Njekwa Mukamba
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View article: Identifying care gaps along the HIV treatment failure cascade: A multistate analysis of viral load monitoring, re-suppression, and regimen switches in Zambia
Identifying care gaps along the HIV treatment failure cascade: A multistate analysis of viral load monitoring, re-suppression, and regimen switches in Zambia Open
Background Timely response to treatment failure is critical for improved outcomes and viral re-suppression among people living with HIV, but care gaps along the treatment failure cascade can occur due to delays by both clients (e.g., reten…
View article: Effect of a multicomponent, person-centred care intervention on client experience and HIV treatment outcomes in Zambia: a stepped-wedge, cluster-randomised trial
Effect of a multicomponent, person-centred care intervention on client experience and HIV treatment outcomes in Zambia: a stepped-wedge, cluster-randomised trial Open
View article: Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program
Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program Open
Faced with declining donor funding for HIV, low- and middle-income countries must identify efficient and cost-effective ways to integrate HIV prevention programs into public health systems for long-term sustainability. In Zambia, donor sup…
View article: Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program
Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program Open
Faced with declining donor funding for HIV, low- and middle-income countries must identify efficient and cost-effective ways to integrate HIV prevention programs into public health systems for long-term sustainability. In Zambia, donor sup…
View article: Assessing the Response Results of an mHealth-Based Patient Experience Survey Among People Receiving HIV Care in Lusaka, Zambia: Cohort Study
Assessing the Response Results of an mHealth-Based Patient Experience Survey Among People Receiving HIV Care in Lusaka, Zambia: Cohort Study Open
Background This pilot study evaluates the effectiveness of mobile talk-time incentives in maintaining participation in a longitudinal mobile health (mHealth) data collection program among people living with HIV in Lusaka, Zambia. While mHe…
View article: Developing a framework for understanding policy decision-making behaviors in the transition of a HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program
Developing a framework for understanding policy decision-making behaviors in the transition of a HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program Open
Faced with declining donor funding for HIV, low- and middle-income countries must identify efficient and cost-effective ways to integrate HIV prevention programs into public health systems for long-term sustainability. In Zambia, donor sup…
View article: Comparison of patient exit interviews with unannounced standardised patients for assessing HIV service delivery in Zambia: a study nested within a cluster randomised trial
Comparison of patient exit interviews with unannounced standardised patients for assessing HIV service delivery in Zambia: a study nested within a cluster randomised trial Open
Objectives To compare unannounced standardised patient approach (eg, mystery clients) with typical exit interviews for assessing patient experiences in HIV care (eg, unfriendly providers, long waiting times). We hypothesise standardised pa…
View article: Provider perspectives on patient‐centredness: participatory formative research and rapid analysis methods to inform the design and implementation of a facility‐based HIV care improvement intervention in Zambia
Provider perspectives on patient‐centredness: participatory formative research and rapid analysis methods to inform the design and implementation of a facility‐based HIV care improvement intervention in Zambia Open
Introduction Implementation of patient‐centred care (PCC) practices in HIV treatment depends on healthcare workers’ (HCWs) perceptions of the acceptability, appropriateness and feasibility of such practices (e.g. use of intentional, metric…
View article: Patterns of person‐centred communications in public HIV clinics: a latent class analysis using the Roter interaction analysis system
Patterns of person‐centred communications in public HIV clinics: a latent class analysis using the Roter interaction analysis system Open
Introduction Poor client−provider communication is a critical barrier to long‐term retention in care among people living with HIV. However, standardized assessments of this key metric are limited in Africa. We used the Roter Interaction An…
View article: Trajectories of re‐engagement: factors and mechanisms enabling patient return to HIV care in Zambia
Trajectories of re‐engagement: factors and mechanisms enabling patient return to HIV care in Zambia Open
Introduction While disengagement from HIV care threatens the health of persons living with HIV (PLWH) and incidence‐reduction targets, re‐engagement is a critical step towards positive outcomes. Studies that establish a deeper understandin…
View article: HIV care experiences and health priorities during the first wave of COVID-19: clients’ perspectives – a qualitative study in Lusaka, Zambia
HIV care experiences and health priorities during the first wave of COVID-19: clients’ perspectives – a qualitative study in Lusaka, Zambia Open
View article: “Provider discretionary power practices to support implementation of patient-centered HIV care in Lusaka, Zambia”
“Provider discretionary power practices to support implementation of patient-centered HIV care in Lusaka, Zambia” Open
Introduction Traditional patient-provider relationships privilege the providers, as they possess the formal authority and clinical knowledge applied to address illness, but providers also have discretion over how they exercise their power …
View article: ‘I need time to start antiretroviral therapy’: understanding reasons for delayed ART initiation among people diagnosed with HIV in Lusaka, Zambia’
‘I need time to start antiretroviral therapy’: understanding reasons for delayed ART initiation among people diagnosed with HIV in Lusaka, Zambia’ Open
Introduction
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\nRapid antiretroviral therapy (ART) initiation can improve patient outcomes such as viral suppression and prevent new infections. However, not everyone who can start ART does so immediately.
