Identifying care gaps along the HIV treatment failure cascade: A multistate analysis of viral load monitoring, re-suppression, and regimen switches in Zambia.

Background: Timely response to treatment failure is critical for improved outcomes and viral re-suppression among people living with HIV, but care gaps along the treatment failure cascade can occur due to delays by both clients (e.g., retention and adherence) and health systems (e.

-specific antibodies in plasma and saliva in cholera patients during a severe outbreak in Zambia: an antibody profiling approach.

Background: Cholera is a public health threat in resource-limited settings and is responsible for causing over 3 million cases globally. Mucosal immune responses play an important role in protecting against infection, a non-invasive mucosal pathogen, yet traditional plasma-based assays are invasive and logistically challenging, particularly during outbreaks in low- and middle-income countries (LMICs). Saliva offers a unique window into mucosal immunity and may serve as a non-invasive alternative for seroprevalence and vaccine immunogenicity studies.

Breaking barriers, changing paradigms: Africa's radical agenda for HIV sustainability.

Despite significant progress in the HIV response, the sustainability of this journey is threatened by over-reliance on external support and imported and often inappropriate models. The recent sudden shifts in the United States Government's foreign aid policy have heightened the urgency for independence. Africa is at a critical point, which presents an opportunity to move from dependency on external assistance to establishing itself as a self-sustaining center of innovation and sustainable growth.

Mental, physical, and respiratory health in people with tuberculosis in Southern Africa: a multi-country cohort analysis.

Background: Tuberculosis (TB) affects people's quality of life (QoL). We prospectively monitored physical and mental health-related QoL over time in people with TB in the Southern African region with a high HIV and TB burden.

Methods: Adults aged ≥ 15 years with pulmonary TB were enrolled in five cohorts in Malawi, Mozambique, South Africa, Zambia, and Zimbabwe from October 2022 to September 2024.

Measuring alcohol consumption with biomarkers in intervention studies: A scoping review.

In intervention studies, alcohol consumption is often measured by self-report alone, which can be impacted by social desirability, recall, and other biases. Biomarkers and biosensors have gained popularity as objective measurements of alcohol consumption that can improve the accuracy of results. This scoping review provides a narrative overview and describes the use of biomarkers in alcohol intervention studies to inform future research.

Patterns of engagement in care during clients' first 12 months after HIV treatment initiation in Zambia: a retrospective cohort analysis using routinely collected data.

Background: The first year after HIV treatment initiation or re-initiation is the period of highest risk of a treatment interruption or disengagement, yet little is known about the timing, patterns and effects of interruptions in the early treatment period.

Methods: Using routinely collected electronic medical record data from 543 Zambian facilities from 2018 to 2023, we described patterns of engagement during the first year of HIV treatment. We defined engagement patterns for months 0-6 and months 7-12 after initiation or reinitiation as (1) continuous (attended all scheduled clinic and medication pickup visits as planned; (2) cyclical (attended ≥1 visits late >28 days but returned to and remained in care) or (3) disengaged (missed a scheduled visit by >28 days and had no evidence of return).

Establishing shared definitions of virological failure and discontinuation for long-acting injectable cabotegravir and rilpivirine therapy (the CONSENSUS-LAI Study): an international survey and Delphi process.

Background: Definitions of virological failure and treatment discontinuation for long-acting injectable (LAI) cabotegravir and rilpivirine antiretroviral therapy are inconsistent in clinical practice and observational studies, which complicates interpretation and implementation of findings. The CONSENSUS-LAI study aimed to establish consistent definitions of virological failure and treatment discontinuation to enhance evidence transferability and support optimal clinical outcomes.

Methods: The study had two phases.

Integrating mental health care to reduce intimate partner violence in complex humanitarian emergencies.

