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The CIDRZ Research Repository serves as an open-access archive for peer-reviewed publications, conference papers, and other scholarly outputs from CIDRZ researchers. Our goal is to promote the dissemination of knowledge and support evidence-based public health initiatives.
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Item Antimicrobial resistance and heterogeneity of Neisseria gonorrhoeae isolated from patients attending sexually transmitted infection clinics in Lusaka, Zambia.(2024-Mar-18) Sarenje KL; van Zwetselaar M; Kumburu H; Sonda T; Mmbaga B; Ngalamika O; Maimbolwa MC; Siame A; Munsaka S; Kwenda G; Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, P.O. Box 50110, Zambia. kelvinsarenje@gmail.com.; Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, P.O. Box 50110, Zambia.; Department of Dermato-venereology, University Teaching Hospital, Lusaka, Zambia. kelvinsarenje@gmail.com.; Department of Dermato-venereology, University Teaching Hospital, Lusaka, Zambia.; Kilimanjaro Christian Medical Centre, Moshi, Tanzania.; Department of Midwifery Child, and Women's Health, School of Nursing Sciences, University of Zambia, Lusaka, Zambia.; Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania.; Kilimanjaro Christian Medical University College, Moshi, Tanzania.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)BACKGROUND: Antimicrobial resistance (AMR) of Neisseria gonorrhoeae is a threat to public health as strains have developed resistance to antimicrobials available for the treatment of gonorrhea. Whole genome sequencing (WGS) can detect and predict antimicrobial resistance to enhance the control and prevention of gonorrhea. Data on the molecular epidemiology of N. gonorrhoeae is sparse in Zambia. This study aimed to determine the genetic diversity of N. gonorrhoeae isolated from patients attending sexually transmitted infection (STI) clinics in Lusaka, Zambia. METHODS: A cross-sectional study that sequenced 38 N. gonorrhoeae isolated from 122 patients with gonorrhea from 2019 to 2020 was conducted. The AMR profiles were determined by the E-test, and the DNA was extracted using the NucliSens easyMaG magnetic device. Whole genome sequencing was performed on the Illumina NextSeq550 platform. The Bacterial analysis pipeline (BAP) that is readily available at: https://cge.cbs.dtu.dk/services/CGEpipeline-1.1 was used for the identification of the species, assembling the genome, multi-locus sequence typing (MLST), detection of plasmids and AMR genes. Phylogeny by single nucleotide polymorphisms (SNPs) was determined with the CCphylo dataset. RESULTS: The most frequent STs with 18.4% of isolates each were ST CONCLUSION: This study revealed remarkable heterogeneity of N. gonorrhoeae with blaItem Engagement of private health care facilities in TB management in Lusaka district of Zambia: lessons learned and achievements.(2024-Mar-14) Hambwalula R; Kagujje M; Mwaba I; Musonda D; Singini D; Mutti L; Sanjase N; Kaumba PC; Ziko LM; Zimba KM; Kasese-Chanda P; Muyoyeta M; TB department, Centre of Infectious Disease Research in Zambia, Plot # 34620 Off Alick Nkhata Road, Mass Media, P.O. Box 34681, Lusaka, 10101, Zambia. Mary.Kagujje@cidrz.org.; Lusaka District Health Office, Ministry of Health, Great East Road, Lusaka, Zambia.; TB department, Centre of Infectious Disease Research in Zambia, Plot # 34620 Off Alick Nkhata Road, Mass Media, P.O. Box 34681, Lusaka, 10101, Zambia.; Division of Health, United States Agency for International Development, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)BACKGROUND: Globally, at least 3 million TB patients are missed every year. In Zambia, the TB treatment coverage increased from 66% in 2020 to 92% in 2022. Involvement of all levels of health care service delivery is critical to finding all the missing TB patients. METHODS: A survey was undertaken in 15 private facilities in Lusaka district of Zambia using a structured tool administered by project team and a district health team member. Data collected during the survey was analysed and results were used to determine the type of TB services that were offered as well as barriers and enablers to TB service provision. This was followed by a set of interventions that included; training and mentorship on active case finding and systematic TB screening, increased diagnostic capacity, provision of national recording and reporting tools and provision of TB medication through linkage with the National TB program (NTP). We report findings from the baseline survey and changes in presumptive TB identification and notification following interventions. RESULTS: Major barriers to TB service delivery were the high cost of TB diagnostic testing and treatment in facilities where services were not supported by the National TB program; the mean cost was 33 (SD 33) and 93 (SD 148) for GeneXpert testing and a full course of