Browsing by Author "Mutale, Wilbroad"

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Alcohol consumption and tobacco smoking associated with decreased antiretroviral therapy adherence among people living with HIV in Zambia: Evidence from a 2023 national NCDs/ HIV survey.
(2026) Zyambo, Cosmas; Somwe, Paul; Musukuma, Mwiche; Mandyata, Chomba; Bwembya, Phoebe; Phiri, Henry; Chavula, Malizgani; Halwindi, Hikabasa; Zulu, Joseph; Mutale, Wilbroad
BACKGROUND: In order to achieve the 95-95-95 goals and obtain optimal benefits from ART, PLWH must adhere to prescribed medication. AIM: Investigate factors associated with ART adherence in a clinical setting in Zambia. METHODS: National cross-sectional study involving 193 clinics across all 10 provinces of Zambia. The primary outcomes assessed were ART adherence status, associated behavioral factors, and clinical characteristics. Logistic regression analysis was conducted to evaluate associations between these factors and ART adherence. Both unadjusted odds ratios (UOR) and adjusted odds ratios (AOR) were calculated, with adjustments made for relevant covariates, and all estimates reported with 95% confidence intervals. RESULTS: Of the 5,204 PLWH, 7.1% were non-adherent to ART (9.7% males vs 5.9% females). Of those who were non adherent, 60% and 22% consumed alcohol and smoked tobacco respectively. In adjusted analysis, age; 45-59 (AOR: 0.5, 95% CI:0.32-0.79), 60+ (AOR: 0.26, 95% CI: 0.12-0.59) and education; Primary (AOR: 0.6, 95% CI: 0.4-0.9), secondary (AOR: 0.57, 95% CI: 0.4-0.82), college/university (AOR: 0.5, 95% CI: 0.29-0.89) were associated with decreased odds of being non-adherence to ART. In contrast, being male (AOR: 1.45, 95% CI:1.07-1.98), being in informal employment (AOR:1.65, 95% CI:1.15-2.36), having average yearly income; > $160 (AOR: 1.55, 95% CI: 1.16-2.06), Alcohol consumption; healthy consumption (AOR: 2.72, 95% CI: 1.9-3.89), unhealthy consumption (AOR: 2.76, 95% CI: 1.8-4.22), indeterminant consumption (AOR: 3.03, 95% CI: 2.04-4.5) and tobacco smoking (AOR: 95% CI: 2.03 1.42-2.9) were associated with increased odds of being non-adherence to ART. CONCLUSIONS: ART non-adherence among PLWH in Zambia is 7.1%, with higher rates in males. Substance use especially alcohol and tobacco are common among the non-adherent. The associations between alcohol consumption, tobacco smoking, and ART adherence highlight the potential value of targeted support strategies. These results can inform future longitudinal research and contribute to the development of evidence-based interventions.
Evaluating a multifaceted implementation strategy and package of evidence-based interventions based on WHO PEN for people living with HIV and cardiometabolic conditions in Lusaka, Zambia: protocol for the TASKPEN hybrid effectiveness-implementation stepped wedge cluster randomized trial.
(2024-Jun-06) Herce, Michael E.; Bosomprah, Samuel; Masiye, Felix; Mweemba, Oliver; Edwards, Jessie K.; Mandyata, Chomba; Siame, Mmamulatelo ; Mwila, Chilambwe; Matenga, Tulani; Frimpong, Christiana ; Mugala, Anchindika; Mbewe, Peter; Shankalala, Perfect; Sichone, Pendasambo; Kasenge, Blessings; Chunga, Luanaledi ; Adams, Rupert; Banda, Brain; Mwamba, Daniel; Nachalwe, Namwinga; Agarwal, Mansi; Williams, Makeda J.; Tonwe, Veronica; Pry, Jake M.; Musheke, Maurice; Vinikoor, Michael; Mutale, Wilbroad
BACKGROUND: Despite increasing morbidity and mortality from non-communicable diseases (NCD) globally, health systems in low- and middle-income countries (LMICs) have limited capacity to address these chronic conditions, particularly in sub-Saharan Africa (SSA). There is an urgent need, therefore, to respond to NCDs in SSA, beginning by applying lessons learned from the first global response to any chronic disease-HIV-to tackle the leading cardiometabolic killers of people living with HIV (PLHIV). We have developed a feasible and acceptable package of evidence-based interventions and a multi-faceted implementation strategy, known as "TASKPEN," that has been adapted to the Zambian setting to address hypertension, diabetes, and dyslipidemia. The TASKPEN multifaceted implementation strategy focuses on reorganizing service delivery for integrated HIV-NCD care and features task-shifting, practice facilitation, and leveraging HIV platforms for NCD care. We propose a hybrid type II effectiveness-implementation stepped-wedge cluster randomized trial to evaluate the effects of TASKPEN on clinical and implementation outcomes, including dual control of HIV and cardiometabolic NCDs, as well as quality of life, intervention reach, and cost-effectiveness. METHODS: The trial will be conducted in 12 urban health facilities in Lusaka, Zambia over a 30-month period. Clinical outcomes will be assessed via surveys with PLHIV accessing routine HIV services, and a prospective cohort of PLHIV with cardiometabolic comorbidities nested within the larger trial. We will also collect data using mixed methods, including in-depth interviews, questionnaires, focus group discussions, and structured observations, and estimate cost-effectiveness through time-and-motion studies and other costing methods, to understand implementation outcomes according to Proctor's Outcomes for Implementation Research, the Consolidated Framework for Implementation Research, and selected dimensions of RE-AIM. DISCUSSION: Findings from this study will be used to make discrete, actionable, and context-specific recommendations in Zambia and the region for integrating cardiometabolic NCD care into national HIV treatment programs. While the TASKPEN study focuses on cardiometabolic NCDs in PLHIV, the multifaceted implementation strategy studied will be relevant to other NCDs and to people without HIV. It is expected that the trial will generate new insights that enable delivery of high-quality integrated HIV-NCD care, which may improve cardiovascular morbidity and viral suppression for PLHIV in SSA. This study was registered at ClinicalTrials.gov (NCT05950919).
