and stretch and c) describe the natural history of cardiac pathology during the course of TB treatment.
Collapse
Affiliation(s)
- Marcello S Scopazzini
- Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Zambart, University of Zambia - Ridgeway Campus, Off-Nationalist Road, Lusaka, Zambia.
| | - Pamela Chansa
- Department of Cardiology, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
| | - Edith D Majonga
- Biomedical Research Training Institute, 10 Seagrave, Avondale, Harare, Zimbabwe
- Department of Oncology, Medical Physics and Imaging Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nina Bual
- Echocardiography Department, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Albertus Schaap
- Zambart, University of Zambia - Ridgeway Campus, Off-Nationalist Road, Lusaka, Zambia
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Kondwelani J Mateyo
- Zambart, University of Zambia - Ridgeway Campus, Off-Nationalist Road, Lusaka, Zambia
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Remmy Musukuma
- Zambart, University of Zambia - Ridgeway Campus, Off-Nationalist Road, Lusaka, Zambia
| | - Veronica Mweemba
- Zambart, University of Zambia - Ridgeway Campus, Off-Nationalist Road, Lusaka, Zambia
| | - Maina Cheeba
- Zambart, University of Zambia - Ridgeway Campus, Off-Nationalist Road, Lusaka, Zambia
| | - Chipili C Mwila
- Zambart, University of Zambia - Ridgeway Campus, Off-Nationalist Road, Lusaka, Zambia
| | - Lucheka Sigande
- Zambart, University of Zambia - Ridgeway Campus, Off-Nationalist Road, Lusaka, Zambia
| | - Isabel Banda
- Department of Cardiology, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
| | - Joseph Ngulube
- Department of Cardiology, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
| | - Kwame Shanaube
- Zambart, University of Zambia - Ridgeway Campus, Off-Nationalist Road, Lusaka, Zambia
| | - Dominik Zenner
- Wolfson Institute of Population Health, Mary University of London, London, Queen, UK
| | - Helen Ayles
- Zambart, University of Zambia - Ridgeway Campus, Off-Nationalist Road, Lusaka, Zambia
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Anoop S V Shah
- Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
2
|
Simwinga M, Gwanu L, Hensen B, Sigande L, Mainga M, Phiri T, Mwanza E, Kabumbu M, Mulubwa C, Mwenge L, Bwalya C, Kumwenda M, Mubanga E, Mee P, Johnson CC, Corbett EL, Hatzold K, Neuman M, Ayles H, Taegtmeyer M. Lessons learned from implementation of four HIV self-testing (HIVST) distribution models in Zambia: applying the Consolidated Framework for Implementation Research to understand impact of contextual factors on implementation. BMC Infect Dis 2024; 22:977. [PMID: 38448832 PMCID: PMC10916003 DOI: 10.1186/s12879-024-09168-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Although Zambia has integrated HIV-self-testing (HIVST) into its Human Immunodeficiency Virus (HIV) regulatory frameworks, few best practices to optimize the use of HIV self-testing to increase testing coverage have been documented. We conducted a prospective case study to understand contextual factors guiding implementation of four HIVST distribution models to inform scale-up in Zambia. METHODS We used the qualitative case study method to explore user and provider experiences with four HIVST distribution models (two secondary distribution models in Antenatal Care (ANC) and Antiretroviral Therapy (ART) clinics, community-led, and workplace) to understand factors influencing HIVST distribution. Participants were purposefully selected based on their participation in HIVST and on their ability to provide rich contextual experience of the distribution models. Data were collected using observations (n = 31), group discussions (n = 10), and in-depth interviews (n = 77). Data were analyzed using the thematic approach and aligned to the four Consolidated Framework for Implementation Research (CFIR) domains. RESULTS Implementation of the four distribution models was influenced by an interplay of outer and inner setting factors. Inadequate compensation and incentives for distributors may have contributed to distributor attrition in the community-led and workplace HIVST models. Stockouts, experienced at the start of implementation in the secondary-distribution and community-led distribution models often disrupted distribution. The existence of policy and practices aided integration of HIVST in the workplace. External factors complimented internal factors for successful implementation. For instance, despite distributor attrition leading to excessive workload, distributors often multi-tasked to keep up with demand for kits, even though distribution points were geographically widespread in the workplace, and to a less extent in the community-led models. Use of existing communication platforms such as lunchtime and safety meetings to promote and distribute kits, peers to support distributors, reduction in trips by distributors to replenish stocks, increase in monetary incentives and reorganisation of stakeholder roles proved to be good adaptations. CONCLUSION HIVST distribution was influenced by a combination of contextual factors in variable ways. Understanding how the factors interacted in real world settings informed adaptations to implementation devised to minimize disruptions to distribution.