treatment respectively. Pre-intervention, presumptive TB identification appeared to increase monthly by 4 (P = 0.000, CI=[3.00-5.00]). The monthly trends of presumptive TB identification during the intervention period increased by 5.32 (P = 0.000, [CI 4.31-6.33. Pre-intervention, the notification of TB appeared to decrease every month by -4.0 (P = 0.114, CI=[-9.00-0.10]) followed by an immediate increase in notifications of 13.94 TB patients (P = 0.001, CI [6.51, 21.36] in the first month on intervention. The monthly trends of notification during the intervention period changed by 0.34 (P = 0.000 [CI 0.19-0.48]). Private facility contribution to TB notification increased from 3 to 7%. CONCLUSION: Engagement and inclusion of private health facilities in TB service provision through a systems strengthening approach can increase contribution to TB notification by private health facilities.Item Trends in SARS-CoV-2 seroprevalence among pregnant women attending first antenatal care visits in Zambia: A repeated cross-sectional survey, 2021-2022.(2024) Heilmann E; Tembo T; Fwoloshi S; Kabamba B; Chilambe F; Kalenga K; Siwingwa M; Mulube C; Seffren V; Bolton-Moore C; Simwanza J; Yingst S; Yadav R; Rogier E; Auld AF; Agolory S; Kapina M; Gutman JR; Savory T; Kangale C; Mulenga LB; Sikazwe I; Hines JZ; Surveillance and Disease Intelligence, Zambia National Public Health Institute, Lusaka, Zambia.; Public Health Institute, Oakland, California, United States of America.; Adult Centre of Excellence, University Teaching Hospital, Lusaka, Zambia.; Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.; PATH, Lusaka, Zambia.; Division of Infectious Diseases, Ministry of Health, Lusaka, Zambia.; Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)SARS-CoV-2 serosurveys help estimate the extent of transmission and guide the allocation of COVID-19 vaccines. We measured SARS-CoV-2 seroprevalence among women attending ANC clinics to assess exposure trends over time in Zambia. We conducted repeated cross-sectional SARS-CoV-2 seroprevalence surveys among pregnant women aged 15-49 years attending their first ANC visits in four districts of Zambia (two urban and two rural) during September 2021-September 2022. Serologic testing was done using a multiplex bead assay which detects IgG antibodies to the nucleocapsid protein and the spike protein receptor-binding domain (RBD). We calculated monthly SARS-CoV-2 seroprevalence by district. We also categorized seropositive results as infection alone, infection and vaccination, or vaccination alone based on anti-RBD and anti-nucleocapsid test results and self-reported COVID-19 vaccination status (vaccinated was having received ≥1 dose). Among 8,304 participants, 5,296 (63.8%) were cumulatively seropositive for SARS-CoV-2 antibodies from September 2021 through September 2022. SARS-CoV-2 seroprevalence primarily increased from September 2021 to September 2022 in three districts (Lusaka: 61.8-100.0%, Chongwe: 39.6-94.7%, Chipata: 56.5-95.0%), but in Chadiza, seroprevalence increased from 27.8% in September 2021 to 77.2% in April 2022 before gradually dropping to 56.6% in July 2022. Among 5,906 participants with a valid COVID-19 vaccination status, infection alone accounted for antibody responses in 77.7% (4,590) of participants. Most women attending ANC had evidence of prior SARS-CoV-2 infection and most SARS-CoV-2 seropositivity was infection-induced. Capturing COVID-19 vaccination status and using a multiplex bead assay with anti-nucleocapsid and anti-RBD targets facilitated distinguishing infection-induced versus vaccine-induced antibody responses during a period of increasing COVID-19 vaccine coverage in Zambia. Declining seroprevalence in Chadiza may indicate waning antibodies and a need for booster vaccines. ANC clinics have a potential role in ongoing SARS-CoV-2 serosurveillance and can continue to provide insights into SARS-CoV-2 antibody dynamics to inform near real-time public health responses.Item Present or Absent: Risks and protective factors of sudden infant death syndrome (SIDS) in the Zambian context.(2025-May-13) Zulu EM; Mwananyanda L; Pieciak RC; Forman LS; Shah J; Heeren T; Gill CJ; Chilengi R; Payne-Lohman B; Duffy CR; Osei-Poku G; Thea DM; Wa Somwe S; Herlihy JM; University of Rhode Island.; University of Zambia.; Commonwealth of Massachusetts.; Boston University School of Public Health.; Centre for Infectious Disease Research in Zambia.; Right to Care Zambia.; Beth Israel Deaconess Medical Center, Harvard Medical School.