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Background: Family planning (FP) is an essential health service and an important part of comprehensive HIV care. However, there is limited information about the contraceptive needs of people living with HIV in sub-Saharan Africa, which in turn has hampered efforts to expand and integrate FP services into existing HIV programs.Methods: We performed a cross-sectional survey to determine FP prevalence and predictors among HIV-positive women and men attending 18 public antiretroviral therapy (ART) clinics in Lusaka, Zambia. Trained peer counselors administered the 10-question survey to those seeking care for five days at each of the target sites.Results: From February to April 2014, we surveyed 7,046 HIV-infected patients receiving routine HIV services. Use of modern contraception was reported by 69 % of female ART patients and 79 % of male ART patients. However, highly effective contraceptive use and dual method use were low among women (38 and 25 %, respectively) and men (19 and 14 %, respectively). HIV disclosure status (adjusted odds ratio (AOR) = 4.91, 95 % confidence interval (CI) = 3.32-7.24 for women, AOR = 3.58, 95 % CI = 2.39-5.38 for men) and sexual activity in the last 6 months (AOR = 5.80, 95 % CI = 4.51-7.47 for women, AOR = 6.24, 95 % CI = 3.51-11.08 for men) were associated with modern contraceptive use in multivariable regression. Most respondents said they would access FP services if made available within ART clinic.Conclusions: While FP-ART integration may be a promising strategy for increasing FP service uptake, such services must focus on assessing sexual activity and advocating for dual method use to increase effective contraceptive use and prevent unintended pregnancies. [ABSTRACT FROM AUTHOR]

In this large cohort of human immunodeficiency virus–infected patients receiving first-line antiretroviral therapy in Zambia, individuals who started a tenofovir-containing regimen despite baseline renal dysfunction showed comparable mortality and renal function improvement to those not receiving tenofovir.Background. Although tenofovir disoproxil fumarate (TDF) use has increased as part of first-line antiretroviral therapy (ART) across sub-Saharan Africa, renal outcomes among patients receiving TDF remain poorly understood. We assessed changes in renal function and mortality in patients starting TDF- or non–TDF-containing ART in Lusaka, Zambia.Methods. We included patients aged ≥16 years who started ART from 2007 onward, with documented baseline weight and serum creatinine. Renal dysfunction was categorized as mild (estimated glomerular filtration rate [eGFR], 60–89 mL/min), moderate (30–59 mL/min), or severe (<30 mL/min) according to the chronic kidney disease–epidemiology (CKD-EPI) formula. Differences in eGFR during ART were analyzed using linear mixed-effect models. The odds of developing moderate or severe eGFR decrease and mortality were assessed using logistic and competing risk regression, respectively.Results. We included 62 230 adults, of which 38 716 (62.2%) initiated a TDF-based regimen. The proportion with moderate or severe renal dysfunction at baseline was lower in the TDF than in the non-TDF group (1.9% vs 4.0%). Among patients with no or mild renal dysfunction, those receiving TDF were more likely to develop moderate (adjusted odds ratio, 3.11; 95% confidence interval, 2.52–3.87) or severe ( 2.43; 1.80–3.28) eGFR decrease, although the incidence in such episodes was low. Among patients with moderate or severe renal dysfunction at baseline, renal function improved independently of ART regimen, and mortality rates were similar in both treatment groups.Conclusions. TDF use did not attenuate renal function recovery or increase the mortality rate in patients with renal dysfunction. Further studies are needed to determine the role of routine renal function monitoring before and during ART use in Africa. [ABSTRACT FROM AUTHOR]

