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To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic and the subsequent implementation of tuberculosis response measures on tuberculosis notifications in Zambia.We used an interrupted time-series design to compare monthly tuberculosis notifications in Zambia before the pandemic (January 2019 to February 2020), after implementation of national pandemic mitigation measures (April 2020 to June 2020) and after response measures to improve tuberculosis detection (August 2020 to September 2021). The tuberculosis response included enhanced data surveillance, facility-based active case-finding and activities to generate demand for services. We used nationally aggregated, facility-level tuberculosis notification data for the analysis.Pre-pandemic tuberculosis case notifications rose steadily from 2890 in January 2019 to 3337 in February 2020. After the start of the pandemic and mitigation measures, there was a -22% (95% confidence interval, CI: -24 to -19) immediate decline in notifications in April 2020. Larger immediate declines in notifications were seen among human immunodeficiency virus (HIV)-positive compared with HIV-negative individuals (-36%; 95% CI: -38 to -35; versus -12%; 95% CI: -17 to -6). Following roll-out of tuberculosis response measures in July 2020, notifications immediately increased by 45% (95% CI: 38 to 51) nationally and across all subgroups and provinces. The trend in notifications remained stable through September 2021, with similar numbers to the predicted number had the pandemic not occurred.Implementation of a coordinated public health response including active tuberculosis case-finding was associated with reversal of the adverse impact of the pandemic and mitigation measures. The gains were sustained throughout subsequent waves of the pandemic.Évaluer l'impact de la pandémie de maladie à coronavirus 2019 (COVID-19) et la mise en œuvre subséquente de mesures d'intervention pour la notification des cas de tuberculose en Zambie.Nous avons utilisé un modèle de série chronologique interrompue pour comparer les cas de tuberculose signalés chaque mois en Zambie avant la pandémie (de janvier 2019 à février 2020), après le déploiement de mesures visant à atténuer les effets de la pandémie à l'échelle nationale (d'avril 2020 à juin 2020) et après l'adoption de mesures d'intervention destinées à améliorer le dépistage de la tuberculose (d'août 2020 à septembre 2021). Parmi les mesures d'intervention contre la tuberculose figuraient une surveillance accrue des données, un dépistage actif des cas au sein des établissements, ainsi que des activités créant une demande de services. Notre analyse s'est fondée sur des données de notification de la tuberculose récoltées dans les établissements et regroupées pour l'ensemble du pays.Avant la pandémie, le nombre de cas de tuberculose signalés a connu une augmentation constante, passant de 2890 en janvier 2019 á 3337 en février 2020. Après le début de la pandémie et l'instauration de mesures cherchant à en atténuer les effets, le nombre de notifications a instantanément baissé de 22% (IC de 95%: −24 à −19) en avril 2020. Les individus positifs au virus de l'immunodéficience humaine (VIH) affichaient une diminution immédiate des notifications plus importante que les individus négatifs au VIH (−36%; IC de 95%: −38 à −35; contre −12%; IC de 95%: −17 à −6). À la suite du déploiement des mesures d'intervention contre la tuberculose en juillet 2020, les notifications ont bondi de 45% (IC de 95%: 38 à 51), tant au niveau national qu'au sein des sous-groupes et provinces. Cette tendance s'est poursuivie tout au long du mois de septembre 2021, avec des chiffres similaires aux prévisions attendues en l'absence de pandémie.La mise en œuvre d'une intervention de santé publique coordonnée impliquant notamment un dépistage actif de la tuberculose a permis de limiter l'impact négatif de la pandémie et des mesures visant à en atténuer les effets. Les bénéfices de cette intervention ont résisté aux vagues successives de la pandémie.Evaluar los efectos de la pandemia de la enfermedad por coronavirus 2019 (COVID-19) y la posterior aplicación de las medidas de respuesta a la tuberculosis en las notificaciones de esta enfermedad en Zambia.Se empleó un diseño de series temporales interrumpidas para comparar las notificaciones mensuales de tuberculosis en Zambia antes de la pandemia (enero de 2019 a febrero de 2020), después de la aplicación de las medidas nacionales de mitigación de la pandemia (abril de 2020 a junio de 2020) y después de las medidas de respuesta para mejorar la detección de la tuberculosis (agosto de 2020 a septiembre de 2021). La respuesta a la tuberculosis incluyó la mejora de la vigilancia de los datos, la búsqueda activa de casos en los centros y las actividades para generar demanda de servicios. Para el análisis se utilizaron datos de notificación de tuberculosis agregados a nivel nacional y a nivel de los centros.Las notificaciones de casos de tuberculosis anteriores a la pandemia aumentaron de manera constante de 2890 en enero de 2019 a 3337 en febrero de 2020. Tras el inicio de la pandemia y las medidas de mitigación, se produjo un descenso inmediato del -22 % (IC del 95 %: -24 a -19) en las notificaciones en abril de 2020. Se observaron mayores descensos inmediatos en las notificaciones entre las personas infectadas por el virus de la inmunodeficiencia humana (VIH) en comparación con las personas no infectadas (-36 %; IC del 95 %: -38 a -35; frente a -12 %; IC del 95%: -17 a -6). Después del despliegue de las medidas de respuesta a la tuberculosis en julio de 2020, las notificaciones aumentaron de inmediato en un 45 % (IC del 95 %: 38 a 51) a nivel nacional y en todos los subgrupos y provincias. La tendencia de las notificaciones se mantuvo estable hasta septiembre de 2021, con cifras similares a las previstas si la pandemia no hubiera ocurrido.La aplicación de una respuesta de salud pública coordinada que incluyera la búsqueda activa de los casos de tuberculosis se asoció a la reducción de los efectos negativos de la pandemia y a las medidas de mitigación. Los beneficios se mantuvieron durante las siguientes oleadas de la pandemia.تقييم تأثير جائحة فيروس كورونا 2019 (كوفيد 19)، والتنفيذ اللاحق لإجراءات الاستجابة لمرض السل بعد تلقي إخطارات السل في زامبيا.لقد استخدمنا تصميم السلاسل الزمنية المتقطعة لمقارنة الإخطارات الشهرية عن السل في زامبيا قبل الجائحة (يناير/كانون ثاني 2019 إلى فبراير/شباط 2020)، وبعد تنفيذ الإجراءات الوطنية للتخفيف من الجائحة (أبريل/نيسان 2020 إلى يونيو/حزيران 2020)، وبعد إجراءات الاستجابة لتحسين اكتشاف السل (أغسطس/آب 2020 إلى سبتمبر/أيلول 2021). تضمنت الاستجابة لمرض السل تعزيز رصد البيانات، واكتشاف الحالات النشط في المرافق، وأنشطة لتوجيه الطلب على الخدمات. استخدمنا بيانات إخطارات السل المجمعة على مستوى المرافق، وعلى الصعيد الوطني، من أجل التحليل.ارتفعت إخطارات السل لما قبل لجائحة بشكل ثابت من 2890 في يناير/كانون ثاني 2019 إلى 3337 في فبراير/شباط 2020. بعد بدء الجائحة وإجراءات التخفيف، كان هناك انخفاض فوري بنسبة -22% (بفاصل ثقة مقداره 95%: -24 إلى -19) في الإخطارات في أبريل/نيسان 2020. وتمت ملاحظة انخفاضات فورية أكبر في الإخطارات بين الأفراد المصابين بفيروس نقص المناعة البشرية، عنها في الأفراد غير المصابين بفيروس نقص المناعة البشرية (-36%؛ بفاصل ثقة مقداره 95%: -38 إلى -35؛ مقابل -12%؛ بفاصل ثقة مقداره 95%: -17 إلى -6). بعد بدء تطبيق إجراءات الاستجابة للسل في يوليو/تموز 2020، زادت الإخطارات بشكل فوري بنسبة 45% (فاصل الثقة مقداره 95%: 38 إلى 51) على الصعيد الوطني وعبر جميع المجموعات الفرعية والمقاطعات. ظل الاتجاه في الإخطارات مستقرًا حتى سبتمبر/أيلول 2021، مع أرقام مشابهة للرقم المتوقع لو لم تقع الجائحة.إن تنفيذ الاستجابة المنسقة للصحة العمومية، بما في ذلك اكتشاف حالات السل النشط، ارتبط بانعكاس التأثير الضار للجائحة وإجراءات التخفيف. واستمرت المكاسب خلال الموجات اللاحقة للجائحة.旨在评估赞比亚新型冠状病毒肺炎 (COVID-19) 疫情的影响以及后续结核病通报方面的结核病应对措施的实施情况。.我们采用中断时间序列设计来比较赞比亚每个月的结核病通报（从 2019 年 1 月至 2020 年 2 月）并且采用后续应对措施来提升结核病的检测（从 2020 年 8 月至 2021 年 9 月）。结核病应对措施包括增强数据监测、基于机构的主动病例发现和促进服务需求的活动。我们采用基于机构水平的全国性综合结核病通报数据来开展分析。.疫情前的结核病病例通报从 2019 年 1 月的 2890 例增长到 2020 年 2 月的 3337 例。在疫情爆发和采取管控措施之后，通报数在 2020 年 4 月立即减少了-22%（95% CI: -24 至-19）。与人体免疫缺损病毒 (HIV) 阴性相比，HIV 阳性的通报病例数立即减少的幅度更大（-36%; 95% CI: -38 至 -35；对比-12%; 95% CI: -17 至-6）。在 2020 年 7 月推出结核病应对措施之后，全国范围内以及各个地区和省份的通报数立即增加 45%（95% CI: 38 至 51）。截至 2021 年 9 月，通报的趋势保持稳定，与疫情发生前的预测数值相似。.包括结核病主动病例发现在内统筹部署的公共卫生应对措施的实施有助于消除疫情和管控措施的影响。在后续几轮疫情反复中，上述成果一直保持。.Оценить влияние пандемии коронавирусной инфекции 2019 года (COVID-19) и последующего осуществления мер по борьбе с туберкулезом на уведомления о заболевании туберкулезом в Замбии.Для совершенствования мер по борьбе с туберкулезом авторы использовали анализ прерванных временных рядов и сравнили ежемесячные уведомления о заболевании туберкулезом в Замбии до пандемии (с января 2019 г. по февраль 2020 г.), после реализации национальных мер по смягчению последствий пандемии (с апреля по июнь 2020 г.) и после осуществления мер реагирования для улучшения выявления туберкулеза (с августа 2020 г. по сентябрь 2021 г.). Меры по борьбе с туберкулезом состояли из усиленного контроля данных, активного выявления случаев заболевания в медицинских учреждениях и мероприятий для создания спроса на услуги. Для анализа авторы использовали общенациональные данные об уведомлениях о заболевании туберкулезом на уровне медицинских учреждений.Число зарегистрированных случаев заболевания туберкулезом до пандемии неуклонно росло: с 2890 случаев в январе 2019 года до 3337 случаев в феврале 2020 года. После начала пандемии и принятия мер по смягчению последствий пандемии в апреле 2020 г. произошло внезапное снижение количества уведомлений на 22% (95%-й ДИ: с 24 до 19). Более значительное внезапное снижение количества уведомлений наблюдалось среди ВИЧ-положительных лиц по сравнению с ВИЧ-отрицательными (36%; 95%-й ДИ: с 38 до 35; против 12%; 95%-й ДИ: с 17 до 6). После развертывания мер по борьбе с туберкулезом в июле 2020 г. количество уведомлений сразу же увеличилось на 45% (95%-й ДИ: с 38 до 51) на национальном уровне и во всех подгруппах и провинциях. Тенденция в части уведомлений оставалась стабильной до сентября 2021 года, при этом цифры были близки к прогнозируемым в случае отсутствия пандемии.Осуществление скоординированных ответных мер в системе здравоохранения, включая активное выявление случаев заболевания туберкулезом, было связано с обращением вспять неблагоприятного воздействия пандемии и принятием мер по смягчению последствий пандемии. Результаты сохранялись на протяжении последующих волн пандемии.

