National HIV/AIDS/STI/TB Council

ABSTRACT Introduction Postpartum hemorrhage is the leading contributor to maternal morbidity and mortality worldwide, with the burden greatest in low-resource settings. In Zambia, maternal mortality remains above national and global targets, and PPH is a major contributor. While most studies emphasize predictors and prevalence, limited evidence exists on maternal outcomes across different levels of care. This study aimed to examine maternal outcomes of Postpartum hemorrhage following vaginal delivery in first-level and tertiary hospitals in Lusaka. Methods We employed a quantitative, case-control study cross-sectionally on 318 women who delivered vaginally at first-level and tertiary hospitals in Lusaka, Zambia. Data were collected using structured questionnaires and analyzed with descriptive statistics, correlations, and regression. Cases and controls were comparable across baseline variables Results Among Postpartum hemorrhage cases, 56.8% required blood transfusion, 11% developed hemorrhagic shock, 3.8% underwent hysterectomy, and 3.8% died. Adverse outcomes occurred exclusively among cases. Accessibility and provider competence were negatively correlated with complications, while regression analysis identified uterine atony (OR = 2.8, 95% CI: 1.4–5.6), referral delays >2 hours (OR = 3.5, 95% CI: 1.7–7.2), and lack of blood availability (OR = 4.2, 95% CI: 2.0–8.9) as the strongest predictors of the mortality outcome. Conclusion Postpartum hemorrhage imposes a severe burden on first-level hospitals, with blood transfusion demand, referral delays, and systemic gaps driving poor outcomes. Strengthening blood bank infrastructure, improving referral pathways, and continuous provider training are critical to reducing preventable maternal deaths.

Indoor residual spraying (IRS) is a vector control tool recommended by the WHO in areas of high malaria burden. Effective IRS implementation is complicated when up-to-date and accurate counts of structures eligible for IRS are unavailable; resultingly, programmatic spray coverage is typically calculated as the proportion of found structures that are sprayed. From 2016 – 2020 in Zambia, an open-source tool termed “Reveal,” was used to support digital mapping, microplanning, campaign monitoring and evaluation of IRS. Satellite imagery was used to enumerate structures and identify “spray areas,” clusters of structures for operational planning. Spray areas were visualized in the Reveal tool web-based planning module where campaign planners selected which would be sprayed and determined the resources required. Field teams used the Reveal tool mobile application to navigate and to record spray data against each structure. True coverage was calculated as the proportion of enumerated structures that were sprayed. Reveal was implemented in 21 districts across five years and coverage is reported for each district and year. Logistic regression models explored whether structures were more or less likely to be found and sprayed depending on a given calendar year’s targeting strategy, partner support level, and the year of Reveal implementation in a given district (first, second, third, or fourth). District-level programmatic IRS coverages overestimated the true adjusted coverages by an average 31.5 percentage points (range 2.8 - 69.4). The odds of finding and spraying structures increased with year of implementation; in the fourth year of implementation in a district, the odds of a household being sprayed and found were two times higher than in the first year of implementation. Digital tools improve structure and population estimates for planning and deployments in IRS campaigns, which may lead to more accurate coverage measurements and increased coverage over time.

Heavy menstrual bleeding (HMB), clinically defined as excessive menstrual blood loss which interferes with a woman's physical, emotional, social, and/or material quality of life, is a highly prevalent yet understudied global health problem. This cross-sectional study examines associations between HMB and menstruation-related resources, to understand factors that may contribute to HMB.We conducted secondary analyses of household survey data collected from women in eight cities across five countries: Meherpur and Saidpur, Bangladesh; Narsapur, Tiruchirappalli, and Warangal, India; Dakar, Senegal; Kampala, Uganda; and Lusaka, Zambia. HMB was assessed using the clinically validated SAMANTA scale, and menstruation-specific resources were measured through validated scales for safety and security, privacy, financial assets, and time. We conducted regression analyses, controlling for demographic covariates and clustering, of associations between HMB and menstruation-specific resources.Among our analytic sample of 3962 participants, 44.7 % were categorized as experiencing HMB. Results indicated that financial dependence on others for menstruation-related expenses and limited control over time were significantly associated with higher prevalence of HMB. Specifically, each one-point increase in financial dependence was associated with a 9 % higher HMB prevalence (p = 0.008), while greater control over time was associated with a 20 % lower prevalence (p < 0.001). The use of menstrual materials not specifically designed for menstruation, such as cotton wool or toilet paper, was also significantly associated with higher HMB prevalence.These findings highlight the critical importance of control over menstruation-specific resources, particularly financial resources and time, as well as improved access to affordable and high-quality menstrual materials, for menstrual health in urban populations.