Background Although generic anti-retroviral drugs are in common use throughout the developing world, studies comparing their clinical effectiveness with that of proprietary formulations are lacking.Methods We analysed observational data from a large cohort of adults on anti-retroviral therapy (ART) to assess potential differences between generic and proprietary zidovudine (ZDV) formulations in post-90-day mortality, ‘programme failure’ (a composite of death, follow-up losses and withdrawals) and other clinical outcomes. We accounted for drug exposure in three ways: an ‘initial dispensation’ approach that categorized patients according to the first prescription; ‘time-varying’ approach that attributed an outcome to the formulation taken at the time of event; and ‘predominant exposure’ approach that considered only those with >75% exposure to either brand or generic ZDV. Proprietary formulations were used as the reference group in all adjusted Cox proportional hazard regressions.Results Among 14 736 patients eligible for analysis, 7277 (49%) initiated a generic formulation of ZDV and 7459 (51%) initiated a proprietary formulation. When categorized according to initial dispensation, no difference in post-90-day mortality was observed between the two groups [adjusted hazard ratio (AHR): 0.93, 95% confidence interval (CI): 0.77–1.12]. Similar findings were noted when drug formulation was treated as a time-varying exposure (AHR: 1.15, 95% CI: 0.89–1.48) when analysis was limited to those with a predominant exposure to one formulation or the other (AHR: 0.59, 95% CI: 0.24–1.49). Results were consistent across all approaches when programme failure was considered as an outcome. No longitudinal differences were detected between formulations for CD4 response, weight change and haemoglobin concentration. Generic ZDV formulations were associated with slight decreases in single-drug substitution.Conclusions In this large programmatic cohort of adults starting ZDV-based first-line therapy, clinical outcomes appeared similar among patients on generic or proprietary formulations. These findings support continued use of generic anti-retroviral drug formulations in resource-constrained settings. [ABSTRACT FROM AUTHOR]

Objectives: Epidemiologic data of HIV and viral hepatitis coinfection are needed in sub-Saharan Africa to guide health policy for hepatitis screening and optimized antiretroviral therapy (ART). Materials and Methods: We screened 323 HIV-infected, ART-eligible adults for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) at a tertiary hospital in Lusaka, Zambia. We collected basic demographic, medical, and laboratory data to determine predictors for coinfection. Results: Of 323 enrolled patients, 32 (9.9%; 95% CI=6.7–13.2%) were HBsAg positive, while 4 (1.2%; 95% CI=0.03–2.4%) were HCV Ab positive. Patients with hepatitis B coinfection were more likely to be <40 years (84.4% vs. 61.4%; P=0.01) when compared to those who were not coinfected. Patients with active hepatitis B were more likely to have mild to moderately elevated AST/ALT (40–199 IU/L, 15.8% vs. 5.4%; P=0.003). Highly elevated liver enzymes (>200 IU/L) was uncommon and did not differ between the two groups (3.4% vs. 2.3%; P=0.5). We were unable to determine predictors of hepatitis C infection due to the low prevalence of disease. Conclusions: HIV and hepatitis B coinfection was common among patients initiating ART at this tertiary care facility. Routine screening for hepatitis B should be considered for HIV-infected persons in southern Africa. [ABSTRACT FROM AUTHOR]

HIV-infected women in sub-Saharan Africa are at substantial risk of unintended pregnancy and sexually transmitted infections (STIs). Linkages between HIV and reproductive health services are advocated. We describe implementation of a reproductive health counseling intervention in 16 HIV clinics in Lusaka, Zambia. Between November 2009 and November 2010, 18,407 women on antiretroviral treatment (ART) were counseled. The median age was 34.6 years (interquartile range (IQR): 29.9-39.7), and 60.1% of women were married. The median CD4(+) cell count was 394 cells/uL (IQR: 256-558). Of the women counseled, 10,904 (59.2%) reported current modern contraceptive use. Among contraceptive users, only 17.7% reported dual method use. After counseling, 737 of 7,503 women not previously using modern contraception desired family planning referrals, and 61.6% of these women successfully accessed services within 90 days. Unmet contraceptive need remains high among HIV-infected women. Additional efforts are needed to promote reproductive health, particularly dual method use. [ABSTRACT FROM AUTHOR]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In many programs providing antiretroviral therapy (ART), clinicians report substantial patient attrition; however, there are no consensus criteria for defining patient loss to follow-up (LTFU). Data on a multisite human immunodeficiency virus (HIV) treatment cohort in Lusaka, Zambia, were used to determine an empirical “days-late” definition of LTFU among patients on ART. Cohort members were classified as either “in care” or LTFU as of December 31, 2007, according to a range of days-late intervals. The authors then looked forward in the database to determine which patients actually returned to care at any point over the following year. The interval that best minimized LTFU misclassification was described as “best-performing.” Overall, 33,704 HIV-infected adults on ART were included. Nearly one-third (n = 10,196) were at least 1 day late for an appointment. The best-performing LTFU definition was 56 days after a missed visit, which had a sensitivity of 84.1% (95% confidence interval (CI): 83.2, 85.0), specificity of 97.5% (95% CI: 97.3, 97.7), and misclassification of 5.1% (95% CI: 4.8, 5.3). The 60-day threshold performed similarly well, with only a marginal difference (<0.1%) in misclassification. This analysis suggests that ≥60 days since the last appointment is a reasonable definition of LTFU. Standardization to empirically derived definitions of LTFU will permit more reliable comparisons within and across programs. [ABSTRACT FROM PUBLISHER]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents a study which investigates the relationship of CD4+ and subsequent risk of death among patients after antiretroviral therapy in Lusaka, Zambia. It notes that the study was conducted through Cox proportional hazard models. It reveals that in the post six and twelve-month analysis, hazard for mortality was associated with the increase in CD4 cell count. It suggests that definitions used for immunologic treatment failure are related with the increased mortality risk.