Highlights • Whilst African countries were relatively spared initially when COVID-19 was first reported from China, the frequent travel links between China, Europe and Africa, meant importation of SARS-CoV-2 into Africa was inescapable. • In preparation, Zambia had applied a multisectoral national epidemic disease surveillance and response system resulting in the identification of the first case within 48 hours of the individual entering the country by air travel from a trip to France. • Phylogenomic analysis showed that the detected SARS-CoV-2 belonged to lineage B.1.1., sharing the last common ancestor with SARS-CoV-2 strains recovered from South Africa. • At the African continental level, our analysis showed that lineage B.1 and B.1.1 lineages appear to be predominant in Africa. • Whole genome sequence analysis should be part of all surveillance activities to monitor the origin and evolution of SARS-CoV-2 lineages across Africa., Since its first discovery in December 2019 in Wuhan, China, COVID-19, caused by the novel coronavirus SARS-CoV-2, has spread rapidly worldwide. Whilst African countries were relatively spared initially, the initial low incidence of COVID-19 cases was not sustained for long due to continuing travel links between China, Europe and Africa.. In preparation, Zambia had applied a multisectoral national epidemic disease surveillance and response system resulting in the identification of the first case within 48 hours of the individual entering the country by air travel from a trip to France. Contact tracing showed that SARS-CoV-2 infection was contained within the patient’s household, with no further spread to attending health care workers or community members. Phylogenomic analysis of the patient’s SARS-CoV-2 strain showed it belonged to lineage B.1.1., sharing the last common ancestor with SARS-CoV-2 strains recovered from South Africa. At the African continental level, our analysis showed that lineage B.1 and B.1.1 lineages appear to be predominant in Africa. Whole genome sequence analysis should be part of all surveillance and case detection activities in order to monitor the origin and evolution of SARS-CoV-2 lineages across Africa.