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)BACKGROUND: Despite a reduction in Sudden Unexplained Infant Death (SUID) in high-income countries, the incidence of SUID and the prevalence of its risk and protective factors remain poorly understood in Zambia due to limited research. The aim of our study was to describe the infant sleep positions and sleep environments in an urban Zambian population to gain a better understanding of the modifiable risk factors for SUID. METHODS: Data from the Zambian Infant Cohort Study (ZICS), a prospective birth cohort, were collected to describe infant sleep practices in Chawama, a densely populated peri-urban community in Lusaka, Zambia. During the 20-week study visit a structured questionnaire was administered to obtain data about the sleeping and environmental risks associated with SUID. RESULTS: Data were collected from 596 caregivers and 605 infants. Only 6.4% of caregivers did attain an education beyond secondary school, and a significant proportion of infants (20.2%) had low birth weights, with 10.7% of infants confirmed by ultrasound as preterm. Furthermore, 96.5% of infants were placed to sleep on their side or in a prone position, and 98.2% of infants shared a sleep surface with their caregiver. Breastfeeding, a protective factor, was highly prevalent, with 90.2% of infants receiving some form of breastfeeding at the 24-week visit. CONCLUSION: The results of this study show that both modifiable (bed-sharing and prone sleep position) and non-modifiable risk factors (low birthweight and prematurity) of SUID are prevalent in this low socioeconomic setting in Zambia. Public health strategies to prevent SUID will need to be innovative and culturally congruent in addressing modifiable risks, such as bedsharing, in settings where there is a lack of space. TRIAL REGISTRATION: Trial number: 1R01HD094650.Item Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents' sexual and reproductive health needs in rural Zambia.(2024-May-03) Mulubwa C; Zulu JM; Hurtig AK; Goicolea I; Centre for Infectious Disease Research in Zambia (CIDRZ), P.O Box 34681, Lusaka, Zambia. cmulubwa@hotmail.com.; School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia.; School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia. cmulubwa@hotmail.com.; Department of Epidemiology and Global Health, Umeå University, Umeå, SE, Sweden.; Department of Epidemiology and Global Health, Umeå University, Umeå, SE, Sweden. cmulubwa@hotmail.com.INTRODUCTION: Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents' access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents' SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents' SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents. METHODS: Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz's grounded theory approach was used for the analysis. RESULTS: We present the core category "being both a grandmother and a CBHW", which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents' SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges. CONCLUSION: Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people's sexual and reproductive health.Item The impact of the SKILLZ intervention on sexual and reproductive health empowerment among Zambian adolescent girls and young women: results of a cluster randomized controlled trial.(2025-Jun-05) Sheira LA; Mulubwa C; Chiu C; Chipungu J; Coakley C; Smith H; Upadhyay UD; Chilambe C; Chibwe B; Pry JM; Mkandawire B; Musonda M; Moore CB; Liu J; School of Population Health, University of New South Wales, Sydney, Australia.; Grassroot Soccer Zambia, Lusaka, Zambia.; Institute for Health & Aging, School of Nursing, University of California, San Francisco, USA.; Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.; Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA.; Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa.; Division of Epidemiology, School of Medicine, University of California, Davis, USA.; Institute for Health & Aging, School of Nursing, University of California, San Francisco, USA. Lila.sheira@ucsf.edu.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)BACKGROUND: Zambian adolescent girls and young women (AGYW, age 15–24) experience a disproportionate burden of HIV and unintended pregnancy. Sports-based interventions, which affect sexual health behaviors via improving sexual and reproductive empowerment, may be an innovative and effective approach for promoting HIV and unintended pregnancy prevention. We sought to evaluate the impact of a peer-led, sports-based intervention on sexual and reproductive empowerment among in-school Zambian adolescent girls and young women. METHODS: Data come from the ‘SKILLZ’ study, a cluster randomized controlled trial evaluating the impact of a peer-led, sports-based health education program. Sexual and reproductive empowerment, a secondary outcome of SKILLZ, was measured via the 23-item Sexual and Reproductive Empowerment for adolescents and young adults scale (range 0–92, higher = more sexual and reproductive empowerment) three times over approximately 24 months. We conducted a difference-in-differences analysis to evaluate intervention impact over time. RESULTS: The study enrolled 2,153 AGYW (1134 intervention; 1019 control) across 46 secondary schools in Lusaka. Median age at