IntroductionThe simplest and cheapest method for cervical cancer screening is visual inspection after application of acetic acid (VIA). However, this method has limitations for correctly identifying precancerous cervical lesions (sensitivity) and women free from these lesions (specificity). We will assess alternative screening methods that could improve sensitivity and specificity in women living with humanimmunodeficiency virus (WLHIV) in Southern Africa.Methods and analysisWe will conduct a paired, prospective, screening test accuracy study among consecutive, eligible women aged 18–65 years receiving treatment for HIV/AIDS at Kanyama Hospital, Lusaka, Zambia. We will assess a portable magnification device (Gynocular, Gynius Plus AB, Sweden) based on the Swede score assessment of the cervix, test for high-risk subtypes of human papillomavirus (HR-HPV, GeneXpert, Cepheid, USA) and VIA. All study participants will receive all three tests and the reference standard at baseline and at six-month follow-up. The reference standard is histological assessment of two to four biopsies of the transformation zone. The primary histological endpoint is cervical intraepithelial neoplasia grade two and above (CIN2+). Women who are VIA-positive or have histologically confirmed CIN2+ lesions will be treated as per national guidelines. We plan to enrol 450 women. Primary outcome measures for test accuracy include sensitivity and specificity of each stand-alone test. In the secondary analyses, we will evaluate the combination of tests. Pre-planned additional studies include use of cervigrams to test an automated visual assessment tool using image pattern recognition, cost-analysis and associations with trichomoniasis.Ethics and disseminationEthical approval was obtained from the University of Zambia Biomedical Research Ethics Committee, Zambian National Health Regulatory Authority, Zambia Medicines Regulatory Authority, Swissethics and the International Agency for Research on Cancer Ethics Committee. Results of the study will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT03931083; Pre-results.
Background Globally, complications due to preterm birth are the leading contributor to neonatal mortality, resulting in an estimated one million deaths annually. Kangaroo Mother Care (KMC) has been endorsed by the World Health Organisation as a low cost, safe, and effective intervention in reducing morbidity and mortality among preterm infants. The objective of this study was to describe the implementation of a KMC model among preterm infants and its impact on neonatal outcomes at a tertiary level hospital in Lusaka, Zambia. Methods We conducted a prospective descriptive study using data collected from the KMC room at the University Teaching Hospital between January 2016 and September 2017. Mothers and government nurses were trained in KMC. We monitored skin-to-skin and breastfeeding practices, weight at admission, discharge, and length of admission. Results We enrolled 573 neonates into the study. Thirteen extremely low weight infants admitted to the KMC room had graduated to Group A (1,000g-1,499g) at discharge, with a median weight gain of 500g. Of the 419 very low weight neonates at admission, 290 remained in Group A while 129 improved to Group B (1,500g-2,499g), with a median weight gain of 280g. Among the 89 low weight neonates, 1 regressed to Group A, 77 remained in Group B, and 11 improved to Group C (≥2,500g), individually gaining a median of 100g. Of the seven normal weight neonates, 6 remained in Group C individually gaining a median of 100g, and 1 regressed to Group B. Among all infants enrolled, two (0.35%) died in the KMC room. Conclusions Based on the RE-AIM metrics, our results show that KMC is a feasible intervention that can improve neonatal outcomes among preterm infants in Zambia. The study findings show a promising, practical approach to scaling up KMC in Zambia. Trial registration The trial is registered under ClinicalTrials.gov under the following ID number: NCT03923023.
ObjectivesTo estimate potential silent transfer using baseline viral load measures among individuals presenting as new to HIV care in routine HIV clinical settings in Lusaka, Zambia.DesignCross-sectional study.SettingTwo large, urban government-operated health facilities supported by the Centre for Infectious Disease Research in Zambia.ParticipantsA total of 248 participants with an incident positive HIV rapid test.Outcome measuresThe primary outcome measure was HIV viral suppression at baseline (i.e., potential silent transfer), defined as having a viral load ≤1000 RNA copies(c)/mL at the time of initiating HIV care. We also examined viral suppression at ≤60 c/mL.MethodsWe surveyed and measured baseline HIV viral load as part of the national recent infection testing algorithm among people living with HIV (PLWH) presenting as new to care. Using mixed effects Poisson regression, we identified characteristics among PLWH associated with potential silent transfer.ResultsAmong the 248 PLWH included, 63% were women with median age of 30, and 66 (27% (66/248)) had viral suppression at ≤1000 c/mL and 53 (21% (53/248)) at ≤60 c/mL thresholds, respectively. Participants aged 40+ years had a significantly higher adjusted prevalence of potential silent transfer (adjusted prevalence ratio (aPR): 2.10; 95% CI: 2.08, 2.13) compared with participants aged 18–24 years. Participants reporting no formal education had a significantly higher adjusted prevalence of potential silent transfer (aPR: 1.63; 95% CI: 1.52, 1.75) compared with those completing primary education. Among 57 potential silent transfers who completed a survey, 44 (77%) indicated having tested positive previously at ≥1 of 38 clinics in Zambia.ConclusionsThe high proportion of PLWH with potential silent transfer points to clinic shopping and/or co-enrolment at multiple care sites simultaneously, suggesting an opportunity to improve care continuity at the time of HIV care entry.
Background Syphilis in pregnancy is common in Africa with prevalence as high as 10%. In high prevalence areas ( > 5%), WHO recommends universal syphilis screening and benzathine penicillin G treatment at the first antenatal clinic (ANC) visit. Implementation barriers include global stock outs and supply chain issues. Our goal was to document treatment rates and factors associated with lack of treatment among pregnant women with syphilis in Zambia. Methods The retrospective cohort study analyzed medical record data from pregnant women who sought care in 10 public ANC clinics in Lusaka, Zambia during 2018-2019 and tested positive for syphilis. Syphilis was diagnosed based on positive RPR testing and treatment was defined as documented penicillin therapy at the same facility. Patient characteristics were compared across treatment status using Wilcoxon Rank Sum Test for continuous variables, and Pearson Chi-Square Test for categorical variables. Simple logistic models with treatment status as the binary outcome were conducted to evaluate potential factors associated with lack of syphilis treatment in pregnancy. A multivariable logistic model was performed and a 2-sided P < 0.05 was accepted as statistically significant. Results Among 28,480 pregnant women screened for syphilis, 5.6% (n=1363) tested positive. Among those with syphilis, median age was 27 years, 21% of women were nulliparous and 43% were living with HIV. Most women (72%) had their initial ANC visit during the 2nd trimester and 96% were screened for syphilis at the first visit. The documented treatment rate was 42% and the only factor associated with lack of treatment was ANC entry in 2019 compared to 2018 (aOR 2.2; 95% CI 1.7-2.8; p < 0.001). (refer to Tables 1-2). Conclusion Syphilis prevalence among pregnant women tested in ANC clinic in Zambia during 2018-2019 was 5.6%. Recommended penicillin treatment was only documented in 42% of cases. No maternal or clinic characteristic was associated with lack of therapy. Calendar year may have been associated with treatment for unclear reasons. Novel approaches to ensure access to universal diagnosis and early treatment of syphilis among pregnant women in Zambia are needed to improve maternal and neonatal outcomes. Disclosures All Authors: No reported disclosures.
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