IntroductionDuring March-December 2020, Zambia recorded 20,725 confirmed COVID-19 cases, with the first wave peaking between July and August. Of the 388 COVID-19-related deaths occurring nationwide, most occurred in the community. We report findings from COVID-19 mortality surveillance among community deaths brought to the University Teaching Hospital (UTH) mortuary in Lusaka.MethodsIn Zambia, when a person dies in the community, and is brought into a health facility mortuary, they are recorded as ‘brought in dead’ (BID). The UTH mortuary accepts persons BID for Lusaka District, the most populated district in Zambia. We analyzed data for persons BID at UTH during 2020. We analyzed two data sources: weekly SARS-CoV-2 test results for persons BID and monthly all-cause mortality numbers among persons BID. For all-cause mortality among persons BID, monthly deaths during 2020 that were above the upper bound of the 95% confidence interval for the historic mean (2017-2019) were considered significant. Spearman’s rank test was used to correlate the overall percent positivity in Zambia with all-cause mortality and SARS-CoV-2 testing among persons BID at UTH mortuary.ResultsDuring 2020, 7,756 persons were BID at UTH (monthly range 556-810). SARS-CoV-2 testing began in April 2020, and through December 3,131 (51.9%) of 6,022 persons BID were tested. Of these, 212 (6.8%) were SARS-CoV-2 positive with weekly percent test positivity ranging from 0-32%, with the highest positivity occurring during July 2020. There were 1,139 excess persons BID from all causes at UTH mortuary in 2020 compared to the 2017-2019 mean. The monthly number of persons BID from all causes was above the upper bound of the 95% confidence interval during June-September and December.ConclusionIncreases in all-cause mortality and SARS-CoV-2 test positivity among persons BID at UTH mortuary corresponded with the first peak of the COVID-19 epidemic in June and August 2020, indicating possible increased mortality related to the COVID-19 epidemic in Zambia. Combining all-cause mortality and SARS-CoV-2 testing for persons BID provides useful information about the severity of the epidemic in Lusaka and should be implemented throughout Zambia.