Abstract Background: Adolescent girls and young women (AGYW) in sub-Saharan Africa face a disproportionate burden of gender-based violence (GBV), HIV risk, and mental health challenges. Despite the demonstrated effectiveness of psychological interventions such as problem-solving therapy (PST), there is limited evidence on culturally adapted models for GBV-exposed AGYW that concurrently address HIV and mental health, particularly in settings with constrained mental health infrastructure. Objective: This study outlines the protocol for a randomized controlled trial evaluating Mpata Yathu, a church-based adaptation of the Friendship Bench intervention, which delivers lay counselor-led PST to AGYW with a history of GBV in Lusaka, Zambia. Methods: A hybrid implementation-effectiveness type 1 randomized controlled trial (intervention and waitlist control arms) will be conducted among 90 AGYW, aged 15 to 24, per arm with moderate depressive symptoms, lifetime GBV exposure, and HIV risk or diagnosis. The intervention comprises six individual PST sessions delivered over three months in church spaces. Implementation outcomes (feasibility, acceptability, fidelity), common mental disorder (CMD) symptoms (primary outcome), and exploratory outcomes (depression, anxiety, PTSD, HIV engagement, GBV attitudes, childhood adversity, coping self-efficacy) will be assessed at baseline, 3, and 6 months. The trial is powered to detect changes in CMD symptoms only. Mixed-methods data will inform feasibility, intervention refinement, and hypotheses regarding mental health as a mediator of HIV outcomes. Process evaluations will use the Consolidated Framework for Implementation Research (CFIR). Conclusions: This trial will assess the potential of church-based PST to address the intersecting burdens of GBV, HIV, and mental health among AGYW in Zambia. Findings will offer insights into leveraging trusted community institutions (e.g., church and religious settings) for mental health and HIV care delivery in low-resource settings. Trial Registration Number:Pending. The study will be registered prospectively on ClinicalTrials.gov. The WHO Trial Registration Data Set will be completed and submitted with ClinicalTrials.gov registration prior to trial launch. Protocol version: July 2025, Version 1.0; this trial is projected to begin September 2025 and end April 2026

Accurate population size estimates (PSE) of key populations-those disproportionately affected by HIV-are critical to forecast need and inform HIV prevention and treatment programs, though they can be difficult to ascertain due to low visibility of these groups. In Zambia, reliable estimates on the number of people who inject drugs are limited, inhibiting public health response. We sought to estimate the population size of people who inject drugs in 3 large cities in Zambia, assess how PSEs vary across different estimation methods, and explore the strengths and limitations of each approach. We applied 2-source capture-recapture (2S-CRC), 3-source capture-recapture (3S-CRC), and successive sampling population size estimation (SS-PSE) methods in Lusaka, Livingstone, and Ndola, Zambia. 3S-CRC methods included location-based 2S-CRC in combination with a respondent-driven sampling (RDS) survey. Data were collected from November 2021 to February 2022 and analyzed using a Bayesian nonparametric latent class model. SS-PSEs were produced using the RDS recruitment and network sizes. Kruskal tests and general linear models were used to examine sociodemographic and behavioral factors associated with being captured in 2S-CRC among RDS participants. Final city population estimates, incorporating 3S-CRC and SS-PSE with imputed visibility estimates, were generated using a Bayesian consensus estimator. Bayesian consensus PSEs ranged between 0.5% and 1.8% of the adult male population and were below 1% of the total adult population in each city. Consensus estimates were highest in Lusaka (3700, 95% credible interval [CRI] 1500-7500), followed by Ndola (2200, 95% CRI 1600-2900) and Livingstone (1200, 95% CRI 900-1,900). There was variability in estimates by method, with SS-PSE with imputed visibility generally providing the lowest estimates across cities, excluding Lusaka. Across methods, PSEs and uncertainty bounds (95% confidence interval [CI] or CRI depending on method) ranged from 1510 (95% CRI 1030-2070) to 4350 (95% CI 1410-18,890) in Lusaka, 360 (95% CI 290-530) to 2620 (95% CRI 1510-4680) in Livingstone, and 760 (95% CI 390-3060) to 4030 (95% CRI 960-5480) in Ndola. In all cities, fewer recaptures occurred in capture 3 (RDS) than with location sampling via 2S-CRC. Though results varied across cities, RDS participants captured through 2S-CRC differed from those captured solely through RDS in sociodemographic and behavioral risk factors, including housing, education, injection or needle sharing frequency, time since last injection, receipt of drug treatment, and experience with a peer educator in at least one city. This study used rigorous methods to produce PSEs in Zambia, and is the first to produce these for major geographies in the country. Through RDS, 3S-CRC reached people who inject drugs with distinct characteristics that were less accessible via location-based sampling (2S-CRC), yielding a PSE that may better reflect the population and informing the Bayesian consensus estimate. Findings from this study can guide program planning and future surveillance activities.

