Browsing by Author "Lumpa, Mwansa"

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Active TB case finding in a high burden setting; comparison of community and facility-based strategies in Lusaka, Zambia.
(2020) Kagujje, Mary; Chilukutu, Lophina; Somwe, Paul; Mutale, Jacob; Chiyenu, Kanema; Lumpa, Mwansa; Mwanza, Winfrida; Muyoyeta, Monde
INTRODUCTION: We conducted an implementation science study to increase TB case detection through a combination of interventions at health facility and community levels. We determined the impact of the study in terms of additional cases detected and notification rate and compared the yield of bacteriologically confirmed TB of facility based and community based case finding. METHODOLOGY: Over a period of 18 months, similar case finding activities were conducted at George health facility in Lusaka Zambia and its catchment community, an informal peri-urban settlement. Activities included awareness and demand creation activities, TB screening with digital chest x-ray or symptom screening, sputum evaluation using geneXpert MTB/RIF, TB diagnosis and linkage to treatment. RESULTS: A total of 18,194 individuals were screened of which 9,846 (54.1%) were screened at the facility and 8,348 (45.9%) were screened in the community. The total number of TB cases diagnosed during the intervention period were 1,026, compared to 759 in the pre-intervention period; an additional 267 TB cases were diagnosed. Of the 563 bacteriologically confirmed TB cases diagnosed under the study, 515/563 (91.5%) and 48/563 (8.5%) were identified at the facility and in the community respectively (P<0.0001). The TB notification rate increased from 246 per 100,000 population pre-intervention to 395 per 100,000 population in the last year of the intervention. CONCLUSIONS: Facility active case finding was more effective in detecting TB cases than community active case finding. Strengthening health systems to appropriately identify and evaluate patients for TB needs to be optimised in high burden settings. At a minimum, provider initiated TB symptom screening with completion of the TB screening and diagnostic cascade should be provided at the health facility in high burden settings. Community screening needs to be systematic and targeted at high risk groups and communities with access barriers.
Differentiated Care Preferences of Stable Patients on Antiretroviral Therapy in Zambia: A Discrete Choice Experiment.
(2019-Aug-15) Eshun-Wilson, Ingrid; Mukumbwa-Mwenechanya, Mpande; Kim, Hae-Young; Zannolini, Arianna; Mwamba, Chanda P.; Dowdy, David; Kalunkumya, Estella; Lumpa, Mwansa; Beres, Laura K.; Roy, Monika; Sharma, Anjali; Topp, Stephanie M.; Glidden, Dave V.; Padian, Nancy; Ehrenkranz, Peter; Sikazwe, Izukanji; Holmes, Charles B.; Bolton-Moore, Carolyn; Geng, Elvin H.
BACKGROUND: Although differentiated service delivery (DSD) models for stable patients on antiretroviral therapy (ART) offer a range of health systems innovations, their comparative desirability to patients remains unknown. We conducted a discrete choice experiment to quantify service attributes most desired by patients to inform model prioritization. METHODS: Between July and December 2016, a sample of HIV-positive adults on ART at 12 clinics in Zambia were asked to choose between 2 hypothetical facilities that differed across 6 DSD attributes. We used mixed logit models to explore preferences, heterogeneity, and trade-offs. RESULTS: Of 486 respondents, 59% were female and 85% resided in urban locations. Patients strongly preferred infrequent clinic visits [3- vs. 1-month visits: β (ie, relative utility) = 2.84; P < 0.001]. Milder preferences were observed for waiting time for ART pick-up (1 vs. 6 hours.; β = -0.67; P < 0.001) or provider (1 vs. 3 hours.; β = -0.41; P = 0.002); "buddy" ART collection (β = 0.84; P < 0.001); and ART pick-up location (clinic vs. community: β = 0.35; P = 0.028). Urban patients demonstrated a preference for collecting ART at a clinic (β = 1.32, P < 0.001), and although most rural patients preferred community ART pick-up (β = -0.74, P = 0.049), 40% of rural patients still preferred facility ART collection. CONCLUSIONS: Stable patients on ART primarily want to attend clinic infrequently, supporting a focus in Zambia on optimizing multimonth prescribing over other DSD features-particularly in urban areas. Substantial preference heterogeneity highlights the need for DSD models to be flexible, and accommodate both setting features and patient choice in their design.
