Centre for Infectious Disease Research in Zambia
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The impact of HIV and antiretroviral therapy on cervical cancer burden in Zambia: a modelling study
(2026-08-25) Andoh, John; Kapesa, Herbert; Msadabwe, Susan C.; Manasyan, Albert; Kamfwa, Paul; Zulu, Watson; Kerr, Cliff; Egger, Matthias; Rohner, Eliane; Stuart, Robyn; van Schalkwyk, Cari
Abstract
Cervical cancer is the leading cause of cancer death among women in Zambia, where widespread HIV infection elevates cervical cancer risk. However, HIV’s contribution to Zambia’s cervical cancer burden and the extent to which antiretroviral therapy (ART) has mitigated this burden, remain poorly quantified. We adapted HPVsim, an existing open-source mathematical model simulating human papillomavirus (HPV) and cervical cancer natural history, to capture the dual burden of cervical cancer and HIV in Zambian women. We extended HPVsim by incorporating country-specific HIV incidence data and modeled how HIV alters cervical disease progression through CD4 cell count-dependent modification of HPV susceptibility and disease severity. We calibrated the model to GLOBOCAN cervical cancer estimates and cervical cancer incidence rate ratios by HIV status estimated from the Zambian Cancer Registry. We estimated that by 2025, 49.9% of all cervical cancer cases in Zambia could be attributed to HIV co-infection. Although ART prevented at least an estimated 5.4% of cervical cancer cases nationally and 8.7% of cases among women with HIV, HIV remains a major driver of the cervical cancer burden. HIV-stratified prevention strategies will be essential for Zambia to achieve the World Health Organization’s cervical cancer elimination targets.
Higher-volume breastmilk to improve growth among preterm infants in Zambia: A randomized clinical trial
(2026-05-05) Travers, Colm P; Salas, Ariel A; Jeffcoat, Seabrook; Lakhwani, Jyoti; Kapesa, Herbert; Nalwamba, Leukanji; Carlo, Waldemar A.; Manasyan, Albert
Abstract
Objective: To test the hypothesis that among very preterm infants, higher-volume feeding versus usual-volume feeding with exclusive breastmilk improves growth at 40-weeks' postmenstrual age (PMA).
Design/methods: We conducted a randomized controlled trial among preterm infants 28 0/7 to 31 6/7 weeks' gestation or weighing 1000-1999 g at birth admitted to the Kangaroo Mother Care Ward at the Women and Newborn Hospital, Lusaka, Zambia between June 2022 and February 2023. Study participants were randomized with a 1:1 parallel allocation to usual-volume breastmilk (140-180 ml/kg/day) or higher-volume breastmilk (200-240 ml/kg/day) achieved with additional breastmilk expression. Daily measurements of feeding volume were recorded until discharge. Following hospital discharge, study participants were assessed at 40-weeks' postmenstrual age for weight, length, mid-arm circumference, and head circumference. The primary outcome was growth velocity from enrolment to 40-weeks' postmenstrual age.
Results: 190 preterm infants were enrolled. The mean±standard deviation (SD) number of days from enrollment to discharge was 9 ± 4 days. Recorded breastmilk volumes during hospitalization differed between groups (239 ±47 mL/kg/day in higher-volume versus 189±84 mL/kg/day in usual-volume; p < 0.001). There was no difference in growth velocity to 40 weeks' PMA between groups (mean±SD, higher-volume 14.1 ± 4.8 g/kg/day versus usual-volume 14.6 ± 5.4 g/kg/day; p = 0.51). The mid-arm circumference increased in the higher-volume group (10.9 ± 1.3 cm versus 10.5 ± 1.1 cm; p = 0.04) but other growth parameters did not differ at 40-weeks' postmenstrual age. Adverse outcomes did not differ.
Conclusions: Higher-volume exclusive breastmilk feeding with breastmilk expression is feasible but did not improve growth velocity at 40-weeks' postmenstrual age in very preterm infants.
Human papillomavirus detection in liquid-based cytology and cervical histology samples among women living with human immunodeficiency virus in Zambia
(2026-08-11) Taghavi, Katayoun; Moono, Misinzo; Villalobos, Nathalie V. F.; Andoh, John; Glass, Allison; Basu, Partha; Madliwa, Thamsanqa; Mwanahamuntu, Mulindi H.; Manasyan, Albert; Rohner, Eliane
Abstract
Objectives: Cervicovaginal human papillomavirus (HPV) prevalence is high among women living with human immunodeficiency virus (WLHIV), but not all HPV genotypes detected in liquid-based cytology (LBC) may be present in cervical tissue. We explored HPV genotype concordance in paired LBC and histology samples among WLHIV in Zambia.
Methods: WLHIV aged 18-65 years who were enrolled in a cervical screening test accuracy study were invited for follow-up after 30-36 months. LBC samples and two or more cervical biopsies were collected and tested for 28 HPV genotypes (Anyplex II/Allplex HPV28, Seegene, South Korea). HPV prevalence and genotype-specific agreement were assessed using Cohen's kappa.