Objective: We studied the prevalence of and predictors for traditional medicine use among pregnant women seeking care in the Lusaka, Zambia public health system. Subjects: We surveyed 1128 pregnant women enrolled in a clinical trial of perinatal human immunodeficiency virus (HIV) prevention strategies at two district delivery centers. Outcome measures: Postpartum questionnaires were administered to determine demographic characteristics, behavioral characteristics, HIV knowledge, and prior use of traditional medicines. Results: Of the 1128 women enrolled, 335 (30%) reported visiting a traditional healer in the past; 237 (21%) reported using a traditional healer during the current pregnancy. Overall, 54% believed that admitting to a visit to a traditional healer would result in worse medical care. When women who had used traditional medicines were compared to those who had not, no demographic differences were noted. However, women who reported use of traditional medicine were more likely to drink alcohol during pregnancy, have ≥2 sex partners, engage in “dry sex,” initiate sex with their partner, report a previously treated sexually transmitted disease, and use contraception (all p < 0.01). HIV-infected women who reported using traditional healers were also less likely to adhere to a proven medical regimen to reduce HIV transmission to their infant (25% versus 50%, p = 0.048). Conclusions: Use of traditional medicine during pregnancy is common, stigmatized, and may be associated with nonadherence to antiretroviral regimens. Health care providers must open lines of communication with traditional healers and with pregnant women themselves to maximize program success. [ABSTRACT FROM AUTHOR]

Context The Zambian Ministry of Health has scaled-up human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) care and treatment services at primary care clinics in Lusaka, using predominately nonphysician clinicians. Objective To report on the feasibility and early outcomes of the program. Design, Setting, and Patients Open cohort evaluation of antiretroviral-naive adults treated at 18 primary care facilities between April 26, 2004, and November 5, 2005. Data were entered in real time into an electronic patient tracking system. Intervention Those meeting criteria for antiretroviral therapy (ART) received drugs according to Zambian national guidelines. Main Outcome Measures Survival, regimen failure rates, and CD4 cell response. Results We enrolled 21 755 adults into HIV care, and 16198 (75%) started ART. Among those starting ART, 9864 (61%) were women. Of 15 866 patients with documented World Health Organization (WHO) staging, 11 573 (73%) were stage III or IV, and the mean (SD) entry CD4 cell count among the 15336 patients with a baseline result was 143/µL(123/µL). Of 1142 patients receiving ART who died, 1120 had a reliable date of death. Of these patients, 792 (71%) died within 90 days of starting therapy (early mortality rate: 26 per 100 patient-years), and 328 (29%) died after 90 days (post-90-day mortality rate: 5.0 per 100 patient-years). In multivariable analysis, mortality was strongly associated with CD4 cell count between 50/µL and 199/µL (adjusted hazard ratio [AHR], 1.4; 95% confidence interval [Cl], 1.0-2.0), CD4 cell count less than 50/µL (AHR, 2.2; 95% Cl, 1.5-3.1), WHO stage III disease (AHR, 1.8; 95% Cl, 1.3-2.4), WHO stage IV disease (AHR, 2.9; 95% Cl, 2.0-4.3), low body mass index <16; AHR.2.4; 95% Cl, 1.8-3.2), severe anemia (<8.0 g/dL; AHR, 3.1; 95% Cl, 2.3-4.0), and poor adherence to therapy (AHR, 2.9; 95% Cl, 2.2-3.9). Of 11 714 patients at risk, 861 failed therapy by clinical criteria (rate, 13 per 100 patient-years). The mean (SD) CD4 cell count increase was 175/µL (174/µL) in 1361 of 1519 patients (90%) receiving treatment long enough to have a 12-month repeat. Conclusion Massive scale-up of HIV and AIDS treatment services with good clinical outcomes is feasible in primary care settings in sub-Saharan Africa. Most mortality occurs early, suggesting that earlier diagnosis and treatment may improve outcomes. [ABSTRACT FROM AUTHOR]