One Health Baseline Study Report
(Centre for Infectious Disease Research in Zambia (CIDRZ), 2026-12-17) Somwe, Paul; Barry Walsh, Paula; Riblet, Michelle; Butler, David; Lumpa, Mwansa; Sharma, Anjali; Rios, Rafaella; Whelan, Niamh; Chipungu, Jenala; Banda, Humphrey; Mataa, Liywalii
The One Health Baseline Research Study was conducted to assess knowledge, practices, and regulatory frameworks related to food safety, animal health and disease surveillance, and the control of animal medicines in Zambia. The study aimed to inform a just transition toward a sustainable and resilient food system by strengthening One Health interventions that reduce production and consumption shocks and mitigate crisis risks. Using a mixed-methods approach, quantitative and qualitative data were collected from 340 stakeholders, including livestock and crop farmers, food processors, buyers and retailers, and regulators across six districts in Eastern, Lusaka, Northern, and Southern Provinces. Findings indicate that stakeholders possess a holistic understanding of One Health, recognising the interdependence of food safety, animal health, environmental sustainability, and socio-economic factors. Positive progress was observed, including strong awareness of zoonotic diseases among livestock farmers, high compliance with food business registration requirements, and recognition of inspectors as trusted information sources. However, significant challenges persist, particularly related to limited institutional capacity, regulatory overlaps, inadequate risk management skills, weak oversight of animal medicines, and insufficient infrastructure and training. Misuse of veterinary drugs and pesticides poses risks to public health, animal health, and the environment, contributing to antimicrobial resistance and undermining disease control efforts. The study highlights the importance of strengthened institutional coordination, improved policy communication, risk-based approaches, and inclusive stakeholder engagement from farm to fork. Digital innovations such as the Zambia Animal Health Information System demonstrate potential for enhancing disease surveillance and evidence-based decision-making. Overall, the findings underscore the need for integrated, risk-based, and community-informed One Health strategies to improve food safety, support sustainable livelihoods, and strengthen Zambia’s agri-food system resilience.
Participation in adherence clubs and on-time drug pickup among HIV-infected adults in Zambia: A matched-pair cluster randomized trial.
(2020-Jul) Roy, Monika; Bolton-Moore, Carolyn; Sikazwe, Izukanji; Mukumbwa-Mwenechanya, Mpande; Efronson, Emilie; Mwamba, Chanda; Somwe, Paul; Kalunkumya, Estella; Lumpa, Mwansa; Sharma, Anjali; Pry, Jake; Mutale, Wilbroad; Ehrenkranz, Peter; Glidden, David V.; Padian, Nancy; Topp, Stephanie; Geng, Elvin; Holmes, Charles B.
BACKGROUND: Current models of HIV service delivery, with frequent facility visits, have led to facility congestion, patient and healthcare provider dissatisfaction, and suboptimal quality of services and retention in care. The Zambian urban adherence club (AC) is a health service innovation designed to improve on-time drug pickup and retention in HIV care through off-hours facility access and pharmacist-led group drug distribution. Similar models of differentiated service delivery (DSD) have shown promise in South Africa, but observational analyses of these models are prone to bias and confounding. We sought to evaluate the effectiveness and implementation of ACs in Zambia using a more rigorous study design. METHODS AND FINDINGS: Using a matched-pair cluster randomized study design (ClinicalTrials.gov: NCT02776254), 10 clinics were randomized to intervention (5 clinics) or control (5 clinics). At each clinic, between May 19 and October 27, 2016, a systematic random sample was assessed for eligibility (HIV+, age ≥ 14 years, on ART >6 months, not acutely ill, CD4 count not <200 cells/mm3) and willingness to participate in an AC. Clinical and antiretroviral drug pickup data were obtained through the existing electronic medical record. AC meeting attendance data were collected at intervention facilities prospectively through October 28, 2017. The primary outcome was time to first late drug pickup (>7 days late). Intervention effect was estimated using unadjusted Kaplan-Meier survival curves and a Cox proportional hazards model to derive an adjusted hazard ratio (aHR). Medication possession ratio (MPR) and implementation outcomes (adoption, acceptability, appropriateness, feasibility, and fidelity) were additionally evaluated as secondary outcomes. Baseline characteristics were similar between 571 intervention and 489 control participants with respect to median age (42 versus 41 years), sex (62% versus 66% female), median time since ART initiation (4.8 versus 5.0 years), median CD4 count at study enrollment (506 versus 533 cells/mm3), and baseline retention (53% versus 55% with at least 1 late drug pickup in previous 12 months). The rate of late drug pickup was lower in intervention participants compared to control participants (aHR 0.26, 95% CI 0.15-0.45, p < 0.001). Median MPR was 100% in intervention participants compared to 96% in control participants (p < 0.001). Although 18% (683/3,734) of AC group meeting visits were missed, on-time drug pickup (within 7 days) still occurred in 51% (350/683) of these missed visits through alternate means (use of buddy pickup or early return to the facility). Qualitative evaluation suggests that the intervention was acceptable to both patients and providers. While patients embraced the convenience and patient-centeredness of the model, preference for traditional adherence counseling and need for greater human resources influenced intervention appropriateness and feasibility from the provider perspective. The main limitations of this study were the small number of clusters, lack of viral load data, and relatively short follow-up period. CONCLUSIONS: ACs were found to be an effective model of service delivery for reducing late ART drug pickup among HIV-infected adults in Zambia. Drug pickup outside of group meetings was relatively common and underscores the need for DSD models to be flexible and patient-centered if they are to be effective. TRIAL REGISTRATION: ClinicalTrials.gov NCT02776254.