Browsing by Author "Phiri A"

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    Improving PrEP access for adolescent girls and young women: a descriptive analysis of community-based PrEP delivery in the DREAMS programme in Zambia.
    (2025-Jul) Musheke M; Pry JM; Sikazwe I; Muyunda WJ; Chiyenu K; Siame CM; Khondowe WK; Mushiki B; Mwaba MM; Zulu P; Mwape F; Siamasuku B; Shula D; Mweemba MB; Kanene C; Phiri A; Herce ME; School of Medicine, University of California, Davis, California, USA.; 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, USA.; United States Agency for International Development, United States of America Embassy, Lusaka, Zambia.; Young Women Christian Association, Lusaka, Zambia.; Ministry of Health, Ndeke House, Lusaka, Zambia.
    INTRODUCTION: Despite being at high risk of HIV acquisition, access to pre-exposure prophylaxis (PrEP) among adolescent girls and young women (AGYW) is low in Zambia because PrEP is traditionally delivered in clinical settings. We describe the effects of community centres supported by the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative on PrEP outcomes in Zambia and examine factors associated with PrEP continuation. METHODS: We collected individual-level PrEP data for AGYW aged 15-24 years at risk of HIV acquisition and enrolled in DREAMS in seven districts of Zambia between August 2022 and August 2024. We used Pearson's Chi-squared test to examine differences in beneficiary characteristics between clients with a PrEP initiation visit and ≥ 2 PrEP visits (i.e. an initiation plus ≥ 1 return visit), and mixed effects Poisson regression modelling to estimate the association between DREAMS enrolment criteria and PrEP continuation (defined as ≥ 1 PrEP visit within 180 days of initiation). We also estimated the marginal probability of PrEP continuation by number of DREAMS enrolment criteria and used Kaplan-Meier methods to estimate the time to the first PrEP return visit by client age band. RESULTS: Between 11 August 2022 and 23 August 2024, 15,502 AGYW aged 15-24 years were screened for PrEP eligibility, of whom 15,072 (97.2%) initiated PrEP per national guidelines. Of those initiating PrEP, 9807 (65.1%) had sufficient follow-up time to allow for observation of a PrEP return visit. The proportion of AGYW who had ≥ 1 PrEP return visit within 180 days of initiation was 59.0% (n/N = 5706/9675). Across age bands, the percent probability of having a PrEP return visit within 180 days of initiation was highest among clients who reported ≥ 4 DREAMS enrolment criteria at 91.7% (95% CI: 70.7, 112.7%) for clients aged 15-19 years and 83.6% (95% CI: 61.1, 106.2%) for clients aged 20-24 years. Overall, 41.5% of clients had a first PrEP return visit between 21 and 42 days of PrEP initiation. CONCLUSIONS: The high number and proportion of AGYW initiated on PrEP suggests that decentralising PrEP services to DREAMS community centres has the potential to improve PrEP access among AGYW. Increasing HIV risk perception among AGYW may improve PrEP continuation.
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    Knowledge and awareness of bovine tuberculosis associated with raw milk and under-cooked meat contamination among cattle farmers in selected parts of zambia.
    (2025-Apr) Phiri A; Likulunga E; Chauwa A; Zulu M; Kankhuni B; Monde N; Malama S; Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia.; Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia.; Department of Clinical Medicine, Levy Mwanawasa Medical University, Lusaka, Zambia.; Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Biological Sciences, School of Natural Sciences, University of Zambia, Lusaka, Zambia.; Department of Biomedical Sciences, Tropical Disease Research Centre, Ndola, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: Bovine tuberculosis (bTB) is a disease of cattle that is transmitted through direct contact with an infected animal or ingestion of contaminated food. METHODS: A mixed-methods study was conducted in two districts of Zambia, Lundazi and Monze, from December 2021 to June 2022. A cross-sectional survey with 280 respondents, five focus group discussions, and five key informant interviews were conducted. Descriptive statistics were used to analyze quantitative data using R software, while qualitative data was analyzed using Nvivo and content analysis. RESULTS: Social and cultural practices were reported to significantly contribute to bTB transmission with risky behaviors including the consumption of undercooked meat and unpasteurized milk, and inadequate protective measures during cattle slaughtering. Overall, 75.3% of male and 70.3% of female respondents expressed a poor level of awareness of bTB transmission. Among cattle farmers, 85.7% lacked formal education, resulting in low knowledge levels, with 99.5% expressing poor awareness. Additionally, findings revealed that 99.5% of cattle farmers had poor awareness of bTB, human doctors/clinicians, and veterinary/para-veterinarians had 100% excellent knowledge. Abattoir workers had good knowledge at 78.3% and cattle businessmen had a fair knowledge level at 96.4%. Overall, bTB awareness varied across occupations, with human and animal healthcare professionals being the most knowledgeable. CONCLUSIONS: Our study found low levels of awareness and misperception about bTB among cattle farmers. Awareness varied across professionals with educated individuals being more knowledgeable. The consumption of undercooked meat and raw milk highlighted these knowledge gaps. Therefore, it is crucial to conduct public health campaigns to raise awareness about bTB causes, sources of infection, and control measures.