Advancing Sustainable HIV Services Through Integration in Primary Healthcare in Sub-Saharan Africa: A Perspective on Practical Recommendations.

Sub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. Integrating HIV services into primary healthcare is a crucial strategy to accelerate progress towards ending the epidemic. However, several challenges hinder effective integration, including underfunding, human resource shortages, infrastructure limitations, weak health systems, and sociocultural factors.

Evidence of human exposure and associated risk factors to Rift Valley fever in selected districts of Central and Western Zambia.

Rift Valley fever (RVF) is an important viral zoonotic disease that not only affects ruminants but causes serious morbidity and mortality in humans. In humans, its symptoms range from mild flu-like signs to a severe form such as retinal damage, meningoencephalitis to haemorrhagic fever. In this study, 202 human serum samples were collected from central and western parts of Zambia and tested for RVF-specific antibodies using a commercially available ELISA kit.

Safety, Tolerability, and Immunogenicity of the Invaplex Vaccine Co-Administered with the dmLT Adjuvant in Dutch and Zambian Adults: Study Protocol for a Multi-Center, Randomized, Double-Blind, Placebo-Controlled, Dose-Escalation Phase Ia/b Clinical Trial.

Background: Shigella infections remain endemic in places with poor sanitation and are a leading cause of diarrheal mortality globally, as well as a major contributor to gut enteropathy and stunting. There are currently no licensed vaccines for shigellosis but it has been estimated that an effective vaccine could avert 590,000 deaths over a 20-year period. A challenge to effective Shigella vaccine development has been the low immunogenicity and protective efficacy of candidate Shigella vaccines in infants and young children.

Building resilience against cholera: lessons from the implementation of integrated community strategy for cholera control in Zambia.

Cholera has remained a persistent public health challenge in Zambia since the country's first reported outbreak in 1977. The recent outbreak, which began in October 2023 and is ongoing as of June 2024, is the most severe in Zambia's history and part of the larger 2022-2024 Southern Africa cholera outbreak, which has affected multiple countries in the region. This article describes the implementation of the integrated community strategy for cholera control (ICSCC) in three districts of the Copperbelt Province during this outbreak.

An assessment of the progress made in the implementation of the regional framework for cholera prevention and control in the WHO African region.

High-burden cholera outbreaks, spreading beyond the traditional cholera-endemic countries, have been reported since 2021 in the WHO African region. Member states in the region have committed to the global goal of cholera elimination by 2030. To track progress towards this goal, WHO-African countries adopted a regional cholera prevention and control framework in 2018.

A comparison of CXR-CAD software to radiologists in identifying COVID-19 in individuals evaluated for Sars CoV-2 infection in Malawi and Zambia.

AI based software, including computer aided detection software for chest radiographs (CXR-CAD), was developed during the pandemic to improve COVID-19 case finding and triage. In high burden TB countries, the use of highly portable CXR and computer aided detection software has been adopted more broadly to improve the screening and triage of individuals for TB, but there is little evidence in these settings regarding COVID-19 CAD performance. We performed a multicenter, retrospective cross-over study evaluating CXRs from individuals at risk for COVID-19.

Increased Prevalence of Antimicrobial Resistance in Vibrio cholerae in the Capital and Provincial Areas of Zambia, January 2023-February 2024.

Zambia experienced the largest cholera epidemic in the country's history in 2023-2024; however, the antimicrobial susceptibility profile of Vibrio cholerae during the epidemic is unknown. A total of 2,384 stool samples were collected from suspected cholera cases in Eastern, Lusaka, and Luapula provinces in Zambia from January 2023 to March 2024. Among them, 549 (23.

Urine kidney injury molecule-1 predicts subclinical kidney disease among persons living with HIV initiating tenofovir disoproxil fumarate-based ART in Zambia.

Introduction: Antiretroviral therapy (ART) increases the life expectancy of persons living with HIV (PLWH), but not without potentially serious adverse effects. Tenofovir disoproxil fumarate (TDF) can cause nephrotoxicity, manifesting as acute kidney injury (AKI) that may persist after treatment discontinuation. Kidney injury biomarkers such as kidney injury molecule-1 (KIM-1), retinol-binding protein-4 (RBP-4), interleukin-18 (IL-18), and neutrophil gelatinase-associated lipocalin (NGAL) can aid early diagnosis and predict TDF-associated nephrotoxicity.

