Browsing by Author "Chisenga T"

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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.
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    Validation of a National Pediatric HIV Risk Screening Tool at 31 Health Facilities in Zambia: Diagnostic Performance and Programmatic Implications, 2021-2022.
    (2026-Sep-07) Canepa HM; Medley A; Gutreuter S; Connolly H; Itoh M; Aholou T; Rabold E; Torre L; Nkwemu K; Chisuwo E; Haamuleya F; Lungu C; Hansombo M; Nelson R; Vlahakis N; Chisenga T; Mulenga L; Mbulo L; Gross J
    BACKGROUND: To improve testing efficiency, Zambia introduced a national pediatric human immunodeficiency virus (HIV) Risk Screening Tool (HRST) in 2019. However, concerns about its sensitivity led to its suspension in 2021 pending formal evaluation. We therefore undertook a formal validation of this tool to assess its diagnostic performance. METHODS: We conducted a cross-sectional evaluation from February 2021 to March 2022 in 31 health facilities across Lusaka, Southern and Western Provinces. Children aged 2-14 years were screened using the HRST, and all subsequently underwent HIV testing to estimate the tool's sensitivity and specificity. L1-regularized logistic regression was used to identify the most predictive screening questions to develop an optimized tool. Focus group discussions with 85 healthcare providers explored implementation experiences. We also estimated unit costs for HRST-based screening and universal testing and compared these with published cost estimates for provider-assisted HIV self-testing. RESULTS: Among 15,431 children tested, 90 (0.58%) were HIV-positive. The 6-question HRST demonstrated 80.0% sensitivity and 71.0% specificity. An optimized 4-question tool showed similar performance (77.8% sensitivity, 73.2% specificity). Providers reported that the HRST supported targeted testing and workflow efficiency, but highlighted challenges related to consent, disclosure and caregiver knowledge. Estimated unit costs per child tested were $2.25 for universal testing, $0.39 for HRST-based screening and $3.08 for HIV self-testing. CONCLUSION: Although the HRST improves testing efficiency, its moderate sensitivity underscores the risk of missed diagnoses when used alone. Cost and implementation findings support a differentiated pediatric HIV testing strategy that deploys universal testing, risk-based screening, or HIV self-testing based on local capacity and resource constraints.