The public health burden of intimate partner violence (IPV) is immense, particularly in complex humanitarian emergencies, where up to three in four women report experiencing lifetime IPV. Informed by feminist theory, current interventions addressing IPV in these settings often use gender-transformative approaches to advance more equitable gender attitudes, community mobilisation efforts to engage men in changing gender norms, and economic-focused programming to advance equitable financial decision making within couples. In this Viewpoint, we argue that feminist-grounded efforts to reduce IPV might benefit from incorporating interventions specifically targeted towards improving mental health.

Tongue Swab Xpert MTB/RIF Ultra Testing for Tuberculosis Using a Revised Consensus Protocol: A multi-country diagnostic accuracy study.

Background: Tongue swabs are a promising specimen for tuberculosis (TB) diagnosis. In a previous study using a consensus protocol, tongue swabs tested with Xpert MTB/RIF Ultra (Xpert Ultra, Cepheid, USA) outperformed sputum smear microscopy, but a substantial proportion (6.1%) of results were non-actionable (e.

Tobacco smoking and smokeless tobacco use among people living with HIV in Zambia: Findings from a 2023 National NCD/HIV Survey.

Background: People living with HIV (PLWH) who use tobacco face significant public health risks compared to non-users, including an average loss of 12.3 years of life expectancy. Tobacco use increases the likelihood of non-communicable diseases (NCDs), such as cardiovascular diseases, hypertension, diabetes mellitus, and non-AIDS-related cancers.

Outcomes of children aged 2-59 months with chest indrawing pneumonia managed on an outpatient basis in selected primary health facilities in Zambia.

Background: Zambia has a high burden of child pneumonia, with approximately 6000 children under five dying annually from this condition. We aimed to gather evidence about the outcomes two weeks after enrolment for children 2-59 months with chest indrawing pneumonia who were managed in primary health care facilities in Zambia.

Methods: This was a prospective cohort study conducted between October 2022 and April 2024 in eight primary health care facilities from Lusaka, Chibombo, and Chongwe districts.

Preferences for Tongue Swab versus Sputum Collection for Tuberculosis Testing: A Multi-Country Survey.

Background: Sputum collection for tuberculosis (TB) diagnosis poses challenges for children, people living with HIV, and those who struggle with sputum production. Tongue swab-based molecular testing offers a promising non-invasive alternative, but person-centered research on acceptability is limited.

Methods: We conducted a pragmatic survey across eight countries (Vietnam, Philippines, South Africa, Nigeria, Zambia, India, Uganda, Peru) among people with presumptive TB attending primary care facilities.

Scale of differentiated service delivery implementation in HIV care facilities in low- and middle-income countries: a global facility survey.

Introduction: In 2016, the World Health Organization recommended differentiated service delivery (DSD) as a client-centred approach to simplify HIV care in frequency and intensity, thus reducing the clinic visit burden on individuals and HIV programmes. We describe the scale of DSD implementation among HIV facilities in low- and middle-income countries (LMICs) in Latin America, Africa and the Asia-Pacific before the COVID-19 pandemic.

Methods: We analysed facility-level survey data from HIV care facilities participating in the International epidemiology Databases to Evaluate AIDS consortium in 2019.

Improving PrEP access for adolescent girls and young women: a descriptive analysis of community-based PrEP delivery in the DREAMS programme in Zambia.

Introduction: Despite being at high risk of HIV acquisition, access to pre-exposure prophylaxis (PrEP) among adolescent girls and young women (AGYW) is low in Zambia because PrEP is traditionally delivered in clinical settings. We describe the effects of community centres supported by the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative on PrEP outcomes in Zambia and examine factors associated with PrEP continuation.

Methods: We collected individual-level PrEP data for AGYW aged 15-24 years at risk of HIV acquisition and enrolled in DREAMS in seven districts of Zambia between August 2022 and August 2024.

Spatial variations and predictors of neonatal mortality among births to HIV-infected and non-infected mothers in rural Zambia.

