Browsing by Author "Herce M"

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Beyond the pill: Understanding barriers and enablers to oral and long-acting injectable PrEP among women in sex work in Zambia.
(2025) Kumar R; Mwale C; Maritim P; Phiri J; Barrington W; Zyambo R; Zimba M; Mugwanya K; Herce M; Musheke M; Rao D; Sharma A; Department of Development Practice, Laney Graduate School, Emory University, Atlanta, GeorgiaUnited States of America.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, United States of America.; Child, Family, and Population Health Nursing, School of Public Health; University of Washington, Seattle, Washington, United States of America.; Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, United States of America.; Tithandizeni Umoyo Network, Lusaka, Zambia.; Zambia Sex Workers Alliance, Lusaka, Zambia.; University of Zambia, School of Public Health, Lusaka, Zambia.; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America.; Health Systems and Population Health; School of Public Health; University of Washington, Seattle, Washington, United States of America.
Women engaging in sex work (WESW) in low- and middle-income countries face a disproportionately high risk of HIV infection. This study explores enablers and barriers to the uptake and persistence of oral pre-exposure prophylaxis (PrEP) and long-acting injectable PrEP (LAI-PrEP) among WESW in Lusaka, Zambia. We evaluated Capability, Opportunity, and Motivation behavioral domains, using the COM-B model, which affectied behavioral engagement with PrEP services among newly-initiated WESW from community-based safe spaces. Participants were recruited from July-October 2023 and interviewed using a semi-structured guide to explore barriers and enablers to engagement with HIV prevention. We used a rapid analysis approach-a two-step qualitative method-to identify themes aligned with COM-B domains. Interviews were conducted in English, ChiNyanja, or IchiBemba, audio-recorded, translated into English when necessary, and transcribed verbatim. Among 18 participants with a median age of 28 years (IQR:23-33) and 5 years in sex work (IQR:2,7), education during outreach by peer navigators and program staff was crucial to building trust and demystifying PrEP. Persistent knowledge gaps and misconceptions, especially about daily adherence and alcohol use, were significant barriers. Trustworthy program staff and reliable service provision facilitated continued PrEP use, and women preferring that drugs be delivered to them. Social support systems were mixed, offering both aid and competition. Personal empowerment and health protection motivated PrEP use, with LAI-PrEP preferred for eliminating daily pill burdens and associated stigma. However, inconsistent supply and misconceptions about LAI-PrEP were potential barriers. This study underscores the importance of person-centered care in addressing the complex interplay of individual, community, and programmatic factors influencing PrEP engagement among WESW in Zambia. A holistic focus, and adaptive health service delivery approach are both crucial to ensure that advances in HIV prevention translate into tangible benefits for WESW. Reliable, respectful healthcare programs that provide accurate, and trusted information are essential for improving PrEP uptake and persistence.
Effects of real-time electronic data entry on HIV programme data quality in Lusaka, Zambia.
(2020-Mar-21) Moomba K; Williams A; Savory T; Lumpa M; Chilembo P; Tweya H; Harries AD; Herce M; London School of Hygiene & Tropical Medicine, London, UK.; Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Operational Centre Brussels, Medical Department, Médecins Sans Frontières - Operational Research Unit (LuxOR), MSF Luxembourg.; International Union Against Tuberculosis and Lung Disease, Paris, France.; The Lighthouse Clinic, Lilongwe, Malawi.; Centre for Infectious Diseases Research in Zambia (CIDRZ), Lusaka, Zambia.
SETTING: Human immunodeficiency virus (HIV) clinics in five hospitals and five health centres in Lusaka, Zambia, which transitioned from daily entry of paper-based data records to an electronic medical record (EMR) system by dedicated data staff (Electronic-Last) to direct real-time data entry into the EMR by frontline health workers (Electronic-First). OBJECTIVE: To compare completeness and accuracy of key HIV-related variables before and after transition of data entry from Electronic-Last to Electronic-First. DESIGN: Comparative cross-sectional study using existing secondary data. RESULTS: Registration data (e.g., date of birth) was 100% complete and pharmacy data (e.g., antiretroviral therapy regimen) was <90% complete under both approaches. Completeness of anthropometric and vital sign data was <75% across all facilities under Electronic-Last, and this worsened after Electronic-First. Completeness of TB screening and World Health Organization clinical staging data was also <75%, but improved with Electronic-First. Data entry errors for registration and clinical consultations decreased under Electronic-First, but errors increased for all anthropometric and vital sign variables. Patterns were similar in hospitals and health centres. CONCLUSION: With the notable exception of clinical consultation data, data completeness and accuracy did not improve after transitioning from Electronic-Last to Electronic-First. For anthropometric and vital sign variables, completeness and accuracy decreased. Quality improvement interventions are needed to improve Electronic-First implementation.
Lost in translation: key lessons from conducting dissemination and implementation science in Zambia.
(2024-Oct-29) Maritim P; Munakampe MN; Nglazi M; Mweemba C; Sikombe K; Mbewe W; Silumbwe A; Jacobs C; Zulu JM; Herce M; Mutale W; Halwindi H; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia. triciamarie20@gmail.com.; Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.; Implementation Science Department, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Implementation Science Centre for Advancing Practice and Training (IMPACT), University of Zambia, Lusaka, Zambia. triciamarie20@gmail.com.; Implementation Science Centre for Advancing Practice and Training (IMPACT), University of Zambia, Lusaka, Zambia.; Ministry of Health, Lusaka, Zambia.
BACKGROUND: As the field of implementation science continues to grow, its key concepts are being transferred into new contexts globally, such as Low and Middle Income Countries (LMICs), and its use is constantly being reexamined and expanded. Theoretical and methodological positions commonly used in implementation research and practice have great utility in our work but in many cases are at odds with LMIC contexts. As a team of implementation scientists based in Zambia, we offer this commentary as a critical self-reflection on what has worked and what could limit us from fully utilizing the field's promise for addressing health problems with contextual understanding. MAIN BODY: We used a 'premortem,' an approach used to generate potential alternatives from failed assumptions about a particular phenomenon, as a way to reflect on our experiences conducting implementation research and practice. By utilizing prospectively imagined hindsights, we were able to reflect on the past, present and possible future of the field in Zambia. Six key challenges identified were: (i) epistemic injustices; (ii) simplified conceptualizations of evidence-informed interventions; (iii) limited theorization of the complexity of low-resource contexts and it impacts on implementation; (iv) persistent lags in transforming research into practice; (v) limited focus on strategic dissemination of implementation science knowledge and (vi) existing training and capacity building initiatives' failure to engage a broad range of actors including practitioners through diverse learning models. CONCLUSION: Implementation science offers great promise in addressing many health problems in Zambia. Through this commentary, we hope to spur discussions on how implementation scientists can reimagine the future of the field by contemplating on lessons from our experiences in LMIC settings.