Browsing by Author "Hatwiinda S"

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Cross-sectional assessment of tuberculosis and HIV prevalence in 13 correctional facilities in Zambia.
(2021-Sep-27) Kagujje M; Somwe P; Hatwiinda S; Bwalya J; Zgambo T; Thornicroft M; Bozzani FM; Moonga C; Muyoyeta M; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.; Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia mkagujje@gmail.com.; Health directorate, Zambia Correctional Service, Lusaka, Zambia.; Strategic Information Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVE: To determine the prevalence of tuberculosis (TB) and HIV in 13 Zambian correctional facilities. METHODS: Cross-sectional study. SETTING: 13 correctional facilities in seven of the 10 provinces in Zambia. PARTICIPANTS: All incarcerated individuals were eligible for TB and HIV screening and testing. Of the total study population of 9695 individuals, which represent 46.2% of total correctional population at the beginning of the study, 8267 and 8160 were screened for TB and HIV, respectively. INTERVENTIONS: TB and HIV screening and testing was done between July 2018 and February 2019. PRIMARY OUTCOME MEASURES: All forms of TB, bacteriologically confirmed TB, drug-resistant TB, HIV. RESULTS: Prevalence of all forms of TB and bacteriologically confirmed TB was 1599 (1340-1894) per 100 000 population and 1056 (847-1301) per 100 000 population, respectively. Among those with bacteriologically confirmed TB, 4.6% (1.3%-11.4%) had drug-resistant TB.There was no statistically significant difference in the prevalence of all forms of TB, bacteriologically confirmed TB and drug resistant TB between adults and juveniles: (p=0.82), (p=0.23), (p=0.68) respectively. Of the bacteriologically confirmed TB cases, 28.7% were asymptomatic. The prevalence of HIV was 14.3% (13.6%-15.1%). The prevalence of HIV among females was 1.8 times the prevalence of HIV among males (p=0.01). CONCLUSION: Compared with the study in 2011 which screened inmates representing 30% of the country's inmate population, then the prevalence of all forms of TB and HIV in correctional facilities has reduced by about 75% and 37.6%, respectively. However, compared with the general population, the prevalence of all forms of TB and HIV was 3.5 and 1.3 times higher, respectively. TB/HIV programmes in correctional facilities need further strengthening to include aspects of juvenile-specific TB programming and gender responsive HIV programming.
Derivation of a tuberculosis screening rule for sub-Saharan African prisons.
(2014-Jul) Harris JB; Siyambango M; Levitan EB; Maggard KR; Hatwiinda S; Foster EM; Chamot E; Kaunda K; Chileshe C; Krüüner A; Henostroza G; Reid SE; ^¶Zambia Prisons Service, Ministry of Home Affairs, Lusaka, Zambia.; ^§Department of Health Care Organization and Policy, University of Alabama at Birmingham, Alabama, USA.; *Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; ^‡Department of Epidemiology, Birmingham, Alabama, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
SETTING: Lusaka Central Prison, Zambia. OBJECTIVE: To derive screening rules for tuberculosis (TB) using data collected during a prison-wide TB and human immunodeficiency virus (HIV) screening program. DESIGN: We derived rules with two methodologies: logistic regression and classification and regression trees (C&RT). We evaluated the performance of the derived rules as well as existing World Health Organization (WHO) screening recommendations in our cohort of inmates, as measured by sensitivity, specificity, and positive and negative predictive values. RESULTS: The C&RT-derived rule recommended diagnostic testing of all inmates who were underweight (defined as body mass index [BMI] < 18.5 kg/m(2)] or HIV-infected; the C&RT-derived rule had 60% sensitivity and 71% specificity. The logistic regression-derived rule recommended diagnostic testing of inmates who were underweight, HIV-infected or had chest pain; the logistic regression-derived rule had 74% sensitivity and 57% specificity. Two of the WHO recommendations had sensitivities that were similar to our logistic regression rule but had poorer specificities, resulting in a greater testing burden. CONCLUSION: Low BMI and HIV infection were the most robust predictors of TB in our inmates; chest pain was additionally retained in one model. BMI and HIV should be further evaluated as the basis for TB screening rules for inmates, with modification as needed to improve the performance of the rules.
Experiences of Justice-Involved People Transitioning to HIV Care in the Community After Prison Release in Lusaka, Zambia: A Qualitative Study.