Results: From April 2022 to May 2023, 242 WLHIV (22 with high-grade squamous intraepithelial lesions) had valid paired HPV results. The prevalence of any HPV was similar on LBC (39%) and histology (34%). Multiple-type infections were more common on LBC (18%) than on histology (10%). HPV 16 was the most frequent genotype: 9% (n = 22) on LBC, and 15% (n = 36) on histology. Agreement for any high-risk HPV genotype was 66.1% (kappa = 0.27).
Conclusions: Among Zambian WLHIV with mostly low-grade cervical lesions, LBC showed more multiple-type HPV infections and limited agreement with histology samples, possibly reflecting transient infections detected by LBC. The frequent detection of HPV 16 in histology samples but not in LBC warrants further investigation.
Feasibility of Vital Signs Assessment by Community Health Workers during Antenatal Care Community Outreach in Lusaka, Zambia: A Qualitative Study
(2022-09-13) Tembo, Taniya; Muttau, Nobutu; Manasyan, Albert; Mwamba, Chanda P.; Mwamba, Kabwe; Nyirenda, Herbert; Zulu, Tukiya K.; Hamweemba, Esther; Sharma, Anjali; Cauvel, Teresa; Shah, Sona; Nantume, Assumpta
Abstract
Introduction
The integration of digital tools in health initiatives marks a pivotal shift in traditional healthcare delivery methods. Technology-supported antenatal care (ANC) interventions have helped healthcare providers and community health workers (CHWs) to choose the course of action for individual patients. This study aimed to explore the suitability, feasibility, and acceptability of a wearable monitor, neoSpot, for measuring vital signs among pregnant women attending routine ANC visits during community outreach in Lusaka, Zambia.
Methods
This pilot feasibility trial was implemented between March and May 2023 at Kanyama 1st Level Hospital. We conducted 24 in-depth interviews (IDIs) among 12 purposively selected pregnant women and 12 trained CHWs. NeoSpot was placed on a pregnant woman’s arm to monitor vital signs and blood pressure. Thematic framework analysis used inductive and deductive reasoning for coding using NVivo and Excel for data organization. Qualitative data was analysed using NVivo. The suitability-feasibility-acceptability (SFA) framework was used to evaluate the potential of neoSpot as a tool for monitoring vital signs during routine ANC community outreach activities.
Results
The study revealed that neoSpot was accepted by pregnant women and CHWs for its ability to comprehensively assess vital signs, including those not typically assessed at clinics. Participants valued its speed, efficiency, and user-friendliness, believing it could reduce waiting times at antenatal clinics. Initially, pregnant women expressed concerns and apprehension about the new device, fuelled by misinformation and fears of its impact on their unborn babies and their skin.
Conclusion
Overall, all the study participants found the use of neoSpot to be suitable, feasible, and acceptable, and for use during ANC community outreach, largely due to its time efficiency, ability to simultaneously measure multiple vital signs, comfortable design, portability, and rechargeable battery. Incorporating recommendations could enhance the device’s efficiencies and its acceptability by community members and CHWs.
Admission to the kangaroo mother care ward and maternal postpartum depression in Lusaka, Zambia: a randomised controlled trial study protocol
(2026-10-26) Manasyan, Albert; Lakhwani, Jyoti; Kapesa, Herbert; Menon, Anitha J.; Sharma, Anjali; Pry, Jake M.; Brown, Catherine; Tembo, Taniya; Carlo, Waldemar A.
Abstract
Introduction: Postpartum depression (PPD) is a serious public health problem affecting 17% of women globally with higher rates (up to 40%) recorded in southern Africa. Admission to the neonatal intensive care unit (NICU) is a risk factor for PPD. The study aims to determine whether initiation of Kangaroo Mother Care (KMC) at the NICU followed by admission to the KMC Ward for continued support for more than 2 days before discharge home reduces maternal PPD and other maternal and infant adverse outcomes in low-resource settings.
Methods and analysis: This study will enrol mother-infant dyads (n=612), fathers (up to n=612) and a purposive subset of mothers (n=24), fathers (n=24) and family members (n=24) who will complete in-depth interviews (IDIs). Mother-infant dyads will be recruited from the NICU at the Women and Newborn Hospital - University Teaching Hospitals in Lusaka, Zambia. Once deemed stable for admission to the KMC Ward as part of step-down care, mother-infant dyads will be randomised to either the control arm where they will remain at the KMC Ward ≤2 days per standard of care or the intervention arm where they will remain at the KMC Ward for >2 days. The primary outcome is maternal PPD at 6–8 weeks postnatal screened using the Edinburgh Postnatal Depression Scale (EPDS) screening tool. IDIs will explore the feasibility and barriers to practising KMC post-discharge from the perspective of the parents and other family members.
Ethics and dissemination: The study was approved by the University of Zambia Biomedical Research Ethics Committee, the National Health Research Authority and the University of Alabama at Birmingham Institutional Review Board. A Data Safety Monitoring Board (DSMB) has been constituted. Dissemination will be via publications in peer-reviewed journals, conferences, social media and revision of national guidelines.