Browsing by Author "Mbwili-Muleya C"

Now showing 1 - 3 of 3

Contraceptive use among HIV-infected women and men receiving antiretroviral therapy in Lusaka, Zambia: a cross-sectional survey.
(2016-May-12) Hancock NL; Chibwesha CJ; Bosomprah S; Newman J; Mubiana-Mbewe M; Sitali ES; Bolton-Moore C; Mbwili-Muleya C; Chi BH; Centre for Infectious Disease Research in Zambia, PO Box 34681, 5032 Great North Road, Lusaka, Zambia.; Department of Obstetrics and Gynecology, UNC Global Women's Health, University of North Carolina School of Medicine, 3009 Old Clinic Building, Campus, Box 7577, Chapel Hill, NC, 27599-7577, USA.; Centre for Infectious Disease Research in Zambia, PO Box 34681, 5032 Great North Road, Lusaka, Zambia. NancyLHancock@gmail.com.; Department of Obstetrics and Gynecology, UNC Global Women's Health, University of North Carolina School of Medicine, 3009 Old Clinic Building, Campus, Box 7577, Chapel Hill, NC, 27599-7577, USA. NancyLHancock@gmail.com.; Lusaka District Community Health Office, Ministry of Community Development, Mother and Child Health, PO Box 50827, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Family planning (FP) is an essential health service and an important part of comprehensive HIV care. However, there is limited information about the contraceptive needs of people living with HIV in sub-Saharan Africa, which in turn has hampered efforts to expand and integrate FP services into existing HIV programs. METHODS: We performed a cross-sectional survey to determine FP prevalence and predictors among HIV-positive women and men attending 18 public antiretroviral therapy (ART) clinics in Lusaka, Zambia. Trained peer counselors administered the 10-question survey to those seeking care for five days at each of the target sites. RESULTS: From February to April 2014, we surveyed 7,046 HIV-infected patients receiving routine HIV services. Use of modern contraception was reported by 69 % of female ART patients and 79 % of male ART patients. However, highly effective contraceptive use and dual method use were low among women (38 and 25 %, respectively) and men (19 and 14 %, respectively). HIV disclosure status (adjusted odds ratio (AOR) = 4.91, 95 % confidence interval (CI) = 3.32-7.24 for women, AOR = 3.58, 95 % CI = 2.39-5.38 for men) and sexual activity in the last 6 months (AOR = 5.80, 95 % CI = 4.51-7.47 for women, AOR = 6.24, 95 % CI = 3.51-11.08 for men) were associated with modern contraceptive use in multivariable regression. Most respondents said they would access FP services if made available within ART clinic. CONCLUSIONS: While FP-ART integration may be a promising strategy for increasing FP service uptake, such services must focus on assessing sexual activity and advocating for dual method use to increase effective contraceptive use and prevent unintended pregnancies.
Evaluating the costs of cholera illness and cost-effectiveness of a single dose oral vaccination campaign in Lusaka, Zambia.
