Browsing by Author "Phiri J"

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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.
Economic evaluation of implementation science outcomes in low- and middle-income countries: a scoping review.
(2022-Nov-16) Malhotra A; Thompson RR; Kagoya F; Masiye F; Mbewe P; Mosepele M; Phiri J; Sambo J; Barker A; Cameron DB; Davila-Roman VG; Effah W; Hutchinson B; Laxy M; Newsome B; Watkins D; Sohn H; Dowdy DW; Technical University of Munich, Munich, Germany.; Fogarty International Center (FIC), National Institutes of Health (NIH), Bethesda, MD, USA.; University of Washington, Seattle, WA, USA.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ddowdy1@jhmi.edu.; Cavendish University Zambia, Lusaka, Zambia.; Ezintsha, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.; University of Botswana, Gaborone, Botswana.; Center for Global Noncommunicable Diseases, RTI International, Seattle, WA, USA.; Infectious Diseases Research Collaboration, Kampala, Uganda.; Washington University in Saint Louis, Saint Louis, MO, USA.; Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; University of Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Historically, the focus of cost-effectiveness analyses has been on the costs to operate and deliver interventions after their initial design and launch. The costs related to design and implementation of interventions have often been omitted. Ignoring these costs leads to an underestimation of the true price of interventions and biases economic analyses toward favoring new interventions. This is especially true in low- and middle-income countries (LMICs), where implementation may require substantial up-front investment. This scoping review was conducted to explore the topics, depth, and availability of scientific literature on integrating implementation science into economic evaluations of health interventions in LMICs. METHODS: We searched Web of Science and PubMed for papers published between January 1, 2010, and December 31, 2021, that included components of both implementation science and economic evaluation. Studies from LMICs were prioritized for review, but papers from high-income countries were included if their methodology/findings were relevant to LMIC settings. RESULTS: Six thousand nine hundred eighty-six studies were screened, of which 55 were included in full-text review and 23 selected for inclusion and data extraction. Most papers were theoretical, though some focused on a single disease or disease subset, including: mental health (n = 5), HIV (n = 3), tuberculosis (n = 3), and diabetes (n = 2). Manuscripts included a mix of methodology papers, empirical studies, and other (e.g., narrative) reviews. Authorship of the included literature was skewed toward high-income settings, with 22 of the 23 papers featuring first and senior authors from high-income countries. Of nine empirical studies included, no consistent implementation cost outcomes were measured, and only four could be mapped to an existing costing or implementation framework. There was also substantial heterogeneity across studies in how implementation costs were defined, and the methods used to collect them. CONCLUSION: A sparse but growing literature explores the intersection of implementation science and economic evaluation. Key needs include more research in LMICs, greater consensus on the definition of implementation costs, standardized methods to collect such costs, and identifying outcomes of greatest relevance. Addressing these gaps will result in stronger links between implementation science and economic evaluation and will create more robust and accurate estimates of intervention costs. TRIAL REGISTRATION: The protocol for this manuscript was published on the Open Science Framework. It is available at: https://osf.io/ms5fa/ (DOI: 10.17605/OSF.IO/32EPJ).
Mixed-methods protocol for the WiSSPr study: Women in Sex work, Stigma and psychosocial barriers to Pre-exposure prophylaxis in Zambia.
(2024-Sep-05) Kumar R; Rao D; Sharma A; Phiri J; Zimba M; Phiri M; Zyambo R; Kalo GM; Chilembo L; Kunda PM; Mulubwa C; Ngosa B; Mugwanya KK; Barrington WE; Herce ME; Musheke M; Lusaka District Health Office, Zambia Ministry of Health, Lusaka, Zambia.; Epidemiology, Global Health, University of Washington School of Public Health, Seattle, Washington, USA.; Epidemiology; Child, Family, and Population Health Nursing; Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA.; Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Tithandizeni Umoyo Network, Lusaka, Zambia.; Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA.; Zambia Sex Workers Alliance, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; University of Washington School of Public Health, Seattle, Washington, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia ramya.kumar.mlk@gmail.com.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: Women engaging in sex work (WESW) have 21 times the risk of HIV acquisition compared with the general population. However, accessing HIV pre-exposure prophylaxis (PrEP) remains challenging, and PrEP initiation and persistence are low due to stigma and related psychosocial factors. The WiSSPr (Women in Sex work, Stigma and PrEP) study aims to (1) estimate the effect of multiple stigmas on PrEP initiation and persistence and (2) qualitatively explore the enablers and barriers to PrEP use for WESW in Lusaka, Zambia. METHODS AND ANALYSIS: WiSSPr is a prospective observational cohort study grounded in community-based participatory research principles with a community advisory board (CAB) of key population (KP) civil society organi sations (KP-CSOs) and the Ministry of Health (MoH). We will administer a one-time psychosocial survey vetted by the CAB and follow 300 WESW in the electronic medical record for three months to measure PrEP initiation (#/% ever taking PrEP) and persistence (immediate discontinuation and a medication possession ratio). We will conduct in-depth interviews with a purposive sample of 18 women, including 12 WESW and 6 peer navigators who support routine HIV screening and PrEP delivery, in two community hubs serving KPs since October 2021. We seek to value KP communities as equal contributors to the knowledge production process by actively engaging KP-CSOs throughout the research process. Expected outcomes include quantitative measures of PrEP initiation and persistence among WESW, and qualitative insights into the enablers and barriers to PrEP use informed by participants' lived experiences. ETHICS AND DISSEMINATION: WiSSPr was approved by the Institutional Review Boards of the University of Zambia (#3650-2023) and University of North Carolina (#22-3147). Participants must give written informed consent. Findings will be disseminated to the CAB, who will determine how to relay them to the community and stakeholders.