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HIV is increasingly recognized as a chronic illness which may result in episodic disability related to the effects of the virus, side effects of medication, co-morbidities and consequences of aging. Little is known about the episodic disability experiences of people living long-term with HIV in resource-limited countries, which is best understood by following people over time. This qualitative longitudinal study examined the episodic disability experiences and the applicability of four types of episodic disability among people living with HIV and on anti-retroviral therapy in Zambia. We interviewed 31 men and women living with HIV on 3 occasions at 6-month intervals (total of 93 interviews) examining the processes of change over time. We used disability models to inform the interviews exploring impairments/symptoms, activity limitations and participation restrictions. Longitudinal analyses of transcribed interviews confirmed the applicability of four types over time: stable, increasing disability, decreasing disability and significant fluctuations. Analyses highlighted the extent to which determinants of health contributed to the disability experienced. The use of disability models revealed the importance of environmental and social influences on disability and quality of life. The indicators of the type of episodic disability could be used clinically to help understand the nature and potential triggers of the episodes. [ABSTRACT FROM AUTHOR]

Previous research has demonstrated increased comorbidities related to the chronic effects of HIV. Rehabilitation science offers a useful approach for studying chronic illness. This longitudinal qualitative study used a rehabilitation science approach to explore the experiences over time of women and men living with HIV and on antiretroviral therapy (ART) in the high HIV-prevalence setting of Lusaka, Zambia. Thirty-five participants participated in a total of 99 in-depth interviews from 2012 to 2015. The central pattern that emerged across the participants' narratives was the paradoxical experience of profound optimism alongside significant new challenges. Participants' stories of hopefulness in the face of ongoing struggles played out in three interconnected themes: (1) impacts on my body and life; (2) interventions I am grateful to have and new interventions I need; and (3) stigma reduced and created by ART. Results reflected the ups and downs of life with HIV as a chronic illness. Participants, whilst committed to and healthier on ART, typically experienced multiple physical, psychological and sensory impairments that varied in type, severity and trajectory. Participants valued improved relationships enabled by ART, but yearned for support for living long-term with HIV. Frequently participants reflected that their needs were overlooked related to managing side-effects, exercise, family planning and healthy sexuality. ART strengthened acceptance by self and others through improved health and productivity and through becoming a source of support for others. However, being on ART also led to stigma, driven by persistent associations with sickness, death, lack of productivity and uncertainty. This study points to shortcomings in the current focus of HIV care in Zambia and the region, which centres on initiating and adhering to ART. Findings call for evolution of the HIV care continuum to embrace a more holistic and long-term approach to living with HIV as a chronic and episodic condition. [ABSTRACT FROM AUTHOR]

Background: At the University of Zambia, School of Medicine, the Bachelor of Medicine and Surgery was last reviewed in 2010. This poseda threat in the training of medical doctors as the learning outcomes may be unresponsive to emerging trends and methodologies in the management of patients, clients and communities. This paper presents a model that was used in the review of the bachelor of medicine and surgery degree programme at the University of Zambia in 2021. Methods: A modified Kern's 8 step model for curricular design was used in the review of the MBCHB UNZA curriculum: Step 1: Competency Framework Design: - The competency framework was designed based on the World Federation for Medical Education (WFME) standard for basic medical education (WFME, 2015). Step 2: Needs Assessment: - An online needs assessment survey was administered to 614 medical students while a workshop involving Faculty and key stakeholders in medical education was held to discuss the need for the review of the curriculum. Step 3, 4 and 5: Strengths, Weaknesses, Opportunities, Threats, Critical Success Factor Analysis and Educational Strategies design: - these steps were conducted to establish the educational strategies and factors that would result into successful implementation of the programme. Step 6, 7 and 8: Course Writing, Implementation and Evaluation: - Individual expert course writers were assembled to conduct course writing using a 10-day workshop model and development of both the implementation and evaluation plans for the curriculum. Results: The key results obtained from the review process included: 1. Designed the curriculum into the four key thematic competency areas of medical education: Knowledge, Skills and Performance, Safety and Quality, Communication, Partnership, and Teamwork while Maintaining Trust. 2. Reduction of the training period from 7 to 6 years as was before. 3. Development of an innovative and social responsive curriculum by strengthening interprofessional education, implementation science, evidence-based practice, critical thinking and incorporating emerging health needs of society Conclusion: The modified six-step Kern's model to curriculum development can be an effective method for the development and review of curriculum for health professions educational programmes and may be dependent on the availability of a motivated team, financial and other relevant resources in order to fulfil the dictates of all the steps. [ABSTRACT FROM AUTHOR]