Social vulnerability index associated with higher COVID-19 seroprevalence in Nigeria.

Social vulnerability has been shown to be a strong predictor of disparities in health outcomes. A common approach to estimating social vulnerability is using a composite index, such as the social vulnerability index (SVI), which combines multiple factors corresponding to key social determinants of health. Lawal and Osayomi created an SVI to explore key social determinants of health-related COVID-19 infection among the Nigerian population.

Socio-economic and demographic determinants of undernutrition among 6-59 months old children living in Malawian stunting hotspots: a cross-sectional community study.

Background: Malnutrition is a global burden, with 171 million under-five children stunted and 45% of child deaths linked to it. Despite high undernutrition such as stunting in Mchinji, Mangochi, and Mzimba, no study has focused on all three hot spots. This study examined socio-economic and demographic determinants of undernutrition among children aged 6-59 months, offering insights to guide targeted interventions in these areas.

Implementation outcomes of 1-3-7 focus investigation for malaria in a low transmission setting in Southern Province, Zambia: A mixed methods study.

Eleven countries have been certified as malaria free since 2016, but none of these are in subSaharan Africa where elimination challenges are unique. The 1-3-7 focus investigation approach is an implementation strategy that requires case reporting, case investigation/classification, and focal classification/response to be completed one, three, and seven days, respectively, after index case diagnosis. Real-time short-messaging-service reports are sent at each step to add accountability and data transparency.

Prospective Multi-Site Validation of AI to Detect Tuberculosis and Chest X-Ray Abnormalities.

Background: Using artificial intelligence (AI) to interpret chest X-rays (CXRs) could support accessible triage tests for active pulmonary tuberculosis (TB) in resource-constrained settings.

Methods: The performance of two cloud-based CXR AI systems - one to detect TB and the other to detect CXR abnormalities - in a population with a high TB and human immunodeficiency virus (HIV) burden was evaluated. We recruited 1978 adults who had TB symptoms, were close contacts of known TB patients, or were newly diagnosed with HIV at three clinical sites.

Revisiting Africa's Stroke Obstacles and Services (SOS).

Background: As one of the most common non-communicable diseases in Africa, Stroke ought to be dealt with properly with intensifying efforts to control its burden and to face obstacles in its management.

Methods And Results: In this follow-up study we reanalyzed stroke services and related obstacles in 17 African countries that were previously studied in 2021/22 in aspects related to manpower, acute stroke services, rehabilitation programs, number of stroke units/centers, telestroke services, awareness campaigns, and national and international stroke registries through a survey that was sent to stroke specialists and national stroke societies. Overall, there is an improvement in many fields yet many obstacles in the implementation of telestroke services, acute management, secondary prevention, post-discharge services, and follow-ups whether governmental, medical, or societal are prevalent.

DNA damage triggers the death of green sea turtle-derived cells at high temperature.

As temperatures rise due to increasingly severe global warming, the effect of high temperatures on wildlife, including green sea turtles, is one of the issues that must be addressed to ensure the conservation of biodiversity. In the current study, we found that green sea turtle cell death due to apoptosis occurred at 37 °C, which suppressed cell proliferation. We also found that high temperature-induced heat stress led to the accumulation of DNA damage in green sea turtle cells.

Strong Association Between HIV Incidence and Herpes Simplex Virus Type 2 in Zambia and South Africa: Prospective Data From the HPTN 071 (PopART) Trial.

Background: Herpes simplex virus type 2 (HSV2) is an important cofactor for HIV acquisition and transmission. Associations between the infections are reexamined in longitudinal data from an HIV prevention trial.

Methods: The HPTN 071 (PopART) trial evaluated a combination prevention intervention in 21 urban communities in Zambia and South Africa.

Sexual Networks and Behavioral Characteristics of HIV-Positive Male Military Members, Female Sex Workers, and Male Civilians.

Military members and female sex workers (FSWs) may be more likely to acquire or transmit HIV. Mapping HIV transmission across these high-risk populations and identifying behaviors associated with sexual network clustering are needed for effective HIV prevention approaches. A cross-sectional study recruited participants newly diagnosed with HIV among militaries, civilians, and FSWs in Zambia, Senegal, and Democratic Republic of the Congo (DRC).

