Centre for Infectious Disease Research in Zambia
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(2027)
Adapting and implementing health systems guidelines: learning lessons from countries.
(2026-Sep-10) Zeitouny S; Fahim C; Adewuya AO; Adjorlolo S; Mwamba C; Velez CM; Straus SE; Marten R
"This is human life, so I don't know what compensation I can attach to it": perceptions on compensation in human infection challenge studies in Lusaka, Zambia.
(2026-Sep-18) Mwamba C; Kunda-Ng'andu EM; Chirwa M; Nyirenda HC; Mwale S; Muzazu SGY; Simuyandi M; Sharma A
Human infection challenge (HIC) studies where healthy volunteers are deliberately infected expedite vaccine development. However, agreement on fair compensation that avoids both exploitation and undue inducement remains elusive. Without clear compensation policies or guidelines, implementation of HIC studies remains a challenge in Zambia. We conducted 5 focus group discussions and 15 in-depth interviews on compensation prior to initiation of a typhoid HIC study among healthy adults from higher learning institutions in Lusaka, Zambia. Thematic analysis revealed HIC-specific considerations for compensation, including compensation allocated to research participants and their families for potential risk of immediate and long-term side effects from deliberate infection. Preferences for compensation timing varied, with some advocating for upfront compensation and others favouring compensation after participation to account for lived experiences of side-effects, time commitment and emotional burden. Compensation preferences included monetary and non-monetary compensation in the form of long-term medical coverage and tuition for university/college education. However, views on the value of the compensation varied, highlighting the complexity of determining appropriate compensation that balances voluntariness with fair recognition of risks and sacrifices. Sustained engagement of ethics and regulatory authorities with potential research participants must be encouraged to ensure ethically responsive research and to build public trust in HIC studies.
Scaling-up tuberculosis preventive therapy to HIV-negative contacts of bacteriologically confirmed TB cases aged 5 years and above - Lessons from a tuberculosis preventive therapy surge activity in Zambia.
(2026) Mwaba PB; Mwaba I; Maimbolwa MM; Chanda C; Mputu M; Lumbwe C; Zimba K; Chanda NK; Chimzizi R; Mubanga A; Muyoyeta M; Kagujje M
While tuberculosis preventive therapy (TPT) coverage among people living with HIV in Zambia has improved, uptake among HIV-negative contacts aged ≥5 years remains low. Despite evidence showing that TPT can reduce TB incidence by up to 60% in HIV-negative individuals, there is a paucity of evidence on programmatic rollout to this population in Zambia and the region. We present programme data from a TPT surge aimed at increasing uptake among ≥5 years old HIV-negative household TB contacts. The National TB Programme, with support from the TB Local Organizations Network, conducted a TPT surge in 89 high TB-burden facilities across eight project supported provinces in Zambia from October 2024-15th January 2025. After a thorough planning phase, multidisciplinary teams conducted field visits for contact tracing and initiated TPT for eligible household contacts of bacteriologically confirmed TB.. Facility-based TPT initiation was provided for walk-in clients. We collected and analyzed aggregate data from facility registers. A total of 19,371 HIV-negative contacts aged ≥ 5 years were screened: 99.9% (n = 19,344) were eligible for and offered TPT. Of these, 72.4% (n = 14,000) were initiated on TPT, 2.0% (n = 385) refused and 26.2% (n = 4,959) were not initiated on treatment due to unavailability of their preferred regimen. The start of the surge was associated with an immediate 47.7% points increase in TPT coverage (p = 0.001). Overall, 63.7% (n = 8,917) were initiated on three-months Isoniazid+Rifapentine, followed by six-months Isoniazid (30.2%, n = 4226); one-month Isoniazid+Rifapentine (4.5%, n = 625) and on three-months Isoniazid+Rifampicin (1.7%, n = 232). The surge demonstrated that TPT can be rolled out to ≥5 years old HIV-negative TB contacts with high initiation rates achieved. This is achievable through targeted implementation, stakeholder engagement, and community-driven approaches. These findings underscore the feasibility of extending TPT to all TB contacts, regardless of HIV status or age, to accelerate TB prevention efforts in high-burden settings like Zambia.
Raising the bar: translating global guidelines to achieve local policy on cholera elimination in Zambia-a qualitative case study.
(2026-Sep-10) Mwamba C; Banda T; Mazaba M; Mukonka V; Malama K; Hamweemba E; Syulikwa M; Chilengi R; Sharma A; Fahim C; Marten R; Yangchen S; Straus S
BACKGROUND: The global roadmap to eliminating cholera by 2030 relies on early detection and response, vaccination in hotspots and effective partnerships. In sub-Saharan Africa, where 60% of the 2.8 million annual cases occur, cholera elimination requires a multisectoral response. To accelerate progress, improved understanding of how to translate a multisectoral approach to eliminate cholera is needed.
METHODS: We evaluated implementation of Zambia's Multisectoral Cholera Elimination Plan (MCEP) using six phases of Graham's Knowledge-to-Action (KTA) framework (adaption, assessing barriers, implementation, monitoring, evaluation and sustaining knowledge use). We reviewed the MCEP to assess the policy environment for supporting implementation and triangulated information from 24 key informant interviews with policy-makers and implementers, 12 in-depth interviews with cholera survivors and focus group discussions with 28 community-based neighbourhood health committee members. Thematic analysis was used to analyse the data. We present our findings under each KTA phase.
RESULTS: The MCEP prioritizes actions in hotspots, and vaccinations through a multisectoral governance and coordination structure. The appointment of a coordinator and formation of multisectoral technical working groups (TWGs) have improved dissemination, coordination and the case for additional investments in laboratory capacity, cholera vaccines and infrastructure for water, sanitation, hygiene and decentralized solid waste management. However, slow institutionalization of plans, weak coordination, inadequate funding, poor infrastructure and the coronavirus disease 2019 (COVID-19) pandemic has led to fragmented implementation. The sustainability of the MCEP is not assured without: (1) comprehensive advocacy; (2) resource mobilization (international and national budget commitment); (3) monitoring and evaluation (M&E) of progress; and (4) information synthesis and dissemination for end users.
CONCLUSIONS: A multisectoral approach can help gain adequate momentum and efficiencies to eliminate cholera in Zambia, provided stakeholders are fully committed and funding is allocated to support plans. An adaptive collaborative strategy within national guidelines and policies that includes target communities is needed to support local translation, adaptation and concerted efforts to eliminate cholera.