Purpose: We sought to determine the relationship between acceptability of a hypothetical vaginal microbicide, cultural factors, and perceived HIV risk among African-American women in Nashville, TN, USA, and African women in Kafue and Mumbwa, Zambia. Patients and methods: Women in both sites completed a survey. Regression analyses were performed on valid samples (Nashville, 164; Zambia, 101) to determine cultural differences affecting microbicide acceptability. Regression analyses also tested whether individual risk perception affected acceptability. Results: In Zambia, 89.6% of women were willing to use a microbicide versus 81.6% in Nashville (P < 0.0001). One cultural difference is that women in the Zambian cohort viewed risk of HIV infection as distinct from risk of acquiring STIs, with 48% believing they were certain to become infected with AIDS, compared to 4% of Nashville participants. Conclusion: These results suggest a high degree of acceptability toward use of a vaginal microbicide to prevent HIV infection. [ABSTRACT FROM AUTHOR]

Background: There is evidence that multidisciplinary healthcare teams can provide better quality of care and treatment outcomes compared to that delivered by individuals from a single health discipline. In 2019, the Strengthening Health Professional Workforce Education Programmes for Improved Quality Health Outcomes in Zambia (SHEPIZ) project embarked on, among other aims, developing Inter Professional Education (IPE) in chronic disease management for undergraduate health Disciplines. The intended outcomes were premised on enhancing collaborative practice which could lead to strengthened health systems and optimal health service delivery in Zambia. The purpose of this paper is to present the process of developing and piloting IPE modules on chronic disease management for the undergraduate health professions training in Zambia. Methods and Materials: Four distinct but interrelated approaches were applied. (1) desk review to identify best practices in IPE focusing on competences, content, training materials, delivery methods, and assessment methods. (2) module development workshops which comprised diverse experts with experience in IPE, medical education, general education, and management of chronic diseases.(3) review and validation of modules by experts. (4) piloting and review of the training modules. Results: The desk review, showed that there were best practices that could be relevant to IPE for undergraduate programmes at UNZA. Best practices identified from the review guided development of seven chronic disease modules which were piloted. The findings from the pilot showed that 74 - 87% (agree or strongly agree) of the students indicated that the module activities promoted interprofessional education. Conclusion: The process was effective for putting forth an interprofessional training program at the undergraduate level, with the potential to improve quality of care for patients and safety for patients with chronic conditions. [ABSTRACT FROM AUTHOR]

Purpose: We sought to determine the relationship between acceptability of a hypothetical vaginal microbicide, cultural factors, and perceived HIV risk among African-American women in Nashville, TN, USA, and African women in Kafue and Mumbwa, Zambia., Patients and Methods: Women in both sites completed a survey. Regression analyses were performed on valid samples (Nashville, 164; Zambia, 101) to determine cultural differences affecting microbicide acceptability. Regression analyses also tested whether individual risk perception affected acceptability., Results: In Zambia, 89.6% of women were willing to use a microbicide versus 81.6% in Nashville (P < 0.0001). One cultural difference is that women in the Zambian cohort viewed risk of HIV infection as distinct from risk of acquiring STIs, with 48% believing they were certain to become infected with AIDS, compared to 4% of Nashville participants., Conclusion: These results suggest a high degree of acceptability toward use of a vaginal microbicide to prevent HIV infection.