Objective: To measure key obstetric and neonatal outcomes recorded at a tertiary hospital in Zambia over a 5-year period.Methods: A retrospective analysis was conducted among women who had delivered at the University Teaching Hospital in Lusaka, between January 1, 2008, and December 31, 2012. Data were extracted from electronic medical records. The main outcomes were maternal mortality, cesarean delivery, prenatal or intrapartum hemorrhage, stillbirth, a 5-minute Apgar score of less than 7, and admission to the neonatal intensive care unit.Results: A total of 62 470 deliveries were recorded. Rates of maternal mortality, cesarean delivery, and hemorrhage during pregnancy all declined over time. Decreased admissions to the neonatal intensive care unit were observed; however, the rate spiked temporarily in late 2011 and early 2012 before returning to previous levels. The proportion of stillbirths remained stable over time but reports of a 5-minute Apgar score of less than 7 rose.Conclusion: Routinely collected obstetric and neonatal data could aid ongoing program monitoring and should be used to guide quality improvement activities. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between HIV, antiretroviral therapy (ART), and pregnancy-associated hypertension (PAH) in an HIV-endemic setting.Methods: A retrospective cohort study was undertaken of pregnant women for whom information was recorded between February 2006 and December 2012 in the Zambia Electronic Perinatal Record System, which captures data from 25 facilities in Lusaka, Zambia. PAH was defined as eclampsia, pre-eclampsia, hypertension, or elevated blood pressure (>140/80mm Hg) during delivery admission. Logistic regression estimated the odds of PAH among women by HIV serostatus, and by most recent CD4 T lymphocyte count and ART status among women with HIV infection.Results: Among 249 771 women included in the analysis, 5354 (2.1%) had PAH. Compared with women without HIV infection, women with HIV infection not receiving ART had lower odds of PAH (adjusted odds ratio [AOR] 0.86, 95% confidence interval 0.78-0.95), whereas those with HIV infection who had initiated ART had higher odds of PAH (AOR 1.15, 95% CI 1.01-1.32). No association was found between PAH and timing of ART initiation or CD4 lymphocyte count.Conclusion: In a large African urban cohort, women with untreated HIV infection had the lowest odds of PAH. Treatment with ART could increase PAH risk beyond that of women without HIV infection and those with untreated infection. [ABSTRACT FROM AUTHOR]

Objective: To determine the quality of contraceptive services in family planning clinics in Lusaka, Zambia, using a standardized approach.Study Design: We utilized the Quick Investigation of Quality, a cross-sectional survey tool consisting of a facility assessment, client-provider observation and client exit interview, in public-sector family planning clinics. Data were collected on availability of seven contraceptive methods, information given to clients, interpersonal relations between providers and clients, providers' technical competence and mechanisms for continuity and follow-up.Results: Data were collected from five client-provider observations and client exit interviews in each of six public-sector family planning clinics. All clinics had at least two contraceptive methods continuously available for the preceding 6 months. Most providers asked clients about concerns with their contraceptive method (80%) and told clients when to return to the clinic (87%). Most clients reported that the provider advised what to do if a problem develops (93%), described possible side effects (89%), explained how to use the method effectively (85%) and told them when to come for follow-up (83%). Clients were satisfied with services received (93%).Conclusion(s): This application of the Quick Investigation of Quality showed that the participating family planning clinics in Lusaka, Zambia, were prepared to offer high-quality services with the available commodities and that clients were satisfied with the received services. Despite the subjective client satisfaction, quality improvement efforts are needed to increase contraceptive availability.Implications: Although clients perceived the quality of care received to be high, family planning service quality could be improved to continuously offer the full spectrum of contraceptive options. The Quick Investigation of Quality was easily implemented in Lusaka, Zambia, and this simple approach could be utilized in a variety of settings as a modality for quality improvement. [ABSTRACT FROM AUTHOR]

