Implementing incentive-based HIV interventions in Zambia: The COMPACT model

The Population Council received a cooperative agreement from USAID to implement the Community Mobilization for Preventive Action (COMPACT) project, to develop and determine the feasibility of “community compacts” as an innovative approach to prevent HIV in Zambian communities. The aim is to mobilize the communities through a capacity-building process that enables them to identify HIV prevention targets, develop interventions to achieve those targets, and measure the results. This study determined baseline levels of key indicators related to HIV, sexual behaviors, gender-based violence, alcohol abuse, and reproductive health. These baseline measures will be compared with midline and endline levels to assess COMPACT’s programmatic success. Additionally, the baseline findings provided critical insights into key areas for interventions in these four communities and highlighted variability in the populations across the communities and between males and females that provide valuable guidance for programming

Multi-Level Risk and Protective Factors for Substance Use among Zambian Street Youth

Background: High rates of substance use have been reported among youth in Zambia. This is particularly concerning given that substance use is one of the biggest risk factors placing young people at risk for HIV infection. Objectives: The purpose of the current study is to examine how multilevel risk and protective factors (i.e., community, family, peers, individual) influence alcohol and marijuana use. Methods: A total of 250 street youth in Lusaka, Zambia, were interviewed in the summer of 2014 about their alcohol and marijuana use and reasons for usage. Data were analyzed using descriptive and multivariate methods. Results: Youth reported high rates of alcohol use. At the multivariate level, peer- and individual-level variables (e.g., using alcohol or drugs for coping or for fun) explained the most variance, followed by family-level factors. Community-level variables explained the least variance in all models. Conclusion/Importance: A better understanding of multilevel risk and protective factors for young people’s alcohol and marijuana use could lead to the development of better intervention strategies to reduce this behavior among Zambian street youth

The Community Mobilization for Preventive Action (COMPACT) project in Zambia: A midline evaluation

The Population Council and its partner, Project Concern International, implemented the Community Mobilization for Preventive Action (COMPACT) HIV-prevention program in Zambia. The program works with communities to develop “compacts” through a participatory, community-led process, and assists them in working toward reaching HIV-related “benchmarks,” intended to result in a reduction in HIV-related risk behaviors and harmful norms and ultimately contribute over time to the reduction of HIV incidence. This mid-term evaluation in four of six COMPACT communities indicates that COMPACT is improving some HIV-related behaviors and attitudes, particularly those related to gender norms, multiple sex partnerships, and alcohol abuse. The report concludes that HIV-prevention programs in Zambia must incorporate alcohol risk reduction activities; furthermore, lessons learned from income-generation programs and programs addressing harmful gender norms should be used to strengthen other HIV prevention programs

Potential contribution of cereal and milk based fermented foods to dietary nutrient intake of 1-5 years old children in Central province in Zambia

Zambia is still facing undernutrition and micronutrient deficiencies despite fortification and supplementation programmes stressing the need for additional solutions. Fermented foods have the potential to improve nutrient intake and, therefore, could have an important role in food based recommendations (FBRs) to ensure adequate intake of nutrients for optimal health of populations. Secondary dietary intake data was used in Optifood, a linear programming software to develop FBRs, for children aged 1–3 and 4–5 years in Mkushi district of Zambia. Three scenarios per age group were modeled to determine FBRs based on: (1) FBRs based on local available foods (2) FBR and Mabisi, a fermented milk beverage, and (3) FBR with Munkoyo, a cereal fermented beverage. The scenarios were compared to assess whether addition of Mabisi or Munkoyo achieved a better nutrient intake. FBRs based on only locally available non-fermented foods did not meet ≥70% of recommended nutrient intake (RNI) for calcium, fat, iron and zinc, so-called problem nutrients. The addition of Munkoyo to the FBRs did not reduce the number of problem nutrients, but after adding Mabisi to the FBR’s only iron (67% of RNI) in the 1–3 year age group and only zinc (67% of RNI) in the 4–5 year age group remained problem nutrients. Mabisi, a fermented milk product in combination with the local food pattern is a good additional source of nutrients for these age groups. However, additional nutrition sensitive and cost-effective measures would still be needed to improve nutrient intake, especially that of iron and zinc.</p

Assessing the impact of a food supplement on the nutritional status and body composition of HIV-infected Zambian women on ARVs

Background Zambia is a sub-Saharan country with one of the highest prevalence rates of HIV, currently estimated at 14%. Poor nutritional status due to both protein-energy and micronutrient malnutrition has worsened this situation. In an attempt to address this combined problem, the government has instigated a number of strategies, including the provision of antiretroviral (ARV) treatment coupled with the promotion of good nutrition. High-energy protein supplement (HEPS) is particularly promoted; however, the impact of this food supplement on the nutritional status of people living with HIV/AIDS (PLHA) beyond weight gain has not been assessed. Techniques for the assessment of nutritional status utilising objective measures of body composition are not commonly available in Zambia. The aim of this study is therefore to assess the impact of a food supplement on nutritional status using a comprehensive anthropometric protocol including measures of skinfold thickness and circumferences, plus the criterion deuterium dilution technique to assess total body water (TBW) and derive fat-free mass (FFM) and fat mass (FM). Methods/Design This community-based controlled and longitudinal study aims to recruit 200 HIV-infected females commencing ARV treatment at two clinics in Lusaka, Zambia. Data will be collected at four time points: baseline, 4-month, 8-month and 12-month follow-up visits. Outcome measures to be assessed include body height and weight, body mass index (BMI), body composition, CD4, viral load and micronutrient status. Discussion This protocol describes a study that will provide a longitudinal assessment of the impact of a food supplement on the nutritional status of HIV-infected females initiating ARVs using a range of anthropometric and body composition assessment techniques

Multi-Level Risk and Protective Factors for Substance Use among Zambian Street Youth

Background: High rates of substance use have been reported among youth in Zambia. This is particularly concerning given that substance use is one of the biggest risk factors placing young people at risk for HIV infection. Objectives: The purpose of the current study is to examine how multilevel risk and protective factors (i.e., community, family, peers, individual) influence alcohol and marijuana use. Methods: A total of 250 street youth in Lusaka, Zambia, were interviewed in the summer of 2014 about their alcohol and marijuana use and reasons for usage. Data were analyzed using descriptive and multivariate methods. Results: Youth reported high rates of alcohol use. At the multivariate level, peer- and individual-level variables (e.g., using alcohol or drugs for coping or for fun) explained the most variance, followed by family-level factors. Community-level variables explained the least variance in all models. Conclusion/Importance: A better understanding of multilevel risk and protective factors for young people’s alcohol and marijuana use could lead to the development of better intervention strategies to reduce this behavior among Zambian street youth

Risk Factors for HIV among Zambian Street Youth

The sub-Saharan African region has been disproportionately affected by HIV, and Zambia has one of the highest HIV prevalence rates within this region. Moreover, new incidences of HIV infection are increasing most rapidly among those 15–24 years of age. Though young people are at high risk for HIV infection, street youth are even more vulnerable given their exposure to high-risk behaviors. The current study examines multiple levels of social influence on HIV infection among 250 street youth in Zambia. Results reveal that though the majority of youth understand what behaviors increase their risk for HIV, youth still hold many misconceptions about HIV/AIDS. Additionally, youth who do not have a home to return to and those who report parental drug misuse were significantly more likely to be HIV positive. This study underscores the need for further education among street youth regarding HIV knowledge