During the July 2020 first wave of severe acute respiratory syndrome coronavirus 2 in Zambia, PCR-measured prevalence was 13.4% among outpatients at health facilities, an absolute difference of 5.7% compared with prevalence among community members. This finding suggests that facility testing might be an effective strategy during high community transmission.

The Saving Mothers, Giving Life district health systems strengthening approach provides a sustainable model for reducing maternal mortality at scale. Lessons from the learning districts demonstrated increased efficiency in allocation of resources for maternal and newborn health, better use of strategic information, improved management capacities, and increased community engagement., Background: Saving Mothers, Giving Life (SMGL) significantly reduced maternal and perinatal mortality in Uganda and Zambia by using a district health systems strengthening approach to address the key delays women and newborns face in receiving quality, timely, and appropriate medical care. This article documents the transition of SMGL from pilot to scale in Uganda and Zambia and analyzes the sustainability of the approach, examining the likelihood of maintaining positive trends in maternal and newborn health in both countries. Methods: We analyzed the potential sustainment of SMGL achievements using a tool adapted from the HIV-focused domains and elements of the U.S. President's Emergency Plan for AIDS Relief Sustainability Index and Dashboard for maternal and neonatal health pro-gramming adding a domain on community normative change. Information for each of the 5 resulting domains was drawn from SMGL and non-SMGL reports, individual stakeholder interviews, and group discussions. Findings: In both Uganda and Zambia, the SMGL proof-of-concept phase catalyzed commitment to saving mothers and newborns and a renewed belief that significant change is possible. Increased leadership and accountability for maternal and newborn health, particularly at the district and facility levels, was bolstered by routine maternal death surveillance reviews that engaged a wide range of local leadership. The SMGL district-strengthening model was found to be cost-effective with cost of death averted estimated at US$177-206 per year of life gained. When further considering the ripple effect that saving a mother has on child survival and the household economy, the value of SMGL increases. Ministries of health and donor agencies have already demonstrated a willingness to pay this amount per year of life for other programs, such as HIV and AIDS. Conclusion: As SMGL scaled up in both Uganda and Zambia, the intentional integration of SMGL interventions into host country systems, alignment with other large-scale programs, and planned reductions in annual SMGL funding all contributed to increasing host government ownership of the interventions and set the SMGL approach on a path more likely to be sustained following the close of the initiative. Lessons from the learning districts resulted in increased efficiency in allocation of resources for maternal and newborn health, better use of strategic information, improved management capacities, and increased community engagement.

The effect of HIV infection on COVID-19 outcomes is unclear. Studies in South Africa (1) and the United Kingdom (2) found an independent association between HIV infection and COVID-19 mortality; however, other studies have not found an association between poor COVID-19 outcomes and either HIV status among hospitalized patients (3-5) or HIV-associated factors such as CD4 count, viral load, or type of antiretroviral therapy (ART) (6). The effect of HIV infection on COVID-19 outcomes remains an urgent question in sub-Saharan Africa, where many countries are experiencing dual HIV and COVID-19 epidemics, and capacity to treat severe COVID-19 is limited. Using data from patients with probable or confirmed COVID-19 admitted to specialized treatment centers during March-December 2020 in Zambia, the Zambian Ministry of Health and CDC assessed the relationship between HIV infection and severe COVID-19 and COVID-19-associated death. Among 443 patients included in the study, 122 (28%) were HIV-positive, and of these, 91 (89%) were receiving ART at the time of hospitalization. HIV status alone was not significantly associated with severe COVID-19 at admission or during hospitalization or with COVID-19-associated death. However, among HIV-positive persons, those with severe HIV disease were more likely to develop severe COVID-19 and were at increased risk for COVID-19-associated death. Ensuring that persons maintain HIV disease control, including maintaining ART continuity and adherence, achieving viral suppression, and addressing and managing underlying medical conditions, could help reduce COVID-19-associated morbidity and mortality in sub-Saharan Africa.

Background Healthcare workers (HCWs) in Zambia have become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). However, SARS-CoV-2 prevalence among HCWs is not known in Zambia. Methods We conducted a cross-sectional SARS-CoV-2 prevalence survey among Zambian HCWs in 20 health facilities in 6 districts in July 2020. Participants were tested for SARS-CoV-2 infection using polymerase chain reaction (PCR) and for SARS-CoV-2 antibodies using enzyme-linked immunosorbent assay (ELISA). Prevalence estimates and 95% confidence intervals (CIs), adjusted for health facility clustering, were calculated for each test separately, and a combined measure for those who had PCR and ELISA was performed. Results In total, 660 HCWs participated in the study, with 450 (68.2%) providing a nasopharyngeal swab for PCR and 575 (87.1%) providing a blood specimen for ELISA. Sixty-six percent of participants were females, and median age was 31.5 years (interquartile range, 26.2–39.8). The overall prevalence of the combined measure was 9.3% (95% CI, 3.8%–14.7%). PCR-positive prevalence of SARS-CoV-2 was 6.6% (95% CI, 2.0%–11.1%), and ELISA-positive prevalence was 2.2% (95% CI, .5%–3.9%). Conclusions SARS-CoV-2 prevalence among HCWs was similar to a population-based estimate (10.6%) during a period of community transmission in Zambia. Public health measures such as establishing COVID-19 treatment centers before the first cases, screening for COVID-19 symptoms among patients who access health facilities, infection prevention and control trainings, and targeted distribution of personal protective equipment based on exposure risk might have prevented increased SARS-CoV-2 transmission among Zambian HCWs.