Exploring community participation in project design: application of the community conversation approach to improve maternal and newborn health in Zambia.
(2017-Mar-23) Mutale, Wilbroad; Masoso, Chisala; Mwanza, Bisalom; Chirwa, Cindy; Mwaba, Lasidah; Siwale, Zumbe ; Lamisa, Barbara; Musatwe, Dennis; Chilengi, Roma
BACKGROUND: The United Nations Development Programme (UNDP) has adopted an approach entitled Community Conversation (CC) to improve community engagement in addressing health challenges. CCs are based on Paulo Freire's transformative communication approach, in which communities pose problems and critically examine their everyday life experiences through discussion. We adopted this approach to engage communities in maternal and newborn health discussions in three rural districts of Zambia, with the aim of developing community-generated interventions. METHODS: Sixty (60) CCs were held in three target districts, covering a total of 20 health facilities. Communities were purposively selected in each district to capture a range of rural and peri-urban areas at varying distances from health facilities. Conversations were held four times in each community between May and September 2014. All conversations were digitally recorded and later transcribed. NVivo version 10 was used for data analysis. RESULTS AND DISCUSSION: The major barriers to accessing maternal health services included geography, limited infrastructure, lack of knowledge, shortage of human resources and essential commodities, and insufficient involvement of male partners. From the demand side, a lack of information and misconceptions, and, from the supply side, inadequately trained health workers with poor attitudes, negatively affected access to maternal health services in target districts either directly or indirectly. At least 17 of 20 communities suggested solutions to these challenges, including targeted community sensitisation on the importance of safe motherhood, family planning and prevention of teenage pregnancy. Community members and key stakeholders committed time and resources to address these challenges with minimal external support. CONCLUSION: We successfully applied the CC approach to explore maternal health challenges in three rural districts of Zambia. CCs functioned as an advocacy platform to facilitate direct engagement with key decision makers within the community and to align priorities while incorporating community views. There was a general lack of knowledge about safe motherhood and family planning in all three districts. However, other problems were unique to health facilities, demonstrating the need for tailored interventions.
Improving health information systems for decision making across five sub-Saharan African countries: Implementation strategies from the African Health Initiative.
(2013) Mutale, Wilbroad; Chintu, Namwinga; Amoroso, Cheryl; Awoonor-Williams, Koku; Phillips, James; Baynes, Colins; Michel, Cathy; Taylor, Angela; Sherr, Kenneth
BACKGROUND: Weak health information systems (HIS) are a critical challenge to reaching the health-related Millennium Development Goals because health systems performance cannot be adequately assessed or monitored where HIS data are incomplete, inaccurate, or untimely. The Population Health Implementation and Training (PHIT) Partnerships were established in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze advances in strengthening district health systems. Interventions were tailored to the setting in which activities were planned. COMPARISONS ACROSS STRATEGIES: All five PHIT Partnerships share a common feature in their goal of enhancing HIS and linking data with improved decision-making, specific strategies varied. Mozambique, Ghana, and Tanzania all focus on improving the quality and use of the existing Ministry of Health HIS, while the Zambia and Rwanda partnerships have introduced new information and communication technology systems or tools. All partnerships have adopted a flexible, iterative approach in designing and refining the development of new tools and approaches for HIS enhancement (such as routine data quality audits and automated troubleshooting), as well as improving decision making through timely feedback on health system performance (such as through summary data dashboards or routine data review meetings). The most striking differences between partnership approaches can be found in the level of emphasis of data collection (patient versus health facility), and consequently the level of decision making enhancement (community, facility, district, or provincial leadership). DISCUSSION: Design differences across PHIT Partnerships reflect differing theories of change, particularly regarding what information is needed, who will use the information to affect change, and how this change is expected to manifest. The iterative process of data use to monitor and assess the health system has been heavily communication dependent, with challenges due to poor feedback loops. Implementation to date has highlighted the importance of engaging frontline staff and managers in improving data collection and its use for informing system improvement. Through rigorous process and impact evaluation, the experience of the PHIT teams hope to contribute to the evidence base in the areas of HIS strengthening, linking HIS with decision making, and its impact on measures of health system outputs and impact.