Objective To determine rates of stillbirth and the associated risk factors for stillbirth among twins delivered in Lusaka, Zambia. Methods A retrospective cohort analysis was conducted of singletons and twins delivered at 26 public sector facilities between February 1, 2006, and May 31, 2013. Data were obtained from the Zambian Electronic Perinatal Record System. Risk of stillbirth was estimated using logistic regression. Results Overall, 260 657 singletons and 4021 twin pairs were included. There were 5105 stillbirths; 317 twins were stillborn. The crude stillbirth rate for twins was 39.4 per 1000 births (95% confidence interval [CI] 35.2–43.7) whereas the rate for singletons was 18.4 per 1000 births (95% CI 17.9–18.9; P < 0.001). Factors associated with stillbirth among twins were increased interval between delivery (> 60 minutes), low birth weight (< 2500 g), birth order (being the second-born), and difference in birth weights (> 30% discordance). Conclusion Twins were at an increased risk of stillbirth. Improved understanding of factors associated with stillbirth in this population could help to improve perinatal outcomes globally. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify predictors and outcomes associated with a birth weight of 4000g or more in Lusaka, Zambia. Methods: Data from women who delivered between February 2006 and August 2011 were obtained from electronic perinatal records at 25 public sector facilities in Lusaka. Macrosomia was defined as a birth weight of 4000g or more and normal birth weight as 2500–3999g. Maternal and newborn characteristics were analyzed for association with macrosomia. Results: There were 4717 macrosomic and 187 117 normal birth weight newborns. The strongest predictors of macrosomia were high BMI (adjusted odds ratio [AOR], 2.88; 95% confidence interval [CI], 1.95–4.24), prior macrosomic newborn (AOR, 7.60; 95% CI, 6.81–8.49), and history of diabetes (AOR, 3.09; 95% CI, 1.36–6.98). Macrosomic newborns were at increased risk for cesarean delivery (AOR, 1.63; 95% CI, 1.35–1.96), fresh stillbirth (AOR, 2.24; 95% CI, 1.56–3.21), Apgar score of under 7 at 5minutes (AOR, 2.03; 95% CI, 1.33–3.11), and neonatal intensive care admission (AOR, 2.07; 95% CI, 1.32–3.23). Conclusion: Screening for macrosomia should be considered for high-risk patients in Sub-Saharan Africa. Institutional delivery at facilities with operating rooms and neonatal intensive care services should be encouraged. [Copyright &y& Elsevier]

The article presents a retrospective cohort study conducted in Lusaka, Zambia to determine the rates and determinants of stillbirth in the area's urban obstetric population. Based on the analysis, stillbirth is associated to such factors as placental abruption, cesarean delivery and operative vaginal delivery. Stillbirth or fetal death is defined by the International Classification of Disease as the death of a fetus who has reached 22 weeks of completed gestation or weighs at least 500 grams (g).

The article presents a study on the relationship between 6-month weight gain after the antiretroviral therapy (ART) and subsequent clinical treatment failure and death in malnourished adults in Lusaka, Zambia. The study used Cox proportional hazards model and Kaplan-Meier analysis and arranged the gathered data of 27915 adults based on their body mass index (BMI). Results revealed that weight gain after ART is related to the decreased clinical failure and improved survival.

The article presents a study that focuses on the provision of food supplementation among food-insecure adults in Lusaka, Zambia to improve their adherence to antiretroviral therapy (ART). As a method of the study, a home-based adherence support program was organized to assess the adherence of the patients. Results show that food supplementation is relevant to the improved adherence to therapy and medication.

Objective HIV prevention has been ongoing in Lusaka for many years. Recent reports suggest a possible decline in HIV seroincidence in Zambia and some neighbouring countries. This study aimed to examine trends in HIV seroprevalence among pregnant and parturient women between 2002 and 2006. Methods We analysed HIV seroprevalence trends from two Lusaka sources: (i) antenatal data from a city-wide programme to prevent mother-to-child HIV transmission, and (ii) delivery data from two anonymous unlinked cord-blood surveillances performed in 2003 and again in 2005-2006, where specimens from > 97% of public-sector births in each period were obtained and analysed. Findings Between July 2002 and December 2006, the Lusaka district tested 243 302 antenatal women for HIV; 54 853 (22.5%) were HIV infected. Over this period, the HIV seroprevalence among antenatal attendees who were tested declined steadily from 24.5% in the third quarter of 2002 to 21.4% in the last quarter of 2006 (P < 0.001). The cord-blood surveillances were conducted between June and August 2003 and again between October 2005 and January 2006. Overall HIV seroprevalence declined from 25.7% in 2003 to 21.8% in 2005-2006 (P = 0.001). Among women ? 17 years of age, seroprevalence declined from 12.1% to 7.7% (P = 0.015). Conclusion HIV seroprevalence appears to be declining among antenatal and parturient women in Lusaka. The decline is most dramatic among women ≤ 17 years of age, suggesting a reduction in sero-incidence in this important age group. [ABSTRACT FROM AUTHOR]