Effects of neighbourhood-level educational attainment on HIV prevalence among young women in Zambia

<p>Abstract</p> <p>Background</p> <p>Investigations of the association between socio-economic position indicators and HIV in East, Central and Southern Africa have chiefly focused on factors that pertain to individual-level characteristics. This study investigated the effect of neighbourhood educational attainment on HIV prevalence among young women in selected urban and rural areas in Zambia.</p> <p>Methods</p> <p>This study re-analysed data from a cross-sectional population survey conducted in Zambia in 2003. The analyses were restricted to women aged 15–24 years (n = 1295). Stratified random cluster sampling was used to select 10 urban and 10 rural clusters. A measure for neighbourhood-level educational attainment was constructed by aggregating individual-level years-in-school. Multi-level mixed effects regression models were run to examine the neighbourhood-level educational effect on HIV prevalence after adjusting for individual-level underlying variables (education, currently a student, marital status) and selected proximate determinants (ever given birth, sexual activity, lifetime sexual partners).</p> <p>Results</p> <p>HIV prevalence among young women aged 15–24 years was 12.5% in the urban and 6.8% in the rural clusters. Neighbourhood educational attainment was found to be a strong determinant of HIV infection in both urban and rural population, i.e. HIV prevalence decreased substantially by increasing level of neighbourhood education. The likelihood of infection in low vs. high educational attainment of neighbourhoods was 3.4 times among rural women and 1.8 times higher among the urban women after adjusting for age and other individual-level underlying variables, including education. However, the association was not significant for urban young women after this adjustment. After adjusting for level of education in the neighbourhood, the effect of the individual-level education differed by residence, i.e. a strong protective effect among urban women whereas tending to be a risk factor among rural women.</p> <p>Conclusion</p> <p>The findings suggested structural effects on HIV prevalence. Future research should include more detailed mapping of neighbourhood factors of relevance to HIV transmission as part of the effort to better understand the causal mechanisms involved.</p

A case-study of OVC Case Management through the Zambia Family (ZAMFAM) project

Zambia’s HIV prevalence is estimated at 11% among adults aged 15–49 years and 1% among children younger than 15 years. An estimated 10% of Zambia’s population is at high risk of being orphaned or vulnerable due to the HIV epidemic. The Zambia Family (ZAMFAM) project aims to improve the care and resilience of vulnerable populations while supporting HIV epidemic control. ZAMFAM used a case management approach that tracks beneficiaries from identification to graduation. The Population Council conducted a qualitative case study to understand actors and perceptions, and document best practices. Program beneficiaries viewed the ZAMFAM program as having made a positive contribution to the lives of orphans and vulnerable children. Testimonials from beneficiaries reflect high knowledge of HIV prevention, care, and management and identify educational support as a benefit of the program. Home visitations were also hailed by beneficiaries and key stakeholders. As noted in this report, the perspectives of beneficiaries and stakeholders were sought in addition to a detailed review of key program documentation to identify best practices and lessons for future programming

Seroprevalence survey of SARS-CoV-2, community behaviors, and practices in Kansanshi and Kalumbila mining towns