\nMethods
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\nWe conducted a q…
View article: Patterns and Predictors of Incident Return to HIV Care Among Traced, Disengaged Patients in Zambia: Analysis of a Prospective Cohort
Patterns and Predictors of Incident Return to HIV Care Among Traced, Disengaged Patients in Zambia: Analysis of a Prospective Cohort Open
Background: Dynamic movement of patients in and out of HIV care is prevalent, but there is limited information on patterns of patient re-engagement or predictors of return to guide HIV programs to better support patient engagement. Methods…
View article: Understanding patient transfers across multiple clinics in Zambia among HIV infected adults
Understanding patient transfers across multiple clinics in Zambia among HIV infected adults Open
Many patients in HIV care in Africa considered lost to follow up (LTFU) at one facility are reportedly accessing care in another. The success of these unofficial transfers as measured by time to re-entry at the new-facility, prevalence of …
View article: Profiles of HIV Care Disruptions Among Adult Patients Lost to Follow-up in Zambia: A Latent Class Analysis
Profiles of HIV Care Disruptions Among Adult Patients Lost to Follow-up in Zambia: A Latent Class Analysis Open
Background: Patients report varied barriers to HIV care across multiple domains, but specific barrier patterns may be driven by underlying, but unobserved, behavioral profiles. Methods: We traced a probability sample of patients lost to fo…
View article: How might improved estimates of HIV programme outcomes influence practice? A formative study of evidence, dissemination and response
How might improved estimates of HIV programme outcomes influence practice? A formative study of evidence, dissemination and response Open
Longitudinal Care Cascade Outcomes Among People Eligible for Antiretroviral Therapy Who Are Newly Linking to Care in Zambia: A Multistate Analysis Open
View article: Human-Centered Design Lessons for Implementation Science: Improving the Implementation of a Patient-Centered Care Intervention
Human-Centered Design Lessons for Implementation Science: Improving the Implementation of a Patient-Centered Care Intervention Open
Background: Evidence-based HIV interventions often fail to reach anticipated impact due to insufficient utilization in real-world health systems. Human-centered design (HCD) represents a novel approach in tailoring innovations to fit end-u…
View article: Patients’ Satisfaction with HIV Care Providers in Public Health Facilities in Lusaka: A Study of Patients who were Lost-to-Follow-Up from HIV Care and Treatment
Patients’ Satisfaction with HIV Care Providers in Public Health Facilities in Lusaka: A Study of Patients who were Lost-to-Follow-Up from HIV Care and Treatment Open
Prognosis among those who are HIV infected has improved but long-term retention is challenging. Health systems may benefit from routinely measuring patient satisfaction which is a potential driver of engagement in HIV care, but it is not o…
View article: Longitudinal engagement trajectories and risk of death among new ART starters in Zambia: A group-based multi-trajectory analysis
Longitudinal engagement trajectories and risk of death among new ART starters in Zambia: A group-based multi-trajectory analysis Open
Among new ART starters in Zambia, we observed 6 patient subgroups that demonstrated distinctive engagement trajectories over time and that were associated with marked differences in the subsequent risk of mortality. Further efforts to deve…
View article: ‘They care rudely!’: resourcing and relational health system factors that influence retention in care for people living with HIV in Zambia
‘They care rudely!’: resourcing and relational health system factors that influence retention in care for people living with HIV in Zambia Open
Introduction Despite access to free antiretroviral therapy (ART), many HIV-positive Zambians disengage from HIV care. We sought to understand how Zambian health system ‘hardware’ (tangible components) and ‘software’ (work practices and beh…
View article: Rethinking retention: Mapping interactions between multiple factors that influence long-term engagement in HIV care
Rethinking retention: Mapping interactions between multiple factors that influence long-term engagement in HIV care Open
This study moves beyond listing barriers or socio-ecological groupings, to explain how social and health systems interact to produce HIV care outcomes. Our findings challenge the implicit assumption of individual agency underpinning many r…
View article: Estimated mortality on HIV treatment among active patients and patients lost to follow-up in 4 provinces of Zambia: Findings from a multistage sampling-based survey
Estimated mortality on HIV treatment among active patients and patients lost to follow-up in 4 provinces of Zambia: Findings from a multistage sampling-based survey Open
HIV treatment in Zambia is not optimally effective. The high and sustained mortality rates and marked under-reporting of mortality at the provincial-level and unexplained heterogeneity between regions and sites suggest opportunities for th…