(2023-Apr-28) Smith HJ; Herce ME; Mwila C; Chisenga P; Yenga C; Chibwe B; Mai V; Kashela L; Nanyagwe M; Hatwiinda S; Moonga CN; Musheke M; Lungu Y; Sikazwe I; Topp SM; Zambia Correctional Service, Government of the Republic of Zambia, Lusaka, Zambia.; Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.; School of Population Health, University of New South Wales, Sydney, Australia.; College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: In sub-Saharan Africa (SSA), incarcerated people experience a higher HIV burden than the general population. While access to HIV care and treatment for incarcerated people living with HIV (PLHIV) in SSA has improved in some cases, little is known about their transition to and post-release experience with care in the community. To address this gap, we conducted a qualitative study to describe factors that may influence post-release HIV care continuity in Zambia. METHODS: In March-December 2018, we recruited study participants from a larger prospective cohort study following incarcerated and newly released PLHIV at 5 correctional facilities in 2 provinces in Zambia. We interviewed 50 participants immediately before release; 27 (54%) participated in a second interview approximately 6 months post-release. Demographic and psychosocial data were collected through a structured survey. RESULTS: The pre-release setting was strongly influenced by the highly structured prison environment and assumptions about life post-release. Participants reported accessible HIV services, a destigmatizing environment, and strong informal social supports built through comradery among people facing the same trying detention conditions. Contrary to their pre-release expectations, during the immediate post-release period, participants struggled to negotiate the health system while dealing with unexpected stressors. Long-term engagement in HIV care was possible for participants with strong family support and a high level of self-efficacy. CONCLUSION: Our study highlights that recently released PLHIV in Zambia face acute challenges in meeting their basic subsistence needs, as well as social isolation, which can derail linkage to and retention in community HIV care. Releasees are unprepared to face these challenges due to a lack of community support services. To improve HIV care continuity in this population, new transitional care models are needed that develop client self-efficacy, facilitate health system navigation, and pragmatically address structural and psychosocial barriers like poverty, gender inequality, and substance use.
Poor continuity of care for TB diagnosis and treatment in Zambian Prisons: a situation analysis.
(2018-Feb) Hatwiinda S; Topp SM; Siyambango M; Harris JB; Maggard KR; Chileshe C; Kapata N; Reid SE; Henostroza G; University of Alabama at Birmingham, Birmingham, AL, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Zambia Ministry of Health, National Tuberculosis Program, Lusaka, Zambia.; College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Australia.; Zambia Ministry of Home Affairs, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVES: Prisons act as infectious disease reservoirs. We aimed to explore the challenges of TB control and continuity of care in prisons in Zambia. METHODS: We evaluated treatment outcomes for a cohort of inmates diagnosed with TB during a TB REACH funded screening programme initiated by the Zambia Prisons Service and the Centre for Infectious Disease Research in Zambia. RESULTS: Between October 2010 and September 2011, 6282 inmates from six prisons were screened for TB, of whom 374 (6.0%) were diagnosed. TB treatment was initiated in 345 of 374 (92%) inmates. Of those, 66% were cured or completed treatment, 5% died and 29% were lost to follow-up. Among those lost to follow-up, 11% were released into the community and 13% were transferred to other prisons. CONCLUSIONS: Weak health systems within the Zambian prison service currently undermines continuity of care, despite intensive TB screening and case-finding interventions. To prevent TB transmission and the development of drug resistance, we need sufficient numbers of competent staff for health care, reliable health information systems including electronic record keeping for prison facilities, and standard operating procedures to guide surveillance, case-finding and timely treatment initiation and completion.
Screening for tuberculosis and testing for human immunodeficiency virus in Zambian prisons.
(2015-Feb-01) Maggard KR; Hatwiinda S; Harris JB; Phiri W; Krüüner A; Kaunda K; Topp SM; Kapata N; Ayles H; Chileshe C; Henostroza G; Reid SE; Zambia Prisons Service, Ministry of Home Affairs, Kabwe, Zambia .; University of Alabama at Birmingham, Birmingham, United States of America .; Zambia AIDS Related Tuberculosis Project, Lusaka, Zambia .; Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia .; National Tuberculosis and Leprosy Control Programme, Ministry of Health, Lusaka, Zambia .; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVE: To improve the Zambia Prisons Service's implementation of tuberculosis screening and human immunodeficiency virus (HIV) testing. METHODS: For both tuberculosis and HIV, we implemented mass screening of inmates and community-based screening of those residing in encampments adjacent to prisons. We also established routine systems – with inmates as peer educators – for the screening of newly entered or symptomatic inmates. We improved infection control measures, increased diagnostic capacity and promoted awareness of tuberculosis in Zambia's prisons. FINDINGS: In a period of 9 months, we screened 7638 individuals and diagnosed 409 new patients with tuberculosis. We tested 4879 individuals for HIV and diagnosed 564 cases of infection. An additional 625 individuals had previously been found to be HIV-positive. Including those already on tuberculosis treatment at the time of screening, the prevalence of tuberculosis recorded in the prisons and adjacent encampments – 6.4% (6428/100,000) – is 18 times the national prevalence estimate of 0.35%. Overall, 22.9% of the inmates and 13.8% of the encampment residents were HIV-positive. CONCLUSION: Both tuberculosis and HIV infection are common within Zambian prisons. We enhanced tuberculosis screening and improved the detection of tuberculosis and HIV in this setting. Our observations should be useful in the development of prison-based programmes for tuberculosis and HIV elsewhere.