Summary Background Between March and December, 2020, more than 20 000 laboratory-confirmed cases of SARS-CoV-2 infection were reported in Zambia. However, the number of SARS-CoV-2 infections is likely to be higher than the confirmed case counts because many infected people have mild or no symptoms, and limitations exist with regard to testing capacity and surveillance systems in Zambia. We aimed to estimate SARS-CoV-2 prevalence in six districts of Zambia in July, 2020, using a population-based household survey. Methods Between July 4 and July 27, 2020, we did a cross-sectional cluster-sample survey of households in six districts of Zambia. Within each district, 16 standardised enumeration areas were randomly selected as primary sampling units using probability proportional to size. 20 households from each standardised enumeration area were selected using simple random sampling. All members of selected households were eligible to participate. Consenting participants completed a questionnaire and were tested for SARS-CoV-2 infection using real-time PCR (rtPCR) and anti-SARS-CoV-2 antibodies using ELISA. Prevalence estimates, adjusted for the survey design, were calculated for each diagnostic test separately, and combined. We applied the prevalence estimates to census population projections for each district to derive the estimated number of SARS-CoV-2 infections. Findings Overall, 4258 people from 1866 households participated in the study. The median age of participants was 18·2 years (IQR 7·7–31·4) and 50·6% of participants were female. SARS-CoV-2 prevalence for the combined measure was 10·6% (95% CI 7·3–13·9). The rtPCR-positive prevalence was 7·6% (4·7–10·6) and ELISA-positive prevalence was 2·1% (1·1–3·1). An estimated 454 708 SARS-CoV-2 infections (95% CI 312 705–596 713) occurred in the six districts between March and July, 2020, compared with 4917 laboratory-confirmed cases reported in official statistics from the Zambia National Public Health Institute. Interpretation The estimated number of SARS-CoV-2 infections was much higher than the number of reported cases in six districts in Zambia. The high rtPCR-positive SARS-CoV-2 prevalence was consistent with observed community transmission during the study period. The low ELISA-positive SARS-CoV-2 prevalence might be associated with mitigation measures instituted after initial cases were reported in March, 2020. Zambia should monitor patterns of SARS-CoV-2 prevalence and promote measures that can reduce transmission. Funding US Centers for Disease Control and Prevention.

Summary Background Globally, cervical cancer is the fourth leading cause of cancer-related death among women. Poor uptake of screening services contributes to the high mortality. We aimed to examine screening frequency, predictors of screening results, and patterns of sensitisation strategies by age group in a large, programmatic cohort. Methods We did a cohort study including 11 government health facilities in Lusaka, Zambia, in which we reviewed routine programmatic data collected through the Cervical Cancer Prevention Program in Zambia (CCPPZ). Participants who underwent cervical cancer screening in one of the participating study sites were considered for study inclusion if they had a screening result. Follow-up was accomplished per national guidelines. We did descriptive analyses and mixed-effects logistic regression for cervical cancer screening results allowing random effects at the individual and clinic level. Findings Between Jan 1, 2010, and July 31, 2019, we included 183 165 women with 204 225 results for visual inspection with acetic acid and digital cervicography (VIAC) in the analysis. Of all those screened, 21 326 (10·4%) were VIAC-positive, of whom 16 244 (76·2%) received treatment. Of 204 225 screenings, 92 838 (45·5%) were in women who were HIV-negative, 76 607 (37·5%) were in women who were HIV-positive, and 34 780 (17·0%) had an unknown HIV status. Screening frequency increased 65·7% between 2010 and 2019 with most appointments being first-time screenings (n=158 940 [77·8%]). Women with HIV were more likely to test VIAC-positive than women who were HIV-negative (adjusted odds ratio 3·60, 95% CI 2·14–6·08). Younger women (≤29 years) with HIV had the highest predictive probability (18·6%, 95% CI 14·2–22·9) of screening positive. Interpretation CCPPZ has effectively increased women's engagement in screening since its inception in 2006. Customised sensitisation strategies relevant to different age groups could increase uptake and adherence to screening. The high proportion of screen positivity in women younger than 20 years with HIV requires further consideration. Our data are not able to discern if women with HIV have earlier disease onset or whether this difference reflects misclassification of disease in an age group with a higher sexually transmitted infection prevalence. These data inform scale-up efforts required to achieve WHO elimination targets. Funding US President's Emergency Plan for AIDS Relief.