baseline was 17; participants were largely unmarried (96%), with 20% reporting any sexual activity. By endline, nearly 40% reported being sexually active. Between baseline and midline, attending an intervention school was associated with a 6.21-point increase in overall score calculated using the imputed sample (standard error [SE]: 0.75, CONCLUSION: The intervention moderately impacted Sexual and Reproductive Empowerment scores; results were magnified among sexually active AGYW. Given adolescence is a critical period for sexuality and gender programming, as well as for sexual debut, empowerment interventions at schools may support downstream sexual health behaviors that will impact the life-course of AGYW. TRIAL REGISTRATION: This study was registered in ClinicalTrials.gov (NCT04429061) on March 17th, 2020. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12978-025-02046-6.Item Systematic review of associations between gut microbiome composition and stunting in under-five children.(2024-May-23) Chibuye M; Mende DR; Spijker R; Simuyandi M; Luchen CC; Bosomprah S; Chilengi R; Schultsz C; Harris VC; Amsterdam Institute of Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands.; Department of Global Health, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. v.c.harris@amsterdamumc.nl.; Department of Medical Microbiology and Infection Control, Amsterdam University Medical Centers, Amsterdam, The Netherlands.; Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. v.c.harris@amsterdamumc.nl.; Department of Global Health, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.; The Zambia National Public Health Institute (ZNPHI), Lusaka, Zambia.; Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana.; Amsterdam Institute of Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands. v.c.harris@amsterdamumc.nl.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)Childhood stunting is associated with impaired cognitive development and increased risk of infections, morbidity, and mortality. The composition of the enteric microbiota may contribute to the pathogenesis of stunting. We systematically reviewed and synthesized data from studies using high-throughput genomic sequencing methods to characterize the gut microbiome in stunted versus non-stunted children under 5 years in LMICs. We included 14 studies from Asia, Africa, and South America. Most studies did not report any significant differences in the alpha diversity, while a significantly higher beta diversity was observed in stunted children in four out of seven studies that reported beta diversity. At the phylum level, inconsistent associations with stunting were observed for Bacillota, Pseudomonadota, and Bacteroidota phyla. No single genus was associated with stunted children across all 14 studies, and some associations were incongruent by specific genera. Nonetheless, stunting was associated with an abundance of pathobionts that could drive inflammation, such as Escherichia/Shigella and Campylobacter, and a reduction of butyrate producers, including Faecalibacterium, Megasphera, Blautia, and increased Ruminoccoccus. An abundance of taxa thought to originate in the oropharynx was also reported in duodenal and fecal samples of stunted children, while metabolic pathways, including purine and pyrimidine biosynthesis, vitamin B biosynthesis, and carbohydrate and amino acid degradation pathways, predicted linear growth. Current studies show that stunted children can have distinct microbial patterns compared to non-stunted children, which could contribute to the pathogenesis of stunting.Item 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 ME; Bosomprah S; Masiye F; Mweemba O; Edwards JK; Mandyata C; Siame M; Mwila C; Matenga T; Frimpong C; Mugala A; Mbewe P; Shankalala P; Sichone P; Kasenge B; Chunga L; Adams R; Banda B; Mwamba D; Nachalwe N; Agarwal M; Williams MJ; Tonwe V; Pry JM; Musheke M; Vinikoor M; Mutale W; Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA. michael.herce@cidrz.org.; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.; Department of Medicine, Division of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia.; Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Institute of Public Health, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia. michael.herce@cidrz.org.; Division of Infectious Diseases, Department of Medicine, University of Alabama, Birmingham, AL, USA.; Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.; Department of Health Promotion and Education, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia.; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, U.S. National Institutes of Health, Bethesda, MD, USA.; Department of Epidemiology, School of Medicine, University of California at Davis, Davis, CA, USA.; Department of Health Economics, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia.; Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.