In Zambia, neonatal mortality still remains a noteworthy public health problem with a current rate of 27 deaths per 1000 and ranking 162 out of 195 countries globally. The study aimed to investigate the spatial variations and predictors of neonatal mortality in rural Zambia among HIV-infected and non-infected mothers using the national-level data from the 2018 Zambia Demographic and Health Survey (ZDHS). Statistical analyses were conducted using the Rao - Scott Chi-square test to assess associations between neonatal mortality and categorical variables.

Evaluating InferVision's Computer-Aided Detection (CAD) algorithm for Tuberculosis (TB) screening, Lusaka, Zambia.

The objective of this study was to evaluate the diagnostic performance of InferRead DR Chest for tuberculosis (TB) screening in a high HIV and TB burden setting. The study assessed the performance of InferRead DR Chest using anonymized chest X-ray images from an active TB case finding study in Lusaka, Zambia, for individuals aged 15 and older. The Xpert MTB/RIF or MTB culture was the composite reference standard.

Clinical diagnosis of TB: lessons on misdiagnosis and overdiagnosis.

Clinically diagnosed TB patients (n = 335) at two facilities in Lusaka, Zambia were re-evaluated within two weeks of diagnosis. This re-evaluation included sputum Xpert Ultra testing and expert reader interpretation of the chest x-rays (CXRs) used for initial diagnosis. Repeat Xpert Ultra detected TB in just 2.

The impact of the SKILLZ intervention on sexual and reproductive health empowerment among Zambian adolescent girls and young women: results of a cluster randomized controlled trial.

Background: Zambian adolescent girls and young women (AGYW, age 15–24) experience a disproportionate burden of HIV and unintended pregnancy. Sports-based interventions, which affect sexual health behaviors via improving sexual and reproductive empowerment, may be an innovative and effective approach for promoting HIV and unintended pregnancy prevention. We sought to evaluate the impact of a peer-led, sports-based intervention on sexual and reproductive empowerment among in-school Zambian adolescent girls and young women.

Present or Absent: Risks and protective factors of sudden infant death syndrome (SIDS) in the Zambian context.

Background: Despite a reduction in Sudden Unexplained Infant Death (SUID) in high-income countries, the incidence of SUID and the prevalence of its risk and protective factors remain poorly understood in Zambia due to limited research. The aim of our study was to describe the infant sleep positions and sleep environments in an urban Zambian population to gain a better understanding of the modifiable risk factors for SUID.

Methods: Data from the Zambian Infant Cohort Study (ZICS), a prospective birth cohort, were collected to describe infant sleep practices in Chawama, a densely populated peri-urban community in Lusaka, Zambia.

Beyond the pill: Understanding barriers and enablers to oral and long-acting injectable PrEP among women in sex work in Zambia.

Women engaging in sex work (WESW) in low- and middle-income countries face a disproportionately high risk of HIV infection. This study explores enablers and barriers to the uptake and persistence of oral pre-exposure prophylaxis (PrEP) and long-acting injectable PrEP (LAI-PrEP) among WESW in Lusaka, Zambia. We evaluated Capability, Opportunity, and Motivation behavioral domains, using the COM-B model, which affectied behavioral engagement with PrEP services among newly-initiated WESW from community-based safe spaces.

Drug Resistance in People With Viremia on Dolutegravir-based Antiretroviral Therapy in Sub-Saharan Africa: The DTG RESIST Study.

Dolutegravir resistance is an increasing concern. An analysis of the DTG RESIST study found that among 227 integrase sequences from 7 African countries (all non-B subtypes), 59 (26.0%) had at least 1 major drug resistance mutation (primarily G118R and E138A/K/T), with 49 (21.

The global HIV response at a crossroads: protecting gains and advancing sustainability amid funding disruptions.

The global HIV response faces a crisis as abrupt funding cuts, particularly from the USA, threaten decades of progress. Governments across Africa report widespread disruptions in essential services, including HIV testing, treatment, and prevention. Reliance on previously stable partnerships and external funding has left many programmes vulnerable to sudden financial shock.