We conducted a matched case-control (MCC), test-negative case-control (TNCC) and case-cohort study in 2016 in Lusaka, Zambia, following a mass vaccination campaign. Confirmed cholera cases served as cases in all three study designs. In the TNCC, control-subjects were cases with negative cholera culture and polymerase chain reaction results. Matched controls by age and sex were selected among neighbours of the confirmed cases in the MCC study. For the case-cohort study, we recruited a cohort of randomly selected individuals living in areas considered at-risk of cholera. We recruited 211 suspected cases (66 confirmed cholera cases and 145 non-cholera diarrhoea cases), 1055 matched controls and a cohort of 921. Adjusted vaccine effectiveness of one dose of oral cholera vaccine (OCV) was 88.9% (95% confidence interval (CI) 42.7–97.8) in the MCC study, 80.2% (95% CI: 16.9–95.3) in the TNCC design and 89.4% (95% CI: 64.6–96.9) in the case-cohort study. Three study designs confirmed the short-term effectiveness of single dose OCV. Major healthcare-seeking behaviour bias did not appear to affect our estimates. Most of the protection among vaccinated individuals could be attributed to the direct effect of the vaccine.

On October 6, 2017, an outbreak of cholera was declared in Zambia after laboratory confirmation of Vibrio cholerae O1, biotype El Tor, serotype Ogawa, from stool specimens from two patients with acute watery diarrhea. The two patients had gone to a clinic in Lusaka, the capital city, on October 4. Cholera cases increased rapidly, from several hundred cases in early December 2017 to approximately 2,000 by early January 2018 (Figure). In collaboration with partners, the Zambia Ministry of Health (MoH) launched a multifaceted public health response that included increased chlorination of the Lusaka municipal water supply, provision of emergency water supplies, water quality monitoring and testing, enhanced surveillance, epidemiologic investigations, a cholera vaccination campaign, aggressive case management and health care worker training, and laboratory testing of clinical samples. In late December 2017, a number of water-related preventive actions were initiated, including increasing chlorine levels throughout the city's water distribution system and placing emergency tanks of chlorinated water in the most affected neighborhoods; cholera cases declined sharply in January 2018. During January 10-February 14, 2018, approximately 2 million doses of oral cholera vaccine were administered to Lusaka residents aged ≥1 year. However, in mid-March, heavy flooding and widespread water shortages occurred, leading to a resurgence of cholera. As of May 12, 2018, the outbreak had affected seven of the 10 provinces in Zambia, with 5,905 suspected cases and a case fatality rate (CFR) of 1.9%. Among the suspected cases, 5,414 (91.7%), including 98 deaths (CFR = 1.8%), occurred in Lusaka residents.

ObjectiveTuberculosis (TB) remains a leading cause of morbidity and mortality in Zambia, especially for people living with HIV (PLHIV). We undertook a care cascade analysis to quantify gaps in care and align programme improvement measures with areas of need.DesignRetrospective, population-based analysis.SettingWe derived national-level estimates for each step of the TB care cascade in Zambia. Estimates were informed by WHO incidence estimates, nationally aggregated laboratory and notification registers, and individual-level programme data from four provinces.ParticipantsParticipants included all individuals with active TB disease in Zambia in 2018. We characterised the overall TB cascade and disaggregated by drug susceptibility results and HIV status.ResultsIn 2018, the total burden of TB in Zambia was estimated to be 72 495 (range, 40 495–111 495) cases. Of these, 43 387 (59.8%) accessed TB testing, 40 176 (55.4%) were diagnosed with TB, 36 431 (50.3%) were started on treatment and 32 700 (45.1%) completed treatment. Among all persons with TB lost at any step along the care cascade (n=39 795), 29 108 (73.1%) were lost prior to accessing diagnostic services, 3211 (8.1%) prior to diagnosis, 3745 (9.4%) prior to initiating treatment and 3731 (9.4%) prior to treatment completion. PLHIV were less likely than HIV-negative individuals to successfully complete the care cascade (42.8% vs 50.2%, pConclusionsLosses throughout the care cascade resulted in a large proportion of individuals with TB not completing treatment. Ongoing health systems strengthening and patient-centred engagement strategies are needed at every step of the care cascade; however, scale-up of active case finding strategies is particularly critical to ensure individuals with TB in the population reach initial stages of care. Additionally, a renewed focus on PLHIV and individuals with drug-resistant TB is urgently needed to improve TB-related outcomes in Zambia.

Producción Científica, Killed oral cholera vaccines (OCVs) are part of the standard response package to a cholera outbreak, although the two-dose regimen of vaccines that has been prequalified by the World Health Organization (WHO) poses challenges to timely and efficient reactive vaccination campaigns.1 Recent data suggest that the first dose alone provides short-term protection, similar to that of two doses, which may largely dictate the effect of OCVs during epidemics