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).Item Reaching for 90:90:90 in Correctional Facilities in South Africa and Zambia: Virtual Cross-Section of Coverage of HIV Testing and Antiretroviral Therapy During Universal Test and Treat Implementation.(2024-Aug-15) Hoffmann CJ; Herce ME; Chimoyi L; Smith HJ; Tlali M; Olivier CJ; Topp SM; Muyoyeta M; Reid SE; Hausler H; Charalambous S; Fielding K; Department of Family Medicine, School of Medicine, University of Pretoria, Pretoria, South Africa; and.; TB HIV Care, Cape Town, South Africa.; The Aurum Institute, Johannesburg, South Africa.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Department of Medicine, Johns Hopkins University, Baltimore, MD.; Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC.; College of Public Health Medicine and Veterinary Sciences, James Cook University, Townsville, Australia.; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL.; Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia.BACKGROUND: People in correctional settings are a key population for HIV epidemic control. We sought to demonstrate scale-up of universal test and treat in correctional facilities in South Africa and Zambia through a virtual cross-sectional analysis. METHODS: We used routine data on 2 dates: At the start of universal test and treat implementation (time 1, T1) and 1 year later (time 2, T2). We obtained correctional facility census lists for the selected dates and matched HIV testing and treatment data to generate virtual cross-sections of HIV care continuum indicators. RESULTS: In the South African site, there were 4193 and 3868 people in the facility at times T1 and T2; 43% and 36% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 1803 (43%) and 1386 (36%) had known HIV status, 804 (19%) and 845 (21%) were known to be living with HIV, and 60% and 56% of those with known HIV were receiving antiretroviral therapy (ART). In the Zambian site, there were 1467 and 1366 people in the facility at times T1 and T2; 58% and 92% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 857 (59%) and 1263 (92%) had known HIV status, 277 (19%) and 647 (47%) were known to be living with HIV, and 68% and 68% of those with known HIV were receiving ART. CONCLUSIONS: This virtual cross-sectional analysis identified gaps in HIV testing coverage, and ART initiation that was not clearly demonstrated by prior cohort-based studies.Item Preterm birth among women with HIV: impact of preconception cART initiation.(2024-Oct-01) Duffy CR; Herlihy JM; Zulu E; Mwananyanda L; Forman L; Heeren T; Gill CJ; Harper M; Chilengi R; Chavuma R; Payne-Lohman B; Thea DM; Right to Care Zambia, Zambia.; Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA.; Department of Global Health, Boston University School of Public Health.; Institute for Immunology and Informatics, University of Rhode Island, South Kingstown, RI, USA.; Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School.; Centre for Infectious Disease Research in Zambia.; Department of Biostatistics, Boston University School of Public Health, Boston, MA.; Boston University, Chobanian & Avedisian School of Medicine, Department of Pediatrics, Boston Medical Center, Boston, MA, USA.; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)OBJECTIVE: To examine the risk of preterm birth (PTB) and small for gestational age (SGA) among women with HIV compared to women without HIV. Secondary objectives were to explore the role of maternal immune activation (IA) and effect of cART timing on these outcomes. DESIGN: Prospective observational cohort. SETTING: Urban government-run clinic at Chawama Hospital in Lusaka, Zambia. PARTICIPANTS: A total of 1481 women with and without HIV with singleton pregnancies enrolled before 26 weeks' gestation by ultrasound dating. METHODS: From August 2019 to November 2022, pregnant women were enrolled in a 1 : 1 ratio of HIV infection. Maternal baseline clinical factors were collected, as well as CD4 + , viral load and CD8 + T-cell IA in women with HIV. Birth outcomes were also collected. The association of HIV-exposure and cART timing on outcomes was assessed by multivariable logistic regression. The independent role of IA was determined by mediation analysis. MAIN OUTCOME MEASURES: PTB (<37 weeks) and SGA. RESULTS: There were 38 fetal deaths and 1230 singleton live births. Maternal HIV infection was associated with PTB [adjusted odds ratio (AOR) 1.60, 95% confidence interval (CI) 1.11-2.32] and to a lesser extent SGA (AOR 1.29, 95% CI 0.98-1.70). Maternal cART timing impacted these associations, with highest risk in women who started cART after conception (PTB AOR 1.77, 95% CI 1.09-2.87, SGA AOR 1.52, 95% CI 1.04-2.22). Maternal IA was not associated with PTB independent of HIV infection. CONCLUSIONS: HIV is associated with PTB. Risk of PTB and SGA was highest in women with HIV who started cART in pregnancy, a modifiable risk factor.