Browsing by Author "Kabaso, M."
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Item Costs of HIV⁄AIDS outpatient services delivered through Zambian public health facilities(Tropical Medicine and International Health, 2011) Bratt, J.H.; Torpey, K.; Kabaso, M.; Gondwe, Y.objective To present evidence on unit and total costs of outpatient HIV ⁄ AIDS services in ZPCT supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV ⁄ AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother-to child transmission (PMTCT) in Zambia. methods Cost data from 2008 were collected in 12 ZPCT-supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV ⁄ AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009. results Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First-year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT-supported facilities were estimated at US$14.7–$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0–114.2 million for ART and US$57.7 million for ANC including PMTCT. conclusions Consistent with the literature, total costs of services were dominated by drugs, labora tory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility-level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening.Item Do peer educators make a difference? An evaluation of a youth-led HIV prevention model in Zambian Schools(Health Education Research, 2012) Denison, J.A.; Tsui1, S.; Bratt, J.; Torpey, K.; Weave, M.A.; Kabaso, M.Restless Development’s youth-led model places trained Volunteer Peer Educators (VPEs), aged 18–25 years, in schools to teach HIV prevention and reproductive health (RH). VPEs also run youth centers, extracurricular and community based activities. This evaluation assesses (i) pro gram effects on students’ HIV/RH knowledge, attitudes and behaviors using a non-randomized quasi-experimental design among 2133 eighth and ninth grade students in 13 intervention versus 13 matched comparison schools and (ii) program costs. Intervention students had significantly higher levels of knowledge related to HIV [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.18–2.19; P < 0.01] and RH (OR 1.71; 95% CI 1.21–2.49; P < 0.01), more positive attitudes toward people living with HIV and greater self-efficacy to refuse unwanted sex and access condoms. No evidence of differences in ever having had sex was found (28% in the intervention; 29% in the comparison schools). However, intervention students were more likely not to have had sex in the previous year (OR 1.26, 95% CI 1.03–1.56; P < 0.05) and to have had only one sex partner ever (OR 1.43, 95% CI 1.00–2.03; P < 0.05). The average an nual cost of the program was US$21 per benefi ciary. In conclusion, the youth-led model iassociated with increased HIVand RH knowledge and self-efficacy and lowered levels of stigma and sexual risk-taking behaviorsItem Excluding pregnancy among women initiating antiretroviral therapy: efficacy of a family planning job aid(BMC Public Health, 2010) Torpey, K.; Mwenda, L.; Kabaso, M.; et al.Background: Guidelines for initiating ART recommend pregnancy testing, typically a urine test, as part of the basic laboratory package. The principal reason for this recommendation is that Efavirenz, a first-line antiretroviral medication, has the potential of causing birth defects when used in the first trimester of pregnancy and is therefore contraindicated for use by pregnant women. Unfortunately, in many African countries pregnancy tests are not routinely provided or available in ART clinics, and, when available outside clinics, are often not affordable for clients. Recently, the World Health Organization added a family planning job aid called the 'pregnancy checklist,' developed by researchers at Family Health International, as a recommended tool for screening new ART clients to exclude pregnancy. Although the checklist has been validated for excluding pregnancy among family planning clients, there are no data on its efficacy among ART clients. This study was conducted to assess the clinical performance of a job aid to exclude pregnancy among HIV positive women initiating ART. Methods: Non-menstruating women eligible for ART were enrolled from 20 sites in four provinces in Zambia. The pregnancy checklist was administered followed by a urine pregnancy test as a reference standard. Sensitivity, specificity, and positive and negative predictive values were estimated. Results: Of the 200 women for whom the checklist ruled out pregnancy, 198 were not pregnant, for an estimated negative predictive value of 99%. The sensitivity of the checklist was 90.0%, and specificity was 38.7%. Among the women, 416 out of 534 (77.9%) did not abstain from sex since their last menses. Only 72 out of the 534 women (13.4%) reported using reliable contraception. Among the 416 women who did not abstain, 376 (90.4%) did not use reliable contraception. Conclusion: The pregnancy checklist is effective for excluding pregnancy