BackgroundCoronavirus disease 2019 (SARS-CoV-2) was declared a global pandemic by WHO after it spreads quickly around the world from its source city in Wuhan. Africa has some of the lowest documented SARS-CoV-2 incidences globally, with over 9 million confirmed cases as of December 2022. This may be due to efficient mitigation, outbreak response, or demographic traits. Surveillance capability may have suffered as nations changed funding, regulations, and testing plans. Therefore, this study was to document the prevalence of SARS-CoV-2, its characteristics, and the socio-economic characteristics in the two mining districts of Solwezi and Kalumbila of Zambia.MethodsBetween 28 March and 26 April 2021, a cross-sectional cluster-sample survey of households in two mining districts of Zambia was conducted. Twenty standard enumeration areas (SEAs) were randomly selected in Kansanshi (17 SEA) and Kalumbila (3 SEA) from a total of 67 SEA that encompass the two mines. Members of households aged &lt;5 years were not eligible to participate in the survey. All participants that consented to participate in the interview were also asked to consent to test for SARS-CoV-2 infection using a rapid diagnostic test (RDT), which tested for recent infection and past exposure to the virus (IgM and IgG, respectively).ResultOut of the total sample of 3,047 that were present for the interview, 622 of them agreed to test for COVID-19. Of the total that tested for SARS-CoV-2, 2.6% were IgM positive while 9.0% were IgG positive. Despite the above results, 1,586 participants that agreed to the interview indicated a low self-risk assessment of getting COVID-19 (46.5%) or someone (45.5%). On the public health measures, participants who did handwashing more than usual (65.0%), not hand sanitizing more than usual (69.0%), not disinfecting surfaces in their households than usual (87.5%), not avoiding drinking from bars or nightclubs (90.6%), and not wearing a mask when out in public places (71.1%). In the logistic multivariable model, participants with age 24 years and above (AOR = 2.94; 95% CI = 1.10, 7.81) and having experienced symptoms of SARS-CoV-2 (AOR = 2.60; 95% CI: 1.33, 5.05) had a significant effect on testing positive for SARS-CoV-2.ConclusionAlthough the results showed that active COVID-19 prevalence in Solwezi and Kalumbila communities surrounding the two mines was low, exposure to infection was five times high. Government and mining firms should continue to sensitize the community members on the preventive measures of COVID-19 and continue with community testing so that all those positive but without symptoms can self-isolate and those with symptoms and sick can be admitted to the hospital

Benchmark assessment of orphaned and vulnerable children in areas of the Zambia Family (ZAMFAM) Project

The US Agency for International Development and US President’s Emergency Plan for AIDS Relief (PEPFAR) are supporting the Zambia Family (ZAMFAM) project to strengthen comprehensive, integrated service delivery and support to children living with, affected by, or vulnerable to HIV/AIDS (OVC) in the Lusaka, Copperbelt, Southern, and Central Provinces of Zambia. To inform that effort, Project SOAR conducted a benchmark survey among beneficiaries in the four provinces of the ZAMFAM program. The benchmark survey measured the status and conditions of OVC and their families. The findings provide a deeper understanding of the needs of OVC families and the gaps in service provision, as well as suggestions for strengthening care and support strategies for OVC in Zambia

Decline in HIV Prevalence among Young Women in Zambia: National-Level Estimates of Trends Mask Geographical and Socio-Demographic Differences

Background: A decline in HIV incidence has been reported in Zambia and a number of other sub-Saharan countries. The trend of HIV prevalence among young people is a good marker of HIV incidence. In this study, different data sources are used to examine geographical and sub-population group differentials in HIV prevalence trends among men and women aged 15–24 years in Zambia. Design and Methods: We analysed ANC data for women aged 15–24 years from 22 sentinel sites consistently covered in the period 1994–2008, and HIV data for young men and women aged 15–24 years from the ZDHS 2001/2 and 2007. In addition, we systematically reviewed peer-reviewed articles that have reported findings on HIV prevalence and incidence among young people. Findings: Overall trends of the ANC surveillance data indicated a substantial HIV prevalence decline among young women in both urban and rural areas. However, provincial declines differed substantially, i.e. between 10 % and 68 % among urban women, and from stability to 86 % among rural women. Prevalence declines were steeper among those with the highest educational attainments than among the least educated. The ZDHS data indicated a significant reduction in prevalence between the two survey rounds among young women only. Provincial-level ZDHS changes were difficult to assess because the sample sizes were small. ANC-based trend patterns were consistent with those observed in PMTCT-based data (2002

First COVID-19 case in Zambia — Comparative phylogenomic analyses of SARS-CoV-2 detected in African countries

Since its first discovery in December 2019 in Wuhan, China, COVID-19, caused by the novel coronavirus SARS-CoV-2, has spread rapidly worldwide. While African countries were relatively spared initially, the initial low incidence of COVID-19 cases was not sustained for long due to continuing travel links between China, Europe and Africa. In preparation, Zambia had applied a multisectoral national epidemic disease surveillance and response system resulting in the identification of the first case within 48 h of the individual entering the country by air travel from a trip to France. Contact tracing showed that SARS-CoV-2 infection was contained within the patient’s household, with no further spread to attending health care workers or community members. Phylogenomic analysis of the patient’s SARS-CoV-2 strain showed that it belonged to lineage B.1.1., sharing the last common ancestor with SARS-CoV-2 strains recovered from South Africa. At the African continental level, our analysis showed that B.1 and B.1.1 lineages appear to be predominant in Africa. Whole genome sequence analysis should be part of all surveillance and case detection activities in order to monitor the origin and evolution of SARS-CoV-2 lineages across Africa

Trends in HIV Prevalence and Sexual Behaviour among Young People in Zambia: geographical and socioeconomic differentials

Introduction: Differences in the distribution of HIV between and within SSA countries is striking. Recent evidence indicates that HIV prevalence of young people, which is used as a proxy of HIV incidence, has been declining. There is convincing evidence that much of this decline is attributable to changing sexual behaviour. However, HIV epidemiological research has previously focused only on individual factors affecting sexual behaviour and HIV transmission, but recent evidence shows that neighbourhood factors play a significant role. HIV prevalence in Zambia has been estimated at 14.3% among adults (15-49 years) and 6.6% among young people (15-24 years). The major factors believed to be driving the epidemic in Zambia have been extensively surveyed, e.g. early age at sexual debut, concurrent sexual partnerships, low condom use and age-mixing. As a result of the epidemic, multiple prevention programmes have been implemented that have targeted different risk groups and age-groups. Overall objective: To assess trends and examine factors influencing the differential geographical distribution of HIV prevalence and risky sexual behaviours among young people in Zambia. Methods: The empirical basis was from the national antenatal (ANC) sentinel surveillance system on HIV and syphilis, the Zambia Demographic and Health Survey (ZDHS), the Zambia Sexual Behaviour Survey (ZSBS), and a population-based HIV survey in selected urban and rural areas (Chelston and Kapiri Mposhi). A systematic review of peer-reviewed articles on HIV data from Zambia has also been included. Results: ANC-based surveillance showed that HIV prevalence among young women has substantially declined during the period 1994 to 2008 (by 43% in urban and 17% in rural settings). Peer-reviewed articles were also in agreement with these findings; however, both the ANC-based data and the ZDHS data showed striking geographical variation in HIV prevalence in Zambia. Regarding factors affecting HIV infection, young women residing in low educational attainment neighbourhoods in selected communities were at higher risk of HIV infection than those in high educational attainment neighbourhoods. With regard to sexual risk behaviour, there were substantially declining trends between 2000 and 2009 for premarital sex (in both young men and women) and multiple partnerships (only young men). Condom use at last premarital sex remained stable among young people during the same period. Factors associated with lower risk of premarital sex included urban residence, high residential stability, and high comprehensive knowledge of HIV. Conclusion: HIV prevalence among young pregnant women declined substantially during the 14-year period. Parallel decline probably occurred among men, but trend data are limited. The decline in HIV prevalence can probably be attributed to the change in sexual risk behaviour among young people. Both sexual risk taking and HIV prevalence are strongly associated with factors reflecting socio-economic status at both individual and neighbourhood levels

Zambia Family (ZAMFAM) cohort study

To evaluate delivery of integrated psychosocial, economic strengthening, and clinical services to HIV-affected households through the Zambia Family (ZAMFAM) Project, a prospective cohort study compared socio-economic, psychosocial, and health outcomes among ZAMFAM beneficiaries with non-beneficiaries. In July to October 2017, 544 adolescents living with HIV (ALHIV) aged 5–17 years and their adult caregivers were recruited from Central (ZAMFAM implementation sites) and Eastern (non-intervention sites) Provinces. Structured interviews at baseline and one-year follow-up assessed household characteristics, socio-economic wellbeing, health service utilization, and HIV treatment outcomes