Sexual violence (SV) affects millions globally and has a well-documented bidirectional association with HIV. Post-exposure prophylaxis (PEP) is a critical, yet often underutilized, HIV prevention tool in post-SV care. Despite its potential impact to reduce HIV transmission, SV care remains an overlooked service delivery point for HIV prevention. The U.S. Centers for Disease Control and Prevention (CDC), as part of the President's Emergency Plan for AIDS Relief (PEPFAR), supports PEP provision within broader post-violence care (PVC) services. Understanding PEP utilization is crucial for optimizing service delivery and HIV prevention efforts. Using Monitoring Evaluation and Reporting data from fiscal years 2018-2023, we conducted a descriptive analysis of clients who received PVC and SV services through CDC-supported programming in 14 sub-Saharan African countries. From 2018 to 2023, the annual number of clients receiving any PVC, and specifically SV, services increased by 233% (in 2018, n = 206,764; in 2023, n = 689,349) and 163% (in 2018, n = 42,848; in 2023, n = 112,838), respectively. Fewer than half of SV clients completed PEP (38% in 2018, n = 16,103; 31% in 2023, n = 35,118). Across all years combined, most SV clients (female: 185,414; male: 59,618) were aged 15-19 years. The age band and sex with the lowest proportion of clients completing PEP were males aged 15-19 (4%, n = 2296). The findings underscore a critical gap between the scaling of SV services and the completion of PEP within violence response programmes. Innovative implementation science approaches may help to identify and address barriers inhibiting effective PEP delivery and uptake within PVC service delivery programmes. Enhancing PEP uptake and completion can support mitigating the bidirectional relationship between violence and HIV acquisition, particularly among vulnerable populations like adolescents and young adults. Low PEP coverage also reflects missed opportunities, particularly among adolescent girls and young women, who experience disproportionate rates of HIV acquisition.

BackgroundThe increasing availability globally of building footprint datasets has brought new opportunities to support a geographic approach to health programme planning. This is particularly acute in settings with high disease burdens but limited geospatial data available to support targeted planning. The comparability of building footprint datasets has recently started to be explored, but the impact of utilising a particular dataset in analyses to support decision making for health programme planning has not been studied. In this study, we quantify the impact of utilising four different building footprint datasets in analyses to support health programme planning, with an example of malaria vector control initiatives in Zambia.MethodsUsing the example of planning indoor residual spraying (IRS) campaigns in Zambia, we identify priority locations for deployment of this intervention based on criteria related to the area, proximity and counts of building footprints per settlement. We apply the same criteria to four different building footprint datasets and quantify the count and geographic variability in the priority settlements that are identified.ResultsWe show that nationally the count of potential priority settlements for IRS varies by over 230% with different building footprint datasets, considering a minimum threshold of 25 sprayable buildings per settlement. Differences are most pronounced for rural settlements, indicating that the choice of dataset may bias the selection to include or exclude settlements, and consequently population groups, in some areas.ConclusionsThe results of this study show that the choice of building footprint dataset can have a considerable impact on the potential settlements identified for IRS, in terms of (i) their location and count, and (ii) the count of building footprints within priority settlements. The choice of dataset potentially has substantial implications for campaign planning, implementation and coverage assessment. Given the magnitude of the differences observed, further work should more broadly assess the sensitivity of health programme planning metrics to different building footprint datasets, and across a range of geographic contexts and health campaign types.