Factors associated with tuberculosis treatment initiation among bacteriologically negative individuals evaluated for tuberculosis: An individual patient data meta-analysis.

Background: Globally, over one-third of pulmonary tuberculosis (TB) disease diagnoses are made based on clinical criteria after a negative bacteriological test result. There is limited information on the factors that determine clinicians' decisions to initiate TB treatment when initial bacteriological test results are negative.

Methods And Findings: We performed a systematic review and individual patient data meta-analysis using studies conducted between January 2010 and December 2022 (PROSPERO: CRD42022287613).

Antibiotic use at the Centre Hospitalier Universitaire de Zone d'Abomey Calavi/Sô-Ava (CHUZ/AS) in Benin: a point prevalence survey.

Background: Antimicrobial stewardship promotes the appropriate use of antibiotics to prevent the emergence and spread of antimicrobial resistance. This study evaluated the use of antibiotics using a point prevalence survey at the Centre Hospitalier Universitaire de Zone d'Abomey Calavi/Sô-Ava (CHUZ/AS) in Benin.

Methods: This cross-sectional study utilized the WHO point prevalence survey methodology for monitoring antibiotic use among inpatients in hospitals.

Geographic factors associated with SARS-CoV-2 prevalence during the first wave - 6 districts in Zambia, July 2020.

Background: Geographical factors can affect infectious disease transmission, including SARS-CoV-2, a virus that is spread through respiratory secretions. Prioritization of surveillance and response activities during a pandemic can be informed by a pathogen's geographical transmission patterns. We assessed the relationship between geographical factors and SARS-CoV-2 prevalence in Zambia.

A comparative study of menstrual poverty among urban and rural female learners in government schools of Zambia.

Background: Menstrual poverty remains a significant health problem among female learners in Zambia, particularly due to the lack of access to menstrual products, leading to the use of unsafe alternatives and potential health risks such as reproductive tract infections. To address this pressing issue, this study examined the disparities in knowledge, attitudes, and practices concerning menstrual poverty among female learners in both urban and rural government schools within Zambia.

Methods: The study utilized a mixed-method sequential explanatory design, combining quantitative and qualitative approaches.

Enhancing engagement in HIV care among adolescents and young adults: A focus on phone-based navigation and relationship building to address barriers in HIV care.

Structural, psychological, and clinical barriers to HIV care engagement among adolescents and young adults living with HIV (AYAH) persist globally despite gains in HIV epidemic control. Phone-based peer navigation may provide critical peer support, increase delivery flexibility, and require fewer resources. Prior studies show that phone-based navigation and automated text messaging interventions improve HIV care engagement, adherence, and retention among AYAH.

Using Minimally Invasive Tissue Sampling and Determination of Cause of Death to Establish Etiologies of Community Respiratory Deaths Among Zambian Infants and Children.

In low-to-middle-income countries, acute lower respiratory infection (ALRI) remains the leading infectious cause of death among infants and children under 5 years old. Case-control studies based on upper respiratory sampling have informed current understandings of ALRI etiologies; in contrast, minimally invasive tissue sampling (MITS) offers a method of directly interrogating lower respiratory tract pathogens to establish etiologic distributions. This study performed in the postmortem setting used MITS and a Determination of Cause of Death (DeCoDe) panel to elucidate the causes of fatal pneumonia in the community in Lusaka, Zambia.

Associations between dietary patterns and intestinal inflammation among HIV-infected and uninfected adults: A cross-sectional study in Tanzania.

The increased burden of non-communicable diseases (NCDs) is fueled by lifestyle factors including diet. This cross-sectional study explored among Tanzanian adults whether unhealthy dietary patterns are associated with intestinal and systemic inflammation which could increase the risk of NCDs. The study included 574 participants, with both diet and inflammatory markers data.

Undetectable = Untransmittable (U = U): insights from people living with HIV attending health facilities in Rwanda.

Background: Rwanda has made remarkable progress in scaling up HIV testing, treatment, and healthcare services. Recent data show that 95% of people living with HIV (PLWH) were aware of their status, 97.5% of them are on antiretroviral therapy (ART), and 98% of those who are on treatment have achieved viral suppression.