Collapse
Affiliation(s)
| | | | - Bernadette Hensen
- Department of Public Health, Sexual and Reproductive Health Group, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | | | | | | | | | - Moses Kumwenda
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Ellen Mubanga
- National HIV/AID/STI/TB Council (NAC), Lusaka, Zambia
| | - Paul Mee
- Department of Infectious Disease Epidemiology, Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Cheryl C Johnson
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Global HIV, Hepatitis and STI Programmes, World Health Organisation, Geneva, Switzerland
| | - Elizabeth L Corbett
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Karin Hatzold
- Population Services International, Johannesburg, South Africa
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Miriam Taegtmeyer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Diseases Unit, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| |
Collapse
|
3
|
Hensen B, Phiri MM, Sigande L, Schaap A, Simuyaba M, Zulu-Phiri R, Mwape L, Floyd S, Fidler S, Hayes R, Simwinga M, Ayles H. Self-reported uptake of STI testing services among adolescents and young people aged 15-24 years: Findings from the Yathu Yathu cluster randomized trial in Lusaka, Zambia. PLOS Glob Public Health 2024; 4:e0002491. [PMID: 38437238 PMCID: PMC10911628 DOI: 10.1371/journal.pgph.0002491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/18/2023] [Indexed: 03/06/2024]
Abstract
There is little evidence regarding community-based delivery of STI testing and treatment for youth aged 15-24 (AYP) in Zambia. In a cluster-randomised trial, we evaluated whether offering syndromic STI screening through community-based, peer-led sexual and reproductive health services (Yathu Yathu) with referral to a local health facility for testing, increased self-reported testing for STIs (other than HIV) among AYP. Two communities in Lusaka were divided into 10 zones each (20 zones in total); by community, zones were randomly allocated (1:1) to Yathu Yathu or control. Monitoring data were used to describe syndromic STI screening through Yathu Yathu and an endline cross-sectional survey used to evaluate the impact of Yathu Yathu on self-reported ever and recent (last 12 months) STI testing. 10,974 AYP accessed Yathu Yathu; 66.6% (females-67.7%; males-64.7%) were screened for STIs, 6.2% reported any STI symptoms. In the endline survey, 23.3% (n = 350/1501) of AYP who ever had sex ever STI tested; 13.5% (n = 174/1498) who had sex in the last 12 months recently STI tested. By trial arm, there was no difference in self-reported ever or recent STI testing among all AYP. Among men aged 20-24, there was evidence that ever STI testing was higher in the Yathu Yathu compared to control arm (24.1% vs 16.1%; adjPR = 1.67 95%CI = 1.02, 2.74; p = 0.04). Among AYP who ever STI tested, 6.6% (n = 23) reported ever being diagnosed with an STI. Syndromic STI management through community-based, peer-led services showed no impact on self-reported STI testing among AYP. Research on community-based delivery of (near) point-of-care diagnostics is needed. Trial registration number(s): NCT04060420 https://clinicaltrials.gov/ct2/show/NCT04060420; and ISRCTN75609016; https://doi.org/10.1186/ISRCTN75609016.