To describe the implementation and feasibility of an innovative mass vaccination strategy - based on single-dose oral cholera vaccine - to curb a cholera epidemic in a large urban setting.In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign - 2.31 United States dollars (US$) per dose - included the relatively low cost of local delivery - US$ 0.41 per dose.We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered.Rendre compte de la mise en œuvre et de la faisabilité d'une stratégie de vaccination de masse innovante – fondée sur un vaccin anticholérique oral à dose unique – pour enrayer une épidémie de choléra dans une vaste zone urbaine.En avril 2016, aux premiers stades d'une flambée de choléra à Lusaka, en Zambie, le ministère de la Santé a collaboré avec Médecins Sans Frontières et l'Organisation mondiale de la Santé pour organiser une campagne de vaccination de masse fondée sur un vaccin anticholérique oral à dose unique. Pendant 17 jours, ces partenaires ont fait appel à 1700 membres du personnel du ministère de la Santé et bénévoles communautaires pour mener des activités de sensibilisation des communautés, de mobilisation sociale et de vaccination dans 10 municipalités. Chaque jour, des doses de vaccins ont été livrées sur les sites de vaccination et une estimation de la couverture administrative a été effectuée.En tout, les équipes de vaccination ont administré 424 100 doses de vaccins à une population cible estimée à 578 043 individus, ce qui se traduit par une couverture administrative estimée à 73,4%. Après la campagne, seuls de rares cas de choléra ont été signalés et aucun signe de propagation de la maladie dans les zones de vaccination n'a été noté. Le coût total de la campagne – 2,31 dollars des États-Unis ($US) par dose – incluait le coût relativement bas de la livraison locale – 0,41 $US par dose.L'organisation d'une campagne de vaccination réactive précoce, ciblée et à grande échelle – fondée sur un vaccin oral à dose unique – pour répondre à une épidémie de choléra dans une grande ville s'est avérée faisable et efficace. Alors que les vaccins anticholériques demeurent rares, il convient d'envisager la maximisation du nombre de vaccins pour faire face à une épidémie de choléra à travers l'utilisation d'une seule dose par membre d'une communauté vulnérable.describir la aplicación y la viabilidad de una estrategia innovadora de vacunación masiva, basada en una vacuna oral contra el cólera de una sola dosis, para frenar una epidemia de cólera en un entorno urbano grande.en abril de 2016, en las primeras etapas de un brote de cólera en Lusaka, Zambia, el Ministerio de Salud colaboró con Médecins Sans Frontières y la Organización Mundial de la Salud en la organización de una campaña masiva de vacunación basada en una vacuna oral contra el cólera de una sola dosis. Durante un período de 17 días, los socios movilizaron a 1700 voluntarios de personal sanitario y voluntarios de la comunidad para sensibilizar a la comunidad y para actividades de vacunación y movilización social en 10 municipios. Cada día, las dosis de la vacuna se entregaron en los lugares de vacunación y se estimó la cobertura administrativa.en general, los equipos de vacunación administraron 424.100 dosis de la vacuna a una población objetivo de unos 578.043 habitantes, lo que resultó en una cobertura administrativa estimada del 73,4%. Después de la campaña, se registraron pocos casos de cólera y no hubo pruebas de propagación de la enfermedad dentro de las zonas vacunadas. El costo total de la campaña (2,31 dólares estadounidenses (USD) por dosis) incluyó el coste relativamente bajo de la entrega local (0,41 $ por dosis).se descubrió que una campaña reactiva temprana dirigida y en gran escala con una vacuna oral de dosis única, organizada en respuesta a una epidemia de cólera dentro de una gran ciudad, era factible y aparentemente efectiva. Si bien las vacunas contra el cólera siguen siendo escasas, se debe considerar la maximización del número de vacunados en respuesta a una epidemia de cólera, mediante el uso de una sola dosis por miembro de una comunidad en riesgo.وصف لإجراءات تنفيذ استراتيجية مبتكرة للتطعيم الجماعي وإمكانية تطبيقها – إذ تقوم الاستراتيجية على تقديم جرعة واحدة من لقاح الكوليرا يتم تلقيها عبر الفم – وذلك للحد من انتشار وباء الكوليرا في منطقة حضرية واسعة النطاق.شهد عام 2016، مع المراحل الأولى لظهور مرض الكوليرا في مدينة "لوساكا" في زامبيا، تعاونًا بين وزارة الصحة بالبلاد من جهة ومنظمة أطباء بلا حدود (Médecins Sans Frontières) ومنظمة الصحة العالمية من جهة أخرى بشأن تنظيم حملة تطعيم جماعي تقوم على تقديم جرعة واحدة عبر الفم من لقاح الكوليرا. وخلال فترة تبلغ 17 يومًا، عملت الأطراف المتعاونة على حشد 1700 فرد من العاملين بوزارة الصحة والمتطوعين في الخدمات المجتمعية من أجل تحقيق التوعية المجتمعية والتعبئة الاجتماعية وتنفيذ أنشطة التطعيم في 10 أقاليم. وتم توفير جرعات التطعيم في كل يوم في مواقع التطعيم وجرى تقييم للتغطية المتعلقة بالجرعات المقدمة.قدمت فرق التطعيم بوجه عام 424100 جرعة من اللقاح لمجموعة مستهدفة من السكان بلغ عددها 578043 فردًا حسب التقديرات، مما أثمر عن وجود تغطية للجرعات المقدمة تم تقديرها بنسبة ‏73.4%. وبعد الحملة، قل العدد الذي يتم الإبلاغ به من حالات الإصابة بالكوليرا، ولم يوجد أي دليل على انتشار المرض في المناطق التي تم فيها التطعيم. وكانت التكلفة الإجمالية للحملة – التي بلغت 2.31 دولارًا أمريكيًا للجرعة الواحدة، شاملةً التكلفة المنخفضة نسبيًا لتوفير الجرعة محليًا – قد بلغت 0.41 دولارًا أمريكيًا للجرعة الواحدة.تبين لنا أن تنفيذ حملة موجهة واسعة النطاق في مرحلة مبكرة للتصدي للمرض باستخدام جرعة واحدة من لقاح فموي – وهي الحملة التي تم تنظيمها لمواجهة وباء الكوليرا على نطاق مدينة كبرى – أمر يمكن تحقيقه وبدت له نتائج مجدية. وبالرغم من استمرار المعاناة من النقص في الموارد المتاحة للقاح الكوليرا، يجب النظر في تحقيق أقصى استفادة ممكنة من عدد اللقاحات المتاحة للتصدي لوباء الكوليرا، وذلك عن طريق استخدام جرعة واحدة فقط لكل فرد من أفراد المجتمع المهدد بالإصابة بالمرض.旨在说明基于单剂量口服霍乱疫苗的创新型大规模接种策略的实施和可行性，以遏制大型城市环境中的霍乱疫情。.2016 年 4 月，在赞比亚卢萨卡霍乱爆发的早期阶段，卫生部门与无国界医生组织和世界卫生组织合作组织了基于单剂量口服霍乱疫苗的大规模疫苗接种活动。在 17 天的时间里，合作方共动员了 1700 名卫生部工作人员和社区志愿者在 10 个乡镇开展社区宣传、社会动员和疫苗接种活动。每天将疫苗剂量送到疫苗接种处并估计接种覆盖率。.总体而言，疫苗接种小组对估计的目标人群 578043 人进行了 424100 剂疫苗接种，估计接种覆盖率为 73.4％。此项活动后，报告的霍乱案例很少，没有证据表明疫苗接种区域内有传染病。活动的总费用——每剂量 2.31 美元，包括相对较低的本地交付成本（每剂量 0.41 美元）。.我们发现，使用单剂量口服疫苗的早期大规模针对性反应性活动是为了应对大城市内的霍乱疫情而组织起来的，可行且有效。尽管霍乱疫苗仍然供不应求，但每一名处于危险社区中的成员只需一个剂量，应对霍乱疫情所需的最大接种疫苗数量应该考虑在内。.Описать реализацию и осуществимость инновационной стратегии массовой вакцинации, основанной на применении однодозовой пероральной противохолерной вакцины, для борьбы с эпидемией холеры в условиях крупных городов.В апреле 2016 года на ранних стадиях вспышки холеры в Лусаке, Замбия, Министерство здравоохранения сотрудничало с организацией «Врачи без границ» и Всемирной организацией здравоохранения при проведении кампании массовой вакцинации, основанной на применении однодозовой пероральной противохолерной вакцины. В течение 17 дней партнеры мобилизовали 1700 сотрудников Министерства здравоохранения и общинных добровольцев для повышения информированности населения, социальной мобилизации и вакцинации в 10 поселках. Ежедневно на участки вакцинации доставлялись дозы вакцины и оценивался административный охват вакцинацией.В целом группами вакцинации были введены 424 100 доз вакцины в предполагаемой целевой популяции в количестве 578 043 человек, в результате чего административный охват оценивался как 73,4%. После кампании сообщалось о редких случаях заболевания холерой и не было признаков распространения болезни в вакцинированных районах. Общие расходы на кампанию составили 2,31 доллара США (US$) на 1 дозу, включая относительно низкую стоимость местной доставки — 0,41 доллара США на 1 дозу.Мы обнаружили, что ранняя и крупномасштабная целевая реактивная кампания с применением однодозовой пероральной вакцины, организованная в ответ на эпидемию холеры в крупном городе, осуществима и эффективна. Поскольку по-прежнему имеется дефицит противохолерных вакцин, следует рассмотреть вопрос об увеличении числа доступных вакцин в ответ на эпидемию холеры за счет использования только одной дозы на одного члена сообщества, находящегося в зоне риска.

We conducted a prospective cohort study of 496 adults starting antiretroviral treatment (ART) to determine the impact of neuropsychiatric symptoms and socioeconomic status on adherence and mortality. Almost 60% had good adherence based upon pharmacy records. Poor adherence was associated with being divorced, poorer, food insecure, and less educated. Longer travel time to clinic, concealing one's human immunodeficiency virus (HIV) status, and experiencing side effects predicted poor adherence. Over a third of the patients had cognitive impairment and poorer cognitive function was also associated with poor adherence. During follow-up (mean 275 days), 20% died-usually within 90 days of starting ART. Neuropsychiatric symptoms, advanced HIV, peripheral neuropathy symptoms, food insecurity, and poverty were associated with death. Neuropsychiatric symptoms, advanced HIV, and poverty remained significant independent predictors of death in a multivariate model adjusting for other significant factors. Social, economic, cognitive, and psychiatric problems impact adherence and survival for people receiving ART in rural Zambia.

We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones' spouse (P = 0.047), knowing spouses' HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence.