Tulani Francis L. Matenga

Background: Access to obstetric ultrasound remains limited in many countries owing to the limited availability of equipment and specialist operators. Artificial intelligence (AI)‐enabled obstetric point‐of‐care ultrasound (OB POCUS) may expand access to reliable gestational age (GA) dating within routine antenatal care (ANC). Objective: To evaluate the feasibility and clinical utility of implementing AI‐enabled OB POCUS for GA assessment across four public‐sector facilities in Lusaka Province, Zambia. Methods: We integrated routine AI‐enabled OB POCUS into ANC using a training‐of‐trainers model, followed by standardized competency‐based training for facility healthcare providers and ongoing mentorship. We abstracted data from facility ANC registers for women scanned between September 2024 and March 2025. Among patients with both last menstrual period (LMP)‐ and AI‐enabled OB POCUS‐based dating, we calculated the discrepancy between the two estimates and applied American College of Obstetricians and Gynecologists (ACOG) GA‐specific thresholds to classify each patient according to whether the discrepancy was large enough to warrant revising the LMP‐based estimated due date (EDD) to the AI‐enabled OB POCUS‐based EDD. We estimated the proportion meeting these re‐dating criteria and used logistic regression to assess factors associated with meeting them. Results: Among 1068 ultrasound recipients, 859 (80.4%) had both a recorded LMP and a documented AI‐enabled OB POCUS‐based EDD. Of these, the median EDD discrepancy was 11 days (IQR = 5–29 days), and 51% met the ACOG criteria for EDD revision. The proportion meeting re‐dating criteria did not differ by GA at presentation and was not affected by facility or demographic characteristics. Conclusions: Implementation of AI‐enabled OB POCUS within public‐sector ANC in Zambia was feasible. Half of women scanned met the criteria for revising an LMP‐based due date, indicating that such technologies could substantially change pregnancy care where ultrasound is otherwise unavailable.

There has been limited research reporting approaches used in the adaptation of implementation strategies for integrating HIV and NCD services that involve healthcare providers in low- and middle-income country (LMIC) settings. This paper describes how human-centered design (HCD) was used to 1) adapt a multifaceted implementation strategy for integrating HIV and NCD services through end-user engagement and 2) share insights from the specific suggestions made through the HCD process with healthcare providers. As part of the TASKPEN an implementation science-driven intervention aimed at task shifting and integrating the evidence-based WHO Package of Essential NCDs Interventions (WHO-PEN) approach into routine healthcare settings for PLHIV, we co-designed implementation strategy components (i.e., “sub-components”) to strengthen HIV/NCD integration in four HIV clinics in Lusaka, Zambia. The HCD process involved qualitative approaches with healthcare providers, namely lay and non-physician healthcare workers (NPHWs) such as nurses and community healthcare workers (CHWs). A four-phased approach of exploration through formative qualitative work, ideation with intervention deliverers, analysis, and refinement was used to develop strategy sub-components. Rapid thematic data analysis was used to synthesise the data. Applying HCD to a locally-informed intervention for screening and managing cardio-metabolic co-morbidities for Zambian PLHIV informed the addition of sub-components to the multi-faceted implementation strategy to improve adoption, appropriateness, and feasibility. Through co-design workshops, healthcare providers suggested specific sub-components be added to enhance the intervention. Specifically, four sub-component strategy ideas were produced: introducing NCD/HIV champions, circulating a weekly facility NCD medication bulletin, dashboard reporting of HIV/NCD cases, and community sensitization. The use of HCD in implementation science is a promising approach to refining implementation strategies that are likely to result in the success of HIV/NCD integration in Zambia and similar LMIC settings.