Spatial patterns of incident malaria cases and their household contacts in a single clinic catchment area of Chongwe District, Zambia.
(2015-Aug-07) Pinchoff J; Henostroza G; Carter BS; Roberts ST; Hatwiinda S; Hamainza B; Hawela M; Curriero FC; Icahn School of Medicine at Mt Sinai, 1428 Madison Avenue, New York, NY, 10029, USA. bryan.carter@mssm.edu.; Centre for Infectious Disease Research Zambia, 5032 Great North Road, Lusaka, Zambia. Sisa.Hatwiinda@cidrz.org.; Ministry of Health, National Malaria Control Centre, Chainama Hospital, College Grounds, Off Great East Road, PO Box 32509, Lusaka, Zambia. Bossbusk@gmail.com.; Department of Epidemiology, University of Washington School of Public Health, Box 357236, Seattle, WA, 98165, USA. str24@uw.edu.; University of Alabama at Birmingham, 1900 University Boulevard, Birmingham, AL, 35294, USA. germanh@uab.edu.; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA. Jpinchoff@gmail.com.; Centre for Infectious Disease Research Zambia, 5032 Great North Road, Lusaka, Zambia. germanh@uab.edu.; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA. fcurriero@jhu.edu.; Ministry of Health, National Malaria Control Centre, Chainama Hospital, College Grounds, Off Great East Road, PO Box 32509, Lusaka, Zambia. mhawela@yahoo.co.uk.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Reactive case detection (RACD) for malaria is a strategy that may be used to complement passive surveillance, as passive surveillance fails to identify infections that are asymptomatic or do not seek care. The spatial and seasonal patterns of incident (index) cases reported at a single clinic in Chongwe District were explored. METHODS: A RACD strategy was implemented from June 2012 to June 2013 in a single catchment area in Chongwe District. Incident (index) cases recorded at the clinic were followed up at their household, and all household contacts were tested for malaria using rapid diagnostic tests (RDTs). GPS coordinates were taken at each index household. Spatial analyses were conducted to assess characteristics related to clustering, cluster detection and spatial variation in risk of index houses. Effects of season (rainy versus dry), distance to the clinic and distance to the main road were considered as modifying factors. Lastly, logistic regression was used to identify factors associated with the proportion of household contacts testing RDT positive. RESULTS: A total of 426 index households were enrolled, with 1,621 household contacts (45% RDT positive). Two space-time clusters were identified in the rainy season, with ten times and six times higher risk than expected. Significantly increased spatial clustering of index households was found in the rainy season as compared to the dry season (based on K-function methodology). However, no seasonal difference in mapped spatial intensity of index households was identified. Logistic regression analysis identified two main factors associated with a higher proportion of RDT positive household contacts. There was a 41% increased odds of RDT positive household contacts in households where the index case was under 5 years of age [OR = 1.41, 95% confidence intervals (1.15, 1.73)]. For every 500-m increase in distance from the road, there was a 5% increased odds of RDT positive household contacts [OR = 1.05 (1.02, 1.07)], controlling for season. DISCUSSION: Areas of increased report of malaria persist after controlling for distance to the clinic and main road. Clinic-based interventions will miss asymptomatic, non-care seeking infections located farther from the road. RACD may identify additional infections missed at the clinic.
Tuberculosis and HIV control in sub-Saharan African prisons: "thinking outside the prison cell".
(2012-May-15) Reid SE; Topp SM; Turnbull ER; Hatwiinda S; Harris JB; Maggard KR; Roberts ST; Krüüner A; Morse JC; Kapata N; Chisela C; Henostroza G; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. stewart.reid@cidrz.org; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
Tuberculosis is one of the fastest-growing epidemics in prison populations in sub-Saharan Africa (SSA), constituting a threat to both inmates and the wider community. Various factors have contributed to the breakdown of tuberculosis control in prison facilities in SSA, including slow and insensitive diagnostics, failing prison infrastructure, inadequate funding, and weak prevention and treatment interventions for human immunodeficiency virus (HIV). In this article, we describe the challenges inherent in current approaches to tuberculosis control in prisons and consider the alternatives. We argue that although improved implementation of conventional tuberculosis control activities is necessary, considerable investment in a broader range of public health interventions, including infrastructure and staffing upgrades, cutting-edge tuberculosis diagnostics, and combination prevention for HIV, will be equally critical. This combination response to tuberculosis in prisons will be essential for tackling existing and nascent prison tuberculosis epidemics and will require high-level political support and financing.