Browsing by Author "Chimzizi R"

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    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.
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    Undernotification and underreporting of tuberculosis in Zambia: a national data quality assessment.
    (2022-Aug-22) Lungu PS; Kabaso ME; Mihova R; Silumesii A; Chisenga T; Kasapo C; Mwaba I; Kerkhoff, Andrew D.; Muyoyeta, Monde; Chimzizi R; Malama K
    BACKGROUND: Despite national implementation of several high impact interventions and innovations to bolster tuberculosis (TB) detection and improve quality of TB services in Zambia, notifications have been declining since 2004. A countrywide data quality assessment (DQA) of Zambia's National TB and Leprosy Programme (NTLP) was undertaken to quantify the degree to which undernotification and underreporting of TB notifications may be occurring. METHODS: The NTLP conducted a retrospective DQA of health facilities in high burden districts in all ten Zambian provinces. Multiple routine programmatic data sources were triangulated through a multi-step verification process to enumerate the total number of unique TB patients diagnosed between 1st January and 31st August 2019; both bacteriologically confirmed and clinically diagnosed TB patients were included. Undernotification was defined as the number of TB patients identified through the DQA that were not documented in facility treatment registers, while underreporting was defined as the number of notified TB cases not reported to the NTLP. RESULTS: Overall, 265 health facilities across 55 districts were assessed from which 28,402 TB patients were identified; 94.5% of TB patients were ≥ 15 years old, 65.1% were male, 52.0% were HIV-positive, and 89.6% were a new/relapse case. Among all TB cases, 32.8% (95%CI: 32.2-33.3) were unnotified. Undernotification was associated with age ≥ 15 years old (adjusted prevalence odds ratio [aPOR] = 2.4 [95%CI: 2.0-2.9]), HIV-positive status (aPOR = 1.6 [95%CI: 1.5-1.8]), being a new/relapse TB case (aPOR = 17.5 [95%CI: 13.4-22.8]), being a clinically diagnosed TB case (aPOR = 4.2 [95%CI:3.8-4.6]), and being diagnosed at a hospital (range, aPOR = 1.5 [95%CI: 1.3-1.6] to 2.6 [95%CI: 2.3-2.9]). There was substantial heterogeneity in the proportion of unnotified TB cases by province (range, 18.2% to 43.6%). In a sub-analysis among 22,199 TB patients with further data available, 55.9% (95%CI: 55.2-56.6) were notified and reported to the NTLP, 32.8% (95%CI: 32.2-33.4) were unnotified, and 11.3% (95%CI: 10.9-11.7) went unreported to the NTLP. CONCLUSIONS: The findings from Zambia's first countrywide TB programme DQA demonstrate substantial undernotification and underreporting of TB cases across all provinces. This underscores the urgent need to implement a robust and integrated data management system to facilitate timely registration and reporting of all TB patients who are diagnosed and treated.