Integrating HIV and non-communicable disease (NCD) services is an essential strategy for improving health outcomes for people living with HIV (PLHIV) and N

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Background: Illicit alcohol consumption is a major public health problem in Zambia and many other countries in Sub-Saharan Africa. This study aimed to determine drivers of illicit alcohol consumption among at-risk populations, such as youths, in selected urban areas in Zambia, using the social-ecological model as a lens to understand these drivers.Methods: Through a qualitative approach, we conducted semi-structured interviews with 12 key stakeholders from the Ministry of Health, Zambia Revenue Authority, local council public health departments, and rehabilitation centers. We also interviewed 30 alcohol consumers who frequent alcohol retail settings such as bars or liquor stores. Participants were purposively selected based on their knowledge of illicit alcohol consumption.Results: Social demographic factors such as age and sex were identified as key drivers. Adolescents as young as 10 years old initiated illicit consumption, with males constituting the majority of consumers. Limited job opportunities and recreational facilities in communities encouraged young people to consume illicit alcohol; this is worsened by the availability of alcohol in their social circles. Peer influence was also found to be a major driver of illicit alcohol consumption, as cultural norms normalized alcohol use. Lack of productive activities and economic disparities were also found to drive consumption among this group. Low-income individuals sought cheaper alternatives, such as home-distilled spirits or fermented alcohol, due to their affordability and availability in disadvantaged neighbourhoods. Social norms, such as the consumption of homemade alcoholic beverages during social gatherings such as weddings, were also significant drivers.Conclusion: Despite policies and state agencies banning illicit alcohol sale and production, the sale of alcoholic beverages to young people and weak enforcement of regulations across the country, especially in urban areas increases young people’s risk of consuming illicit alcohol. Applying the social-ecological model emphasizes the need for multi-level interventions. These interventions should target individuals, communities, and policy levels. Specifically, they should aim to regulate alcohol consumption, disrupt the social environments that promote illicit alcohol consumption, and ultimately facilitate positive behavior change among young people.

Background Health research in sub-Saharan Africa takes place against a lengthy history of exploitation and unfair collaboration. This has involved the export of samples and data from the continent for the benefit of institutions and researchers elsewhere. In this paper, we report the perspectives of people involved in conducting genomics research in Zambia and the capacity of the Health Research Act (HRA) of 2013 in regulating genomics research. Methods We approached 14 purposively selected stakeholders involved in the development or implementation of the HRA in Zambia for in-depth interviews. These were members of research ethics committees, genomics researchers, Ministry of Health policy makers and institutional lawyers. Results Participants reported that there are benefits in genomics research for Zambia such as diagnosing and treatment of diseases. Participants however, expressed concerns, most of which were ethical in nature. Prominent concerns were on consent. Participants’ main concern was the possible misuse of samples in the future. These concerns resonated with the HRA, which prohibits the use of broad consent for the collection of samples and data for future unspecified research. The implications of this are that Zambians may not participate in any kind of health research for which the storage, sharing and re-use of data or samples is envisaged. The restrictive nature of HRA means that genomics research may be excluded from future health research collaborations, thus isolating the country from potentially beneficial health research. Some policy makers were also worried that the samples and data that comes from such research may be difficult to access by local scientists. Conclusion In this article, we describe the views of Zambian policymakers on genomics research and the capacity of HRA in regulating genomics research. Our findings are relevant for the Zambian audience, and other African countries that are aiming to regulate health research, especially genomics research.

Children who are HIV-exposed and uninfected (CHEU) are at increased risk for poor growth, health, and development compared to children who are HIV-unexposed and uninfected. To support families with CHEU, we assessed the acceptability of engaging family members to support women living with HIV (WLWH) with exclusive breastfeeding (EBF) and antiretroviral therapy (ART) adherence and to engage in responsive infant caregiving. We conducted trials of improved practices, a consultative research approach, that follows participants over time as they try recommended behaviors. We enrolled postpartum women in Lusaka, Zambia, who identified home supporters. At visit 1, WLWH were interviewed about current practices. At visit 2, WLWH and home supporters received tailored EBF, responsive care, and ART adherence counseling. At visit 3, WLWH and home supporters were interviewed about their experiences trying recommended practices for 2–3 weeks. Interview transcripts were analyzed thematically. Participants included 23 WLWH, 15 male partners, and 8 female family members. WLWH reported several barriers to EBF. The most common were fear of HIV transmission via breastfeeding—despite high ART adherence—and insufficient breastmilk. After counseling, WLWH reported less fear of HIV transmission and improved breastfeeding practices. Home supporters reported providing WLWH increased support for EBF and ART adherence and practicing responsive caregiving. Both male and female home supporters appreciated being included in counseling and more involved in caregiving, and WLWH valued the increased support. Families with CHEU need focused support. Tailored counseling and family support for WLWH show promise for improving EBF, responsive caregiving, and ART adherence.

In this chapter, we focus on the meanings and practices around humanitarianism in relation to pandemics. We explore how pandemics have pushed the bounds of humanitarianism, primarily at the macro level. We focus on the HIV/AIDS pandemic in the Global South and explore how the shifting nature of the HIV/AIDS pandemic juxtaposed with the notions of humanitarianism highlight several shortcomings and areas for improvement. We briefly explore the current COVID-19 pandemic that is poised to push our views of humanitarianism and is already elucidating the persistent inequities that lead to differentiated access to care. Considering pandemics and the notion of humanitarianism, the impact of a pandemic on social reform as well as whether the response to a pandemic will lead to reform are often called into question. We explore this concept by examining how the response to the HIV/AIDS pandemic and the recent COVID-19 pandemic illuminates persistent inequalities and the need for reform.

In sub-Saharan Africa, involving male partners in the prevention of mother-to-child transmission of HIV improves maternal and infant outcomes. Male involvement is typically conceptualised as male partners attending antenatal care, which is difficult for many men. Little is known about how men view their involvement in family health within the context of HIV, particularly outside of clinic attendance. Through interviews with 35 male partners of pregnant or postpartum women living with HIV in Kenya and Zambia, this study elicited perceptions of male involvement in maternal and infant health in families affected by HIV. Men supported the importance of clinic attendance but reported conflicts with the need to work and fulfil their role as the family's financial provider. Providing money for necessities was deemed more critical for their family's health than clinic attendance. Men's involvement was conveyed through various other supportive actions, including helping with household chores and providing emotional support (showing love and reducing women's stress). Future strategies to promote male partner involvement in the prevention of mother-to-child transmission of HIV and maternal and child health should build upon the actions men view as most meaningful to promote their family's health within their real-world life circumstances and cultural context, particularly their role as financial providers.

Background: Within the Voluntary Medical Male Circumcision (VMMC) programme, community engagement has been central in facilitating the acceptance of VMMC, especially in non-circumcising communities. We used the case of the development of community engagement plans for sustainability of VMMC in Zambia to illustrate diversity of stakeholders, their power, roles, and strategies in community engagement. Methods: Data were collected using document review, in-depth interviews (n=35) and focus group discussions (n=35) with community stakeholders, health workers, health centre committees, counsellors, teachers, community volunteers and parents/caregivers. Data were analysed using thematic analysis. The analysis was guided by the power and interest model. Results: Differences were noted between the rural and urban sites in terms of power/influence and interest rating of community stakeholders who could be involved in the sustainability phase of the VMMC response in Zambia. For example, in the urban setting, neighbourhood health committees (NHCs), health workers, leaders of clubs, community health workers (CHWs), radio, television and social media platforms were ranked highest. From this list, social media and television platforms were not highly ranked in rural areas. Some stakeholders had more sources of power than others. Forms or sources of power included technical expertise, local authority, financial resources, collective action (action through schools, churches, media platforms, other community spaces), and relational power. Key roles and strategies included strengthening and broadening local coordination systems, enhancing community involvement, promoting community-led monitoring and evaluation, through the use of locally recognised communication spaces and channels, facilitating ownership of VMMC, and improving local accountability processes in VMMC activities. Conclusions: By consulting with the most relevant stakeholders, and considering community needs in programme development, the VMMC programme may be able to leverage the community structures and systems to reduce long term demand generation costs for VMMC and increase the acceptability and frequency of male circumcision.