Browsing by Author "Mwale C"

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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.
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    Mitigating the effects of COVID-19 on HIV treatment and care in Lusaka, Zambia: a before-after cohort study using mixed effects regression.
    (2022-Jan) Pry JM; Sikombe K; Mody A; Iyer S; Mutale J; Vlahakis N; Savory T; Wa Mwanza M; Mweebo K; Mwila A; Mwale C; Mukumbwa-Mwenechanya M; Kerkhoff AD; Sikazwe I; Bolton Moore C; Mwamba D; Geng EH; Herce ME; University of California San Francisco, San Francisco, California, USA.; Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.; Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.; San Francisco General Hospital and Trauma Center, San Francisco, California, USA.; Division of Global HIV & Tuberculosis, Centers for Disease Control and Prevention, Lusaka, Zambia.; Department of Infectious Disease, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.; Department of Internal Medicine, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia jmpry@ucdavis.edu.; Zambia Ministry of Health, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    INTRODUCTION: The Zambian Ministry of Health (MoH) issued COVID-19 mitigation guidance for HIV care immediately after the first COVID-19 case was confirmed in Zambia on 18 March 2020. The Centre for Infectious Disease Research in Zambia implemented MoH guidance by: 1) extending antiretroviral therapy (ART) refill duration to 6 multi-month dispensation (6MMD) and 2) task-shifting communication and mobilisation of those in HIV care to collect their next ART refill early. We assessed the impact of COVID-19 mitigation guidance on HIV care 3 months before and after guidance implementation. METHODS: We reviewed all ART pharmacy visit data in the national HIV medical record for PLHIV in care having ≥1 visit between 1 January-30 June 2020 at 59 HIV care facilities in Lusaka Province, Zambia. We undertook a before-after evaluation using mixed-effects Poisson regression to examine predictors and marginal probability of early clinic return (pharmacy visit >7 days before next appointment), proportion of late visit (>7 days late for next appointment) and probability of receiving a 6MMD ART refill. RESULTS: A total of 101 371 individuals (64% female, median age 39) with 130 486 pharmacy visits were included in the analysis. We observed a significant increase in the adjusted prevalence ratio (4.63; 95% CI 4.45 to 4.82) of early return before compared with after guidance implementation. Receipt of 6MMD increased from a weekly mean of 47.9% (95% CI 46.6% to 49.2%) before to 73.4% (95% CI 72.0% to 74.9%) after guidance implementation. The proportion of late visits (8-89 days late) was significantly higher before (18.8%, 95% CI17.2%to20.2%) compared with after (15.1%, 95% CI13.8%to16.4%) guidance implementation . CONCLUSIONS: Timely issuance and implementation of COVID-19 mitigation guidance involving task-shifted patient communication and mobilisation alongside 6MMD significantly increased early return to ART clinic, potentially reducing interruptions in HIV care during a global public health emergency.