Illicit alcohol consumption is prevalent globally, particularly in low- and middle-income countries where formal regulatory systems are weak or less enforced. Consumption of illicit alcohol has serious consequences, both immediate and long-term. To examine the socio-demographic and behavioral factors associated with the consumption of illicit alcohol among the patrons in selected urban and peri-urban areas in Zambia. This was a cross-sectional study. Illicit alcohol consumption status, socio-demographics and behavioral factors were assessed. Adjusted multivariable logistic regression was used to obtain odds ratios (AOR) at a 95% confidence interval (CI). Of the 416 patrons who participated, 71.2% consumed illicit alcohol (Men, 75.3% vs. women 54.7%). More than 66.8% reported needing a drink first thing in the morning, 50.2% have had problems with friends due to alcohol and 19% did indicate having visited the hospital due to a drinking problem. In multivariable analysis, factors significantly associated with decreased odds of illicit alcohol consumption were females (AOR) 0.38 (95% CI: 0.20-0.73, p = 0.003), Ndola city (AOR = 0.28, 95% CI: 0.12-0.62, p = 0.002), drinking pattern of 2-3 days a month (AOR: 0.19, 95% CI: 0.06-0.53, p = 0.002) and incomes above K10,000 (AOR: 0.40, 95% CI: 0.19-0.85, p = 0.017). The inability to stop drinking (AOR = 2.86, 95% CI: 1.22-6.69, p = 0.016) had an increased odds of illicit alcohol consumption. Our findings underscore the high prevalence of illicit alcohol consumption among the patrons. Addressing illicit alcohol consumption requires a multifaceted set of interventions that consider the various factors contributing to alcohol misuse, and focuses on prevention, education, support, and community engagement.

BackgroundDespite progress towards HIV epidemic control, people living with HIV (PLHIV) in Zambia continue to face high mortality during and especially after hospitalization, with suboptimal post-discharge care leading to poor outcomes. We conducted a qualitative study to better understand factors influencing post-discharge engagement in care for HIV and associated comorbidities.MethodsWe conducted in-depth interviews with 16 recently discharged PLHIV, seven caregivers, and two doctors; and three focus group discussions with inpatient doctors (n = 8) and lay counsellors (n = 16) at two tertiary hospitals in Lusaka, guided by the social-ecological model. Data were audio-recorded, transcribed verbatim, managed with Atlas.ti 9, and thematically analyzed.ResultsIndividual and household-level barriers to post-discharge care for PLHIV included HIV status denial and stigma, limited disclosure, and limited social and emotional support. Health-related barriers included concomitant treatments for TB, HIV comorbidities, and behavioral health issues like depression and alcohol abuse. Health system barriers included limited confidentiality during admission and poor communication between healthcare providers and between facilities aftercare transitions following discharge. Social-economic factors included economic shocks of hospitalization and post-discharge recovery, which compounded pre-existing poverty and high transportation and food costs. Conversely, disclosure of HIV status, better social support, a financially stable household, and hospital follow-up appointment reminders facilitated better post-discharge care.ConclusionAfter hospital discharge with HIV, system and individual challenges exacerbate pre-existing interpersonal, health, environmental, and system-related factors to cause poor outcomes. Holistic community-based interventions to facilitate these patients’ re-engagement in care after discharge could help HIV programs reach the last mile in epidemic control.

Concerning this issue, the present study aims to investigate transformational curriculum development as the key enabler of enhancing learners' critical thinking and problem-solving skills. These include research into curriculum theories and experiences that connect frameworks to the functioning of the 21st-century knowledge economy. This work seeks to critically analyse constructivist, experiential and inquiry learning theories as frameworks for creating a curriculum which fosters higher-order cognition. It also assesses how content area disciplines work in cohesion, taught with collaboration and communication implemented equally within the classroom, and various forms of technology to produce interactive and innovative learning. This research reports a literature and case study analysis of progressive approaches for integrating critical thinking and problem-solving competency within various learning environments. Therefore, the study supports the learning goals, delivery models, and evaluation paradigms underpinning radical change. Implications for classroom practice, system improvement, and curriculum design are considered, focusing on the context and applicability of the ideas described at the classroom, school, district, and state levels. This research's findings help fill the literature gap on curriculum creation and application by providing best practices to enhance practice-based applied theoretical educational approaches for learners who are expected to solve multifaceted issues in the current work environment.