in many women initiating ART, but its moderate sensitivity and specificity precludes its use to completely replace pregnancy testing. Its use should be encouraged in low resource settings where pregnancy tests are unavailable or must be rationed. Family planning methods should be available and integrated into ART clinics.Item Increasing the uptake of prevention of mother to-child transmission of HIV services in a resource-limited setting(BMC Health Services Research, 2010) Torpey, K.; Kabaso, M.; Kasonde, P.; et al.Background: As in other resource limited settings, the Ministry of Health in Zambia is challenged to make affordable and acceptable PMTCT interventions accessible and available. With a 14.3% HIV prevalence, the MOH estimates over one million people are HIV positive in Zambia. Approximately 500,000 children are born annually in Zambia and 40,000 acquire the infection vertically each year if no intervention is offered. This study sought to review uptake of prevention of mother-to-child (PMTCT) services in a resource-limited setting following the introduction of context-specific interventions. Methods: Interventions to improve PMTCT uptake were introduced into 38 sites providing PMTCT services in Zambia in July 2005. Baseline and follow up service data were collected on a monthly basis through September 2008. Data was checked for internal and external consistency using logic built into databases used for data management. Data audits were conducted to determine accuracy and reliability. Trends were analyzed pre- and post- intervention. Results: Uptake among pregnant women increased across the 13 quarters (39 months) of observation, particularly in the case of acceptance of counseling and HIV testing from 45% to 90% (p value = 0.00) in the first year and 99% by year 3 (p value = 0.00). Receipt of complete course of antiretroviral (ARV) prophylaxis increased from 29% to 66% (p = 0.00) in the first year and 97% by year 3 (p value = 0.00). There was also significant improvement in the percentage of HIV positive pregnant women referred for clinical care. Conclusions: Uptake of PMTCT services in resource-limited settings can be improved by utilizing innovative alternatives to mitigate the effects of human resource shortage such as by providing technical assistance and mentorship beyond regular training courses, integrating PMTCT services into existing maternal and child health structures, addressing information gaps, mobilizing traditional and opinion leaders and building strong relationships with the government. These health system based approaches provide a sustainable improvement in the capacity and uptake of services.Item Reducing Pediatric HIV Infection: Estimating Mother-to-Child Transmission Rates in a Program Setting in Zambia(Journal of acquired immune deficiency syndromes and human retrovirology, 2010) Torpey, K.; Kasonde, P.; Kabaso, M.; et al.Background: Vertical transmission of HIV remains the main source of pediatric HIV infection in Africa with transmission rates as high as 25%–45% without intervention. Even though effective interventions to reduce vertical transmission of HIVare now available and remarkable progress has been made in scaling up prevention of mother-to-child transmission (PMTCT) services, the effectiveness of PMTCT interventions is unknown in Zambia. In this study, we estimate HIV vertical transmission rates at different age bands among perinatally exposed children. Methods: The study analyzed program data of DNA polymerase chain reaction results and selected client information on dried blood spot samples from perinatally exposed children aged 0–12 months sent to the polymerase chain reaction laboratory from 5 provinces between September 2007 and January 2009. Results: Samples of 8237 babies between 0 and 12 months were analyzed, with 84% of the mothers having ever breastfed their children. The observed transmission rate was 6.5% (5.1%, 7.8%) among infants aged 0–6 weeks when both mother and infant received interventions compared with 20.9% (12.3%, 29.5%) where no intervention was given to either mother or baby. Observed HIV transmission with single-dose nevirapine (sdNVP) was 8.5% (5.9%, 11.0%) among infants aged 0–6 weeks, whereas zidovudine with sdNVP (zidovudine + NVP) and highly active antiretroviral therapy were associated with observed transmission rates of 6.8% (4.5%, 9.1%) and 5.0% (3.0%, 7.0%), respectively; whereas these estimates were not significantly different from one another, they were all significantly lower than no intervention for which the estimated rate was 20.9%. Regardless of the intervention, the observed transmission rates were higher among infants aged 6–12 months. Conclusions: PMTCT interventions, including sdNVP, are working in program settings. However, postnatal transmission especially after 6 months through suboptimal feeding practises remains an important challenge to further reduce pediatric HIV