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Achieving HIV Epidemic Control and Improving Maternal Healthcare Services with Community-Based HIV Service Delivery in Zambia: Mixed-Methods Assessment of the SMACHT Project

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Abstract

Novel community-based approaches are needed to achieve and sustain HIV epidemic control in Zambia. Under the Stop Mother and Child HIV Transmission (SMACHT) project, the Community HIV Epidemic Control (CHEC) differentiated service delivery model used community health workers to support HIV testing, ART linkage, viral suppression, and prevention of mother-to-child transmission (MTCT). A multi-methods assessment included programmatic data analysis from April 2015 to September 2020, and qualitative interviews from February to March 2020. CHEC provided HIV testing services to 1,379,387 clients; 46,138 were newly identified as HIV-positive (3.3% yield), with 41,366 (90%) linked to ART. By 2020, 91% (60,694/66,841) of clients on ART were virally suppressed. Qualitatively, healthcare workers and clients benefitted from CHEC, with provision of confidential services, health facility decongestion, and increased HIV care uptake and retention. Community-based models can increase uptake of HIV testing and linkage to care, and help achieve epidemic control and elimination of MTCT.

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Acknowledgements

We gratefully acknowledge the community and facility health workers who made this work possible, as well as the clients served through their efforts. We respectfully acknowledge the Ministry of Health, Southern Provincial Health Office, and District Health Offices that partnered with UMB to make the SMACHT project possible.

Funding

The SMACHT project was funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and Tuberculosis (DGHT) under the terms of U2GGH001091, and in collaboration with the Ministry of Health of Zambia. This project was reviewed in accordance with CDC human research protection procedures and was determined to be research, but CDC investigators did not interact with human subjects or have access to identifiable data or specimens for research purposes. The views expressed in the manuscript do not necessarily represent the views of the CDC. The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the funding agencies. A portion of the assessment of the SMACHT project was funded by the International AIDS Society Differentiated Service Delivery Best Practice Model Award.

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Authors and Affiliations

  1. Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA

    Cassidy W. Claassen, Mona Gekanju-Toeque, Brianna Lindsay, Natalia Blanco, Marie-Claude C. Lavoie & Robb Sheneberger

  2. Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia

    Cassidy W. Claassen, Ina Kafunda, Steven Shiyanda, Brianna Lindsay, Olufunso Adebayo, Msangwa Sinjani, Callistus Kaayunga, Pappy Kakonda wa Banza & Robb Sheneberger

  3. Ciheb Zambia, Lusaka, Zambia

    Linah Mwango & Lottie Hachaambwa

  4. University of Maryland College Park, College Park, MD, USA

    Kirsten Stoebenau

  5. U.S. Centers for Disease Control and Prevention, Lusaka, Zambia

    Keith Mweebo, Nzali Kancheya, Kebby Musokotwane & Annie Mwila

  6. Southern Provincial Health Office, Ministry of Health, Choma, Zambia

    Newman Monze

  7. Boston University School of Public Health, Boston, MA, USA

    Brooke E. Nichols

  8. The Hospital for Sick Children, Toronto, Canada

    Douglas C. Watson

  9. MGIC-Zambia, Plot 31C. Bishops Road. Kabulonga, P/B E017, Post-Net Box 319 Crossroads, Lusaka, Zambia

    Cassidy W. Claassen

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  1. Cassidy W. Claassen
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Contributions

All authors contributed to writing, reviewing, and editing the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Cassidy W. Claassen.

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Conflict of interest

The authors declare they have no conflicts of interest/competing interests.

Ethical Approval

Ethical approval for this study was provided under the SMACHT quantitative and qualitative protocols, approved by the ERES Converge Zambian Institutional Review Board (IRB) (Reference numbers 2018-Feb-006, 2018-Feb-005), the Zambian National Health Research Authority (NHRA 3/4/2018, NHRA 3/4/2018), and the UMB IRB (HP-00080438, HP-00080636).

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All qualitative participants provided informed consent; the IRBs waived informed consent for quantitative data as it was de-identified aggregate data.

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All qualitative participants provided informed consent; the IRBs waived informed consent for quantitative data as it was de-identified aggregate data.

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Claassen, C.W., Kafunda, I., Mwango, L. et al. Achieving HIV Epidemic Control and Improving Maternal Healthcare Services with Community-Based HIV Service Delivery in Zambia: Mixed-Methods Assessment of the SMACHT Project. AIDS Behav 27, 3571–3583 (2023). https://doi.org/10.1007/s10461-023-04071-7

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