(2019) Tembo T; Simuyandi M; Chiyenu K; Sharma A; Chilyabanyama ON; Mbwili-Muleya C; Mazaba ML; Chilengi R; Lusaka District Health Office/ Ministry of Health, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Zambia National Public Health Institute, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: In 2016, for the very first time, the Ministry of Health in Zambia implemented a reactive outbreak response to control the spread of cholera and vaccinated at-risk populations with a single dose of Shancol-an oral cholera vaccine (OCV). This study aimed to assess the costs of cholera illness and determine the cost-effectiveness of the 2016 vaccination campaign. METHODOLOGY: From April to June 2017, we conducted a retrospective cost and cost-effectiveness analysis in three peri-urban areas of Lusaka. To estimate costs of illness from a household perspective, a systematic random sample of 189 in-patients confirmed with V. cholera were identified from Cholera Treatment Centre registers and interviewed for out-of-pocket costs. Vaccine delivery and health systems costs were extracted from financial records at the District Health Office and health facilities. The cost of cholera treatment was derived by multiplying the subsidized cost of drugs by the quantity administered to patients during hospitalisation. The cost-effectiveness analysis measured incremental cost-effectiveness ratio-cost per case averted, cost per life saved and cost per DALY averted-for a single dose OCV. RESULTS: The mean cost per administered vaccine was US$1.72. Treatment costs per hospitalized episode were US$14.49-US$18.03 for patients ≤15 years old and US$17.66-US$35.16 for older patients. Whereas households incurred costs on non-medical items such as communication, beverages, food and transport during illness, a large proportion of medical costs were borne by the health system. Assuming vaccine effectiveness of 88.9% and 63%, a life expectancy of 62 years and Gross Domestic Product (GDP) per capita of US$1,500, the costs per case averted were estimated US$369-US$532. Costs per life year saved ranged from US$18,515-US$27,976. The total cost per DALY averted was estimated between US$698-US$1,006 for patients ≤15 years old and US$666-US$1,000 for older patients. CONCLUSION: Our study determined that reactive vaccination campaign with a single dose of Shancol for cholera control in densely populated areas of Lusaka was cost-effective.
Evaluation of service quality in family planning clinics in Lusaka, Zambia.
(2015-Oct) Hancock NL; Vwalika B; Sitali ES; Mbwili-Muleya C; Chi BH; Stuart GS; Centre for Infectious Disease Research in Zambia, PO Box 34681, 5032 Great North Road, Lusaka, Zambia.; Department of Obstetrics and Gynecology, University Teaching Hospital, PO Box 50110, Lusaka, Zambia.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 3009 Old Clinic Building, Campus Box 7577, Chapel Hill, North Carolina, 27599-7577.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 3009 Old Clinic Building, Campus Box 7577, Chapel Hill, North Carolina, 27599-7577; Centre for Infectious Disease Research in Zambia, PO Box 34681, 5032 Great North Road, Lusaka, Zambia. Electronic address: nancylhancock@gmail.com.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 3009 Old Clinic Building, Campus Box 7577, Chapel Hill, North Carolina, 27599-7577; Centre for Infectious Disease Research in Zambia, PO Box 34681, 5032 Great North Road, Lusaka, Zambia.; Lusaka District Community Health Office, Ministry of Community Development, Mother and Child Health, PO Box 50827, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVE: To determine the quality of contraceptive services in family planning clinics in Lusaka, Zambia, using a standardized approach. STUDY DESIGN: We utilized the Quick Investigation of Quality, a cross-sectional survey tool consisting of a facility assessment, client-provider observation and client exit interview, in public-sector family planning clinics. Data were collected on availability of seven contraceptive methods, information given to clients, interpersonal relations between providers and clients, providers' technical competence and mechanisms for continuity and follow-up. RESULTS: Data were collected from five client-provider observations and client exit interviews in each of six public-sector family planning clinics. All clinics had at least two contraceptive methods continuously available for the preceding 6 months. Most providers asked clients about concerns with their contraceptive method (80%) and told clients when to return to the clinic (87%). Most clients reported that the provider advised what to do if a problem develops (93%), described possible side effects (89%), explained how to use the method effectively (85%) and told them when to come for follow-up (83%). Clients were satisfied with services received (93%). CONCLUSION(S): This application of the Quick Investigation of Quality showed that the participating family planning clinics in Lusaka, Zambia, were prepared to offer high-quality services with the available commodities and that clients were satisfied with the received services. Despite the subjective client satisfaction, quality improvement efforts are needed to increase contraceptive availability. IMPLICATIONS: Although clients perceived the quality of care received to be high, family planning service quality could be improved to continuously offer the full spectrum of contraceptive options. The Quick Investigation of Quality was easily implemented in Lusaka, Zambia, and this simple approach could be utilized in a variety of settings as a modality for quality improvement.