Lost in translation: key lessons from conducting dissemination and implementation science in Zambia.
(2024-Oct-29) Maritim, Patricia; Munakampe, Margarate N. ; Nglazi, Mweete; Mweemba, Chris; Sikombe, Kombatende; Mbewe, Wilson; Silumbwe, Adam; Jacobs, Choolwe; Zulu, Joseph M.; Herce, Michael ; Mutale, Wilbroad ; Halwindi, Hikabasa
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.
Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls.
(2019-Jan-05) Chinyama, Joyce; Chipungu, Jenala; Rudd, Cheryl; Mwale, Mercy; Verstraete, Lavuun; Sikamo, Charity; Mutale, Wilbroad; Chilengi, Roma; Sharma, Anjali
INTRODUCTION: While in school, girls require an environment that is supportive of menstrual hygiene management (MHM) in order to ensure regular school attendance and participation. Little is known about schoolgirls access to and practice of MHM in rural Zambia. This study explores girls' experiences of MHM in rural schools of Zambia from the perspectives of schoolgirls, schoolboys and community and school-based adults key to MHM for schoolgirls. METHODS: In July and August 2015, we conducted this qualitative exploratory study in six rural schools of Mumbwa and Rufunsa districts of Zambia. Twelve in-depth interviews (IDIs) and six focus group discussions (FGDs) were conducted among girls ages 14-18 who had begun menstruating. Two FGDs with boys ages 14-18 and 25 key informant interviews were also conducted with teachers, female guardians and traditional leaders to provide the context within which schoolgirls practice MHM. RESULTS: Most girls reported learning about menstruation only at menarche and did not know the physiological basis of menstruation. They reported MHM-related challenges, including: use of non-absorbent and uncomfortable menstrual cloth and inadequate provision of sanitary materials, water, hygiene and sanitation facilities (WASH) in schools. In particular, toilets did not have soap and water or doors and locks for privacy and had a bad odor. Girls' school attendance and participation in physical activities was compromised when menstruating due to fear of teasing (especially by boys) and embarrassment from menstrual leakage. Boys said they could tell when girls were menstruating by the smell and their behaviour, for instance, moving less and isolating themselves from their peers. Girls complained of friction burns on their inner thighs during their long journey to school due to chaffing of wet non-absorbent material used to make menstrual cloth. Girls preferred to dispose used menstrual materials in pit latrines and not waste bins for fear that they could be retrieved for witchcraft against them. Though traditional leaders and female guardians played a pivotal role in teaching girls MHM, they have not resolved challenges to MHM among schoolgirls. CONCLUSION: When menstruating, schoolgirls in rural Zambia would rather stay home than be uncomfortable, inactive and embarrassed due to inadequate MHM facilities at school. A friendly and supportive MHM environment that provides education, absorbent sanitary materials and adequate WASH facilities is essential to providing equal opportunity for all girls.
Use of Lot quality assurance sampling surveys to evaluate community health worker performance in rural Zambia: a case of Luangwa district.
(2017-Apr-17) Mwanza, Moses; Zulu, Japhet; Topp, Stephanie M.; Musonda, Patrick; Mutale, Wilbroad; Chilengi, Roma
BACKGROUND: The Better Health Outcomes through Mentoring and Assessment (BHOMA) project is a cluster randomized controlled trial aimed at reducing age-standardized mortality rates in three rural districts through involvement of Community Health Workers (CHWs), Traditional Birth Attendants (TBAs), and Neighborhood Health Committees (NHCs). CHWs conduct quarterly surveys on all households using a questionnaire that captures key health events occurring within their catchment population. In order to validate contact with households, we utilize the Lot Quality Assurance Sampling (LQAS) methodology. In this study, we report experiences of applying the LQAS approach to monitor performance of CHWs in Luangwa District. METHODS: Between April 2011 and December 2013, seven health facilities in Luangwa district were enrolled into the BHOMA project. The health facility catchment areas were divided into 33 geographic zones. Quality assurance was performed each quarter by randomly selecting zones representing about 90% of enrolled catchment areas from which 19 households per zone where also randomly identified. The surveys were conducted by CHW supervisors who had been trained on using the LQAS questionnaire. Information collected included household identity number (ID), whether the CHW visited the household, duration of the most recent visit, and what health information was discussed during the CHW visit. The threshold for success was set at 75% household outreach by CHWs in each zone. RESULTS: There are 4,616 total households in the 33 zones. This yielded a target of 32,212 household visits by community health workers during the 7 survey rounds. Based on the set cutoff point for passing the surveys (at least 75% households confirmed as visited), only one team of CHWs at Luangwa high school failed to reach the target during round 1 of the surveys; all the teams otherwise registered successful visits in all the surveys. CONCLUSIONS: We have employed the LQAS methodology for assurance that quarterly surveys were successfully done. This methodology proved helpful in identifying poorly performing CHWs and could be useful for evaluating CHW performance in other areas. TRIAL REGISTRATION: Identifier: NCT01942278 . Date of Registration: September 2013.