. Author manuscript; available in PMC: 2015 Jan 1.

Published in final edited form as: J Acquir Immune Defic Syndr. 2014 Jan 1;65(0 1):S32–S35. doi: 10.1097/QAI.0000000000000043

Table 1.

Related areas of service integration at CIDRZ

New and Evolving Research and Programmatic Directions for CIDRZ
In addition to a continued focus on HIV, TB and maternal and newborn health, CIDRZ also is applying its model to newer areas, including: ❖ *Integrated Service Delivery:* Zambia’s national policy on HIV treatment changed in 2004 in conjunction with an influx of international support and radically altered the paradigms of HIV care. The use of decentralized ART clinics allowed access to hundreds of thousands of HIV-infected people. Challenges included late entry into care, and loss to follow-up. CIDRZ has partnered with the Ministry of Health (MoH) and various District health teams to initiate three types of service-integration including ART and TB, ART in maternal and child health, and ART in general outpatient services, simultaneously catalyzing a new direction in service delivery research which is likely to have an significant impact on policy in Zambia. ❖ *Women’s Cancer Prevention and Treatment:* Incidence rates of cervical cancer in Zambia are the second highest in the world. Due to the laboratory and human capacity requirements of Pap smear-based cervical cancer screening and the expense of HPV-based screening, the Zambian government chose to use VIA (visual inspection with acetic acid) as its primary form of cervical cancer screening for the public sector. CIDRZ, as a part of the broader Cervical Cancer Prevention Program in Zambia (CCPPZ) and the Pink Ribbon Red Ribbon (PRRR) program, trains nurses to prevent cervical cancer by first washing the cervix with table vinegar (dilute acetic acid), taking a photograph of the cervix using a digital camera, and then freezing pre-cancers with carbon dioxide or nitrous oxide gas. Patients with complex cervical lesions are referred to a tertiary facility where they undergo a biopsy. The innovative system that uses cervical photographs for patient education, magnification, clinical triage, documentation, consultation and quality assurance has been dubbed “electronic cervical cancer control.” The programme has recently been expanded to new provincial referral centres in all nine provinces and is now moving to districts and primary health facilities. Breast cancer early detection and treatment services using locally appropriate screening methods are also being integrated into the program. ❖ *Prison Health:* The Zambian Ministry of Home Affairs (MHA) has partnered with CIDRZ to assess and improve the health care delivery and outcomes in prison, resulting in recently documented inprovements in TB case detection and HIV diagnosis in six prisons. These successes have been followed by further work with MoH and MHA. This includes the three year “3i’s initiative” (intensified case finding, infection control and isoniazid preventive therapy) funded by CDC/PEPFAR and the three-year Zambian Prisons Health System Strengthening project funded through the European Union. This work has enabled CIDRZ to implement a program to screen for a disease in a vulnerable population but also to develop a unique research platform to better understand the role of structural and social determinants of inmate health within Zambian prisons. ❖ *Prevention of Childhood Diarrheal Disease:* CIDRZ is implementing a comprehensive demonstration project on diarrhoea prevention and control. A multi-faceted collaborative project between CIDRZ, Absolute Return for Kids (ARK) and the MoH. The project has successfully leveraged additional funding from the MoH to refurbish and upgrade cold chain central infrastructure, an independent evaluation funded by the Bill and Melinda Gates Foundation, a donation of over 304,000 Rotarix vaccine dose by GlaxoSmithKline, and an NIH R01 grant to study potential factors that may contribute to lowered vaccine efficacy in Zambia, along with recent funding from Comic Relief and UNICEF that allows CIDRZ to address closely related issues of hygeine and sanitation. With this growth, CIDRZ has established a strategic platform to undertake formal research and training activities in behavior change, water and sanitation, along with plans to work with GRZ to take some of the successful aspects of the provincial pilots to national scale.

New and Evolving Research and Programmatic Directions for CIDRZ

In addition to a continued focus on HIV, TB and maternal and newborn health, CIDRZ also is applying its model to newer areas, including:

❖ Integrated Service Delivery: Zambia’s national policy on HIV treatment changed in 2004 in conjunction with an influx of international support and radically altered the paradigms of HIV care. The use of decentralized ART clinics allowed access to hundreds of thousands of HIV-infected people. Challenges included late entry into care, and loss to follow-up. CIDRZ has partnered with the Ministry of Health (MoH) and various District health teams to initiate three types of service-integration including ART and TB, ART in maternal and child health, and ART in general outpatient services, simultaneously catalyzing a new direction in service delivery research which is likely to have an significant impact on policy in Zambia.
❖ Women’s Cancer Prevention and Treatment: Incidence rates of cervical cancer in Zambia are the second highest in the world. Due to the laboratory and human capacity requirements of Pap smear-based cervical cancer screening and the expense of HPV-based screening, the Zambian government chose to use VIA (visual inspection with acetic acid) as its primary form of cervical cancer screening for the public sector. CIDRZ, as a part of the broader Cervical Cancer Prevention Program in Zambia (CCPPZ) and the Pink Ribbon Red Ribbon (PRRR) program, trains nurses to prevent cervical cancer by first washing the cervix with table vinegar (dilute acetic acid), taking a photograph of the cervix using a digital camera, and then freezing pre-cancers with carbon dioxide or nitrous oxide gas. Patients with complex cervical lesions are referred to a tertiary facility where they undergo a biopsy. The innovative system that uses cervical photographs for patient education, magnification, clinical triage, documentation, consultation and quality assurance has been dubbed “electronic cervical cancer control.” The programme has recently been expanded to new provincial referral centres in all nine provinces and is now moving to districts and primary health facilities. Breast cancer early detection and treatment services using locally appropriate screening methods are also being integrated into the program.
❖ Prison Health: The Zambian Ministry of Home Affairs (MHA) has partnered with CIDRZ to assess and improve the health care delivery and outcomes in prison, resulting in recently documented inprovements in TB case detection and HIV diagnosis in six prisons. These successes have been followed by further work with MoH and MHA. This includes the three year “3i’s initiative” (intensified case finding, infection control and isoniazid preventive therapy) funded by CDC/PEPFAR and the three-year Zambian Prisons Health System Strengthening project funded through the European Union. This work has enabled CIDRZ to implement a program to screen for a disease in a vulnerable population but also to develop a unique research platform to better understand the role of structural and social determinants of inmate health within Zambian prisons.
❖ Prevention of Childhood Diarrheal Disease: CIDRZ is implementing a comprehensive demonstration project on diarrhoea prevention and control. A multi-faceted collaborative project between CIDRZ, Absolute Return for Kids (ARK) and the MoH. The project has successfully leveraged additional funding from the MoH to refurbish and upgrade cold chain central infrastructure, an independent evaluation funded by the Bill and Melinda Gates Foundation, a donation of over 304,000 Rotarix vaccine dose by GlaxoSmithKline, and an NIH R01 grant to study potential factors that may contribute to lowered vaccine efficacy in Zambia, along with recent funding from Comic Relief and UNICEF that allows CIDRZ to address closely related issues of hygeine and sanitation. With this growth, CIDRZ has established a strategic platform to undertake formal research and training activities in behavior change, water and sanitation, along with plans to work with GRZ to take some of the successful aspects of the provincial pilots to national scale.