Collapse
Affiliation(s)
- Bernadette Hensen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Ab Schaap
- Zambart, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Helen Ayles
- Zambart, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
4
|
Hensen B, Gondwe M, Phiri M, Schaap A, Sigande L, Floyd S, Simuyaba M, Zulu-Phiri R, Mwape L, Fidler S, Hayes R, Simwinga M, Ayles H. Does distribution of menstrual products through community-based, peer-led sexual and reproductive health services increase use of appropriate menstrual products? Findings from the Yathu Yathu trial. Reprod Health 2023; 20:92. [PMID: 37340497 DOI: 10.1186/s12978-023-01631-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/30/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Globally, millions of adolescent girls and young women (AGYW) who menstruate have limited access to appropriate and comfortable products to manage their menstruation. Yathu Yathu was a cluster randomised trial (CRT) that estimated the impact of community-based, peer-led sexual and reproductive health (SRH) services on knowledge of HIV status among adolescents and young people aged 15-24 (AYP). Among the services offered through Yathu Yathu were free disposable pads and menstrual cups. This study aimed to investigate whether the availability of free menstrual products through Yathu Yathu increased AGYW's use of an appropriate menstrual product at their last menstruation and explored the characteristics of AGYW who accessed menstrual products through Yathu Yathu. METHODS Yathu Yathu was conducted between 2019 and 2021 in 20 zones across two urban communities of Lusaka, Zambia. Zones were randomly allocated to the intervention or standard-of-care arm. In intervention zones, a community-based hub, staffed by peers, was established to provide SRH services. In 2019, a census was conducted in all zones; all consenting AYP aged 15-24 were given a Yathu Yathu Prevention Points Card, which allowed AYP to accrue points for accessing services at the hub and health facility (intervention arm), or the health facility only (control arm). Points could be exchanged for rewards, thus acting as an incentive in both arms. We conducted a cross-sectional survey in 2021 to estimate the impact of Yathu Yathu on the primary outcome (knowledge of HIV status) and secondary outcomes. Sampling was stratified by sex and age group; we analysed data from AGYW only to estimate the impact of Yathu Yathu on use of an appropriate menstrual product (disposable or reusable pad, cup, tampon) at last menstruation. We analysed data at zone-level using a two-stage process recommended for CRTs with < 15 clusters/arm. RESULTS Among 985 AGYW participating in the survey who had experienced menarche, the most commonly used products were disposable pads (88.8%; n = 875/985). At their last menstruation, 93.3% (n = 459/492) of AGYW in the intervention arm used an appropriate menstrual product compared to 85.7% (n = 420/490) in the control arm (adjPR = 1.09 95%CI 1.02, 1.17; p = 0.02). There was no evidence for interaction by age (p = 0.20), but use of appropriate products was higher among adolescents in the intervention arm relative to control (95.5% vs 84.5%, adjPR = 1.14 95%CI 1.04, 1.25; p = 0.006) with no evidence for a difference among young women (91.1% vs 87.0%, adjPR = 1.06 95%CI 0.96, 1.16, p = 0.22). CONCLUSIONS Delivering community-based peer-led SRH services increased the use of appropriate menstrual products among adolescent girls aged 15-19 at the start of the Yathu Yathu study. With less economic independence, the free provision of appropriate menstrual products is critical for adolescent girls to access materials that allow them to effectively manage their menstruation.
Collapse
Affiliation(s)
- Bernadette Hensen
- Sexual and Reproductive Health Group, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | - Ab Schaap
- , Zambart, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Sarah Fidler
- Imperial College and Imperial College NIHR BRC, London, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Helen Ayles
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- , Zambart, Lusaka, Zambia
| |
Collapse
|
5
|
Hensen B, Floyd S, Phiri MM, Schaap A, Sigande L, Simuyaba M, Mwenge L, Zulu-Phiri R, Mwape L, Fidler S, Hayes R, Simwinga M, Ayles H. The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial. PLoS Med 2023; 20:e1004203. [PMID: 37083700 PMCID: PMC10121029 DOI: 10.1371/journal.pmed.1004203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/20/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The growing population of adolescents and young people (AYP) aged 15 to 24 in sub-Saharan Africa face a high burden of HIV in many settings. Unintended pregnancies among adolescent girls in the region remain high. Nonetheless, the sexual and reproductive health (SRH) service needs of AYP have remained underserved. We conducted a cluster-randomised trial (CRT) to estimate the impact of community-based, peer-led SRH service provision on knowledge of HIV status and other SRH outcomes, including met need for contraceptives. METHODS AND FINDINGS Yathu Yathu was a cluster-randomised trial (CRT) conducted from 2019 to 2021 in 2 urban communities in Lusaka, Zambia. The communities were divided into 20 zones (approximately 2,350 AYP/zone) that were randomly allocated to the Yathu Yathu intervention or control arm. In each intervention zone, a community-based hub, staffed by peer support workers, was established to provide SRH services. In 2019, a census was conducted in all zones; all consenting AYP aged 15 to 24 were given a Yathu Yathu card, which allowed them to accrue points for accessing SRH services at the hub and health facility (intervention arm) or the health facility only (control arm). Points could be exchanged for rewards, thus acting as an incentive to use SRH services in both arms. We conducted a cross-sectional survey in 2021 to estimate the impact of Yathu Yathu on the primary outcome: knowledge of HIV status (self-reporting living with HIV or HIV testing in the last 12 months) and secondary outcomes, including use of pre-exposure prophylaxis (PrEP) in the last 12 months, current use of antiretroviral therapy (ART), and met need for contraceptive services. The sampling was stratified on sex and age group, and we analysed data at cluster-level using a two-stage process recommended for CRTs with <15 clusters/arm. A total of 1,989 AYP consented to participate in the survey (50% male); consent was similar across arms (63% consent/arm). Across zones, knowledge of HIV status ranged from 63.6% to 81.2% in intervention zones and 35.4% to 63.0% in control zones. Adjusting for age, sex, and community, knowledge of HIV status was higher in the intervention arm compared to control (73.3% versus 48.4%, respectively, adjusted prevalence ratio (PR) 1.53 95% CI 1.36, 1.72; p < 0.001). By age and sex, results were similar. There was no evidence for impact on any secondary outcomes, including current use of ART and met need for contraceptives. There were no adverse events reported in either arm. A key limitation of our trial is that approximately 35% of the AYP randomly selected for participation in the endline survey could not be reached. CONCLUSIONS Delivering community-based, peer-led SRH services increased knowledge of HIV status among AYP, both males and females, compared with the control arm. Scaling up the highly effective Yathu Yathu strategy has the potential to make a substantial contribution to increasing access to HIV prevention and care services for young people. However, additional implementation research is needed to understand how to improve uptake of broader SRH services, beyond uptake of HIV testing. TRIAL REGISTRATION ISRCTN75609016, clinicaltrials.gov number NCT04060420.
Collapse
Affiliation(s)
- Bernadette Hensen
- Department of Public Health, the Institute of Tropical Medicine, Antwerp, Belgium
- Department of Clinical Research, the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Ab Schaap
- Department of Infectious Disease Epidemiology, the London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, Lusaka, Zambia
| | | | | | | | | | | | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, United Kingdom
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Helen Ayles
- Department of Clinical Research, the London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, Lusaka, Zambia
| |
Collapse
|
6
|
Neuman M, Mwinga A, Kapaku K, Sigande L, Gotsche C, Taegtmeyer M, Dacombe R, Maluzi K, Kosloff B, Johnson C, Hatzold K, Corbett EL, Ayles H. Sensitivity and specificity of OraQuick® HIV self-test compared to a 4th generation laboratory reference standard algorithm in urban and rural Zambia. BMC Infect Dis 2022; 22:494. [PMID: 35614397 PMCID: PMC9134574 DOI: 10.1186/s12879-022-07457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND HIV self-testing (HIVST) has the potential to increase coverage of HIV testing, but concerns exist about intended users' ability to correctly perform and interpret tests, especially in poor communities with low literacy rates. We assessed the clinical performance of the 2016 prototype OraQuick® HIV Self-Test in rural and urban communities in Zambia to assess the sensitivity and specificity of the test compared to the national HIV rapid diagnostic test (RDT) algorithm and a laboratory reference standard using 4th generation enzyme immunoassays and HIV RNA detection. METHODS Participants were recruited from randomly selected rural and urban households and one urban health facility between May 2016 and June 2017. Participants received a brief demonstration of the self-test, and then self-tested without further assistance. The research team re-read the self-test, repeated the self-test, drew blood for the laboratory reference, and conducted RDTs following the national HIV testing algorithm (Determine™ HIV1/2 (Alere) confirmed using Unigold™ HIV1/2 (Trinity Biotech)). Selected participants (N = 85) were videotaped whilst conducting the testing to observe common errors. RESULTS Initial piloting showed that written instructions alone were inadequate, and a demonstration of self-test use was required. Of 2,566 self-test users, 2,557 (99.6%) were able to interpret their result. Of participants who were videoed 75/84 (89.3%) completed all steps of the procedure correctly. Agreement between the user-read result and the researcher-read result was 99.1%. Compared to the RDT algorithm, user-conducted HIVST was 94.1% sensitive (95%CI: 90.2-96.7) and 99.7% specific (95%CI: 99.3-99.9). Compared to the laboratory reference, both user-conducted HIVST (sensitivity 87.5%, 95%CI: 82.70-91.3; specificity 99.7%, 95%CI: 99.4-99.9) and the national RDT algorithm (sensitivity 93.4%, 95%CI: 89.7-96.1%; specificity 100% (95%CI: 99.8-100%) had considerably lower sensitivity. CONCLUSIONS Self-testers in Zambia who used OraQuick® HIV Self-Test achieved reasonable clinical performance compared to the national RDT algorithm. However, sensitivity of the self-test was reduced compared to a laboratory reference standard, as was the national RDT algorithm. In-person demonstration, along with the written manufacturer instructions, was needed to obtain accurate results. Programmes introducing self-care diagnostics should pilot and optimise support materials to ensure they are appropriately adapted to context.
Collapse
Affiliation(s)
- Melissa Neuman
- MRC International Statistics and Epidemiology Group and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Alwyn Mwinga
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| | - Kezia Kapaku
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| | - Lucheka Sigande
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| | - Caroline Gotsche
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Miriam Taegtmeyer
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, L3 5QA, UK
- Tropical Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
| | - Russell Dacombe
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, L3 5QA, UK
| | - Kwitaka Maluzi
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| | - Barry Kosloff
- MRC International Statistics and Epidemiology Group and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| | - Cheryl Johnson
- World Health Organization, 20 Avenue Appia, Geneva, Switzerland
| | - Karin Hatzold
- PSI-South Africa, 70, 7th Avenue, Rosebank, Johannesburg, South Africa
| | - Elizabeth L Corbett
- MRC International Statistics and Epidemiology Group and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Unit, Blantyre, Malawi
| | - Helen Ayles
- MRC International Statistics and Epidemiology Group and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| |
Collapse
|
7
|
Phiri MM, Hensen B, Schaap A, Sigande L, Simuyaba M, Simwinga M, Floyd S, Fidler S, Hayes R, Ayles H. Adapting community-based sexual and reproductive health services for adolescents and young people aged 15-24 years in response to COVID-19 in Lusaka, Zambia: the implications on the uptake of HIV testing services. BMC Health Serv Res 2022; 22:503. [PMID: 35421966 PMCID: PMC9008386 DOI: 10.1186/s12913-022-07878-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Across Sub-Saharan Africa, adolescents and young people (AYP) aged 15-24 have limited access to sexual and reproductive health (SRH) services, including HIV testing services (HTS). In response, the Yathu Yathu study was implemented in two high-density communities in Lusaka, Zambia. Yathu Yathu provides comprehensive, community-based, peer-led SRH services, including differentiated HTS (finger-prick and HIV self-testing) and comprehensive sexuality education (CSE). We describe adaptations to the Yathu Yathu intervention in response to the COVID-19 epidemic, and implications on uptake of HTS among AYP. METHODS Yathu Yathu provides SRH services through community-based peer-led spaces. AYP in study communities were offered prevention points cards (PPC), which incentivizes and tracks service use. Social media (WhatsApp©/Facebook©) is used to engage and inform AYP about SRH. Due to COVID-19, hubs closed from April-June 2020. We describe adaptations in response to COVID-19 and, using routinely collected PPC data, describe uptake of HTS before (September 2019-March 2020) and after (July-December 2020) adaptations in response to COVID-19. We describe reach of the Yathu Yathu Facebook page and use qualitative data to describe AYP experiences of SRH service access. RESULTS During hub closures, CSE was delivered via video on social media, resulting in an increase in Facebook page followers from 539(April) to 891(June). WhatsApp groups evolved as a platform to deliver CSE and COVID-19 information, with higher participation among young people aged 20-24. Key service delivery adaptations included: reducing the number of participants in hubs, mandatory handwashing before entry, use of personal protective equipment by staff and provision of facemasks to AYP. HTS were provided as normal. Adaptations led to fewer AYP attending hubs. Uptake of HTS among AYP visiting hubs for the first time after COVID-19-related closures was higher (73.2%) compared to uptake before adaptations (65.9%; adjOR=1.24 95%CI 0.99, 1.56, p=0.06). Despite disappointments with some aspects of service delivery, AYP expressed happiness that hubs had reopened. CONCLUSIONS Social media can be a useful additional platform to reach AYP with HIV prevention information during COVID-19. With proper infection control in place, HTS can safely be provided to, accessed and accepted by AYP in community-based settings during COVID-19. TRIAL REGISTRATION National Clinical Trials NCT04060420,19th August 2019. Current Controlled Trials ISRCTN75609016 , 14th September 2021, retrospectively registered.
Collapse
Affiliation(s)
| | - Bernadette Hensen
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Ab Schaap
- Zambart, UNZA Ridgeway Campus, off Nationalist Road, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucheka Sigande
- Zambart, UNZA Ridgeway Campus, off Nationalist Road, Lusaka, Zambia
| | - Melvin Simuyaba
- Zambart, UNZA Ridgeway Campus, off Nationalist Road, Lusaka, Zambia
| | - Musonda Simwinga
- Zambart, UNZA Ridgeway Campus, off Nationalist Road, Lusaka, Zambia
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Fidler
- Imperial College and Imperial College NIHR BRC, London, UK
| | - Richard Hayes
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Ayles
- Zambart, UNZA Ridgeway Campus, off Nationalist Road, Lusaka, Zambia
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
8
|
Hensen B, Phiri M, Schaap A, Sigande L, Simwinga M, Floyd S, Belemu S, Simuyaba M, Shanaube K, Fidler S, Hayes R, Ayles HM. Uptake of HIV Testing Services Through Novel Community-Based Sexual and Reproductive Health Services: An Analysis of the Pilot Implementation Phase of the Yathu Yathu Intervention for Adolescents and Young People Aged 15-24 in Lusaka, Zambia. AIDS Behav 2022; 26:172-182. [PMID: 34302282 DOI: 10.1007/s10461-021-03368-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
Adolescents and young people aged 15-24 are underserved by available HIV-testing services (HTS). Delivering HTS through community-based, peer-led, hubs may prove acceptable and accessible to adolescents and young people, thus increasing HIV-testing coverage. We used data from the pilot phase of a cluster-randomised trial of community-based sexual and reproductive health services for adolescents and young people in Lusaka, Zambia, between September 2019 and January 2020, to explore factors associated with uptake of HTS through community-based hubs. 5,757 adolescents and young people attended the hubs (63% female), among whom 75% tested for HIV (76% of females, 75% of males). Community-based hubs provided HTS to 80% of adolescents and young people with no history of HIV-testing. Among females, uptake of HTS was lower among married/cohabiting females; among males, uptake was lower among unmarried males and among individuals at risk of hazardous alcohol use. The high number of adolescents and young people accessing hubs for HIV testing suggests they are acceptable. Enhanced targeting of HTS to groups who may not perceive their HIV risk needs to be implemented.
Collapse
Affiliation(s)
- B Hensen
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - A Schaap
- Zambart, Lusaka, Zambia
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - S Floyd
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - S Fidler
- Imperial College London, Imperial College National Institute of Heath Research BRC, London, UK
| | - R Hayes
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - H M Ayles
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, Lusaka, Zambia
| |
Collapse
|
9
|
Simpson N, Kydd A, Phiri M, Mbewe M, Sigande L, Gachie T, Ngobeni M, Monese T, Figerova Z, Schlesinger H, Bond V, Belemu S, Simwinga M, Schaap A, Biriotti M, Fidler S, Ayles H. Correction to: Insaka: mobile phone support groups for adolescent pregnant women living with HIV. BMC Pregnancy Childbirth 2021; 21:803. [PMID: 34856933 PMCID: PMC8638207 DOI: 10.1186/s12884-021-04232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nikita Simpson
- Department of Anthropology, London School of Economics and Political Science, London, UK. .,SHM Foundation, 20-22 Bedford Row, London, UK.
| | - Anna Kydd
- SHM Foundation, 20-22 Bedford Row, London, UK
| | | | | | | | | | | | | | | | | | - Virginia Bond
- Zambart, Lusaka, Zambia.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Sarah Fidler
- Department of Infectious Diseases, Imperial College, London, UK
| | - Helen Ayles
- Zambart, Lusaka, Zambia.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
10
|
Simpson N, Kydd A, Phiri M, Mbewe M, Sigande L, Gachie T, Ngobeni M, Monese T, Figerova Z, Schlesinger H, Bond V, Belemu S, Simwinga M, Schaap A, Biriotti M, Fidler S, Ayles H. Insaka: mobile phone support groups for adolescent pregnant women living with HIV. BMC Pregnancy Childbirth 2021; 21:663. [PMID: 34592959 PMCID: PMC8482634 DOI: 10.1186/s12884-021-04140-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mobile phone-based interventions have been demonstrated in different settings to overcome barriers to accessing critical psychosocial support. In this study, we aimed to assess the acceptability and feasibility of a phone-based, peer-to-peer support group intervention for adolescent pregnant women aged 15-24 years living with HIV in Zambia. METHODS Sixty-one consenting participants were recruited from Antenatal Clinics of two large urban communities in Lusaka. They were invited to participate in the mobile phone-based intervention that allowed them to anonymously communicate in a small group led by a facilitator for 4 months. A mixed methods approach was used to assess acceptability and feasibility, including a focus group discussion, pre- and post-intervention interview and analysis of the content of the text message data generated. RESULTS Participants reported finding the platform "not hard to use" and enjoyed the anonymity of the groups. Seventy-one percent of participants (n = 43) participated in the groups, meaning they sent text messages to their groups. Approximately 12,000 text messages were sent by participants (an average of 169 messages/user and 6 mentors in 6 groups. Topics discussed were related to social support and relationships, stigma, HIV knowledge and medication adherence. CONCLUSION The study showed that the intervention was acceptable and feasible, and highlighted the potential of the model for overcoming existing barriers to provision of psychosocial support to this population.
Collapse
Affiliation(s)
- Nikita Simpson
- Department of Anthropology, London School of Economics and Political Science, London, UK.
- SHM Foundation, 20-22 Bedford Row, London, UK.
| | - Anna Kydd
- SHM Foundation, 20-22 Bedford Row, London, UK
| | | | | | | | | | | | | | | | | | - Virginia Bond
- Zambart, Lusaka, Zambia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Sarah Fidler
- Department of Infectious Diseases, Imperial College, London, UK
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
11
|
Hensen B, Phiri M, Schaap A, Floyd S, Simuyaba M, Mwenge L, Sigande L, Belemu S, Shanaube K, Simwinga M, Fidler S, Hayes R, Ayles H. Yathu Yathu ("For us, by us"): Design of a cluster-randomised trial of the impact of community-based, peer-led comprehensive sexual and reproductive health services for adolescents and young people aged 15 to 24 in Lusaka, Zambia. Contemp Clin Trials 2021; 110:106568. [PMID: 34543725 DOI: 10.1016/j.cct.2021.106568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/16/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In sub-Saharan Africa, the growing population of adolescents and young people aged 15 to 24 face a high burden of HIV, and other preventable and treatable sexually transmitted infections. Despite this burden, adolescents and young people are the population least served by available sexual and reproductive (SRH) services. This trial aims to evaluate the impact of community-based peer-led SRH services, combined with a novel incentivised "loyalty card" system, on knowledge of HIV status and coverage of SRH services. METHODS A cluster-randomised trial (CRT) with embedded process and economic evaluation. DISCUSSION With little available evidence of the impact of community-based, peer-led services on coverage of SRH services, our study will provide evidence critical to expanding our knowledge of how to reach adolescents and young people. The "loyalty card" system is also a novel approach to providing SRH services. The delivery of community-based services supported by incentives in the form of loyalty cards is innovative, and may prove a simple strategy to improve access to SRH services. Adolescents and young people remain underserved by available SRH services; there remains a critical need to identify ways to provide adolescents and young people with access to SRH services. Rigorous evidence of whether this innovative strategy, with strong links to the local health facility, increases coverage of critical SRH services would add to the evidence-base of how to reach adolescents and young people.
Collapse
Affiliation(s)
- B Hensen
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | - A Schaap
- Zambart, Lusaka, Zambia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | | | | | | | - S Fidler
- Imperial College and Imperial College NIHR BRC, London, United Kingdom
| | - R Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - H Ayles
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom; Zambart, Lusaka, Zambia
| |
Collapse
|