Data Collection Begins for First PHIA Survey

The groundbreaking Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) survey enrolled its first participants on October 18th, with 12 ZIMPHIA field teams kicking off data collection in the northern region of Zimbabwe.

ZIMPHIA is part of the PHIA Project, a five-year, multi-country initiative funded by the U.S. Centers for Disease Control and Prevention (CDC) through the President’s Emergency Plan for AIDS Relief (PEPFAR) and led by ICAP at Columbia. The PHIA Project consists of household-based, population surveys that will collect information related to HIV in approximately 15 to 20 African countries. Each survey, beginning with ZIMPHIA, will collect information and conduct laboratory tests in order to estimate the magnitude of the HIV epidemic in adults and children and to measure access to prevention, care and treatment services in each country.

“ZIMPHIA will allow Zimbabwe to gain a deeper understanding of what has been accomplished and what still needs to be done in the future,” said Dr. Jessica Justman, principal investigator and senior technical director at ICAP. “ZIMPHIA, and the PHIA Project as a whole, will provide critical evidence that will guide HIV programs over the next decade.”

Dr. Owen Mugurungi, Director of the AIDS and TB Unit in the Government of Zimbabwe’s Ministry of Health and Child Care, announced the survey’s launch in the Mbire District of Mashonaland Central Province, saying, “ZIMPHIA survey data collection has started, marking a very important milestone in our HIV response efforts as a country.” Dr. Mugurungi noted that this survey will be the first of its kind to be conducted in the country. “We are expecting a smooth survey and look forward to high rates of participation by the population,” added Dr. Mugurungi.

ZIMPHIA teams will visit 15,000 randomly selected households across Zimbabwe and administer tablet-based questionnaires to consenting household members. Survey participants receive HIV and syphilis testing and counseling, with immediate return of results, all provided with privacy in each participant’s home. Participants who test positive are referred to their preferred health care facility for treatment.

Zimbabwe’s success in responding to the HIV epidemic has been the result of well-coordinated efforts at the national level. Both the Zimbabwe and U.S. governments are enthusiastic about the ZIMPHIA survey and their continued collaboration supporting the country’s HIV response. The survey is supported by substantial resources provided by PEPFAR with additional resources provided by the Government of Zimbabwe and the Global Fund.

“This is a historic and timely effort. It will provide critical information to inform the next phase of the global response to the HIV epidemic,” added Wafaa El-Sadr, ICAP director.

ZIMPHIA, a Government of Zimbabwe initiative, is being implemented in partnership the Biomedical Research and Training Institute of Zimbabwe and Lancet Laboratories. The PHIA Project partners include, in addition to ICAP, the African Society for Laboratory Medicine, ICF International, Statistical Center for HIV/AIDS Research and Prevention at the Fred Hutchinson Cancer Center, University of California San Francisco’s Global Health Sciences and Westat, Inc.

Founded in 2003, ICAP at Columbia University supports programs and research that address major health issues such as HIV, malaria, tuberculosis, maternal and child health and non-communicable diseases. ICAP works in collaboration with partners around the world to support high-performing health system strengthening initiatives and implements innovative and sustainable health solutions. ICAP, situated at the Columbia Mailman School of Public Health, works in partnership with governmental and non-governmental organizations across 21 countries.

Major HIV Assessment Launches in Zimbabwe

On September 18th, the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) was formally launched in Harare by Zimbabwe’s Ministry of Health and Child Care, the National AIDS Council, the Ambassador of the Government of the United States of America, and representatives of PEPFAR, CDC, ICAP at Columbia University, and other project partners.

This major initiative will describe the current status of the HIV epidemic in Zimbabwe, with survey teams set to visit approximately 15,000 randomly selected households in order to estimate national HIV incidence, prevalence, and viral load suppression among adults and children. The results of the ZIMPHIA survey will help guide policy and set funding priorities in Zimbabwe in the years to come.

ZIMPHIA teams will offer free and voluntary HIV, CD4, viral load, and syphilis testing to approximately 30,000 adults and children. ZIMPHIA participants will be provided with their HIV test results and post-test counseling, and anyone who tests HIV-positive will be referred to the nearest health facility for care.

As high participation rates are essential, ZIMPHIA project partners are dedicating significant efforts to sensitize communities around Zimbabwe. The Ministry of Health and partners are working with traditional leaders, religious leaders, and local organizations to engage the community through educational brochures, advertising, radio spots, and even a song specially produced in collaboration with local Zimbabwean artists: Knock, Knock, Knock.

To prepare local teams to carry out the large-scale, very technical survey and to conduct the various blood tests, ICAP led the training of over 100 nurses, 15 medical laboratory scientists, and 40 interviewers. The ZIMPHIA team is also working with 12 district-level laboratories to ensure the medical tests are conducted correctly.

Over the past 30 years, Zimbabwe has made important strides in responding to the HIV epidemic. Through targeted HIV prevention efforts from voluntary medical male circumcision to the prevention of mother-to-child transmission of HIV, Zimbabwe has lowered its national HIV prevalence rate from 30 percent to less than 15 percent.

“Zimbabwe is at a turning point where an AIDS-free generation and an end to AIDS deaths is not only possible, but is in sight,” said Robert Scott, deputy chief of mission for the U.S. Embassy in Zimbabwe. “Not only will ZIMPHIA advance HIV insights, programming and policy in Zimbabwe, it will also serve as a template and example for other African countries that will conduct similar surveys in the coming years.”

ZIMPHIA is a Ministry of Health and Child Care initiative being implemented in partnership with National AIDS Council, ZIMSTAT, the U.S. Centers for Disease Control and Prevention (CDC), with support from the United States President’s Emergency Plan forAIDS Relief (PEPFAR). ICAP at Columbia University is the implementing agency for ZIMPHIA. Other ZIMPHIA partners include: Biomedical Research and Training Institute (BRTI), Lancet Laboratories, and Westat.

ICAP to lead large population-based HIV surveys in 20 African countries

ICAP at Columbia University has received $25 million in the first year of a $125 million, five-year award from the U.S. Centers for Disease Control and Prevention to conduct national, population-based HIV impact assessments (PHIAs) in 20 countries in sub-Saharan Africa. These surveys will provide critical information on the state of the HIV epidemic in these countries and help shape policies and programs to confront the epidemic. The findings may also help inform global funding priorities.

After a decade of successful scale-up of HIV prevention and treatment efforts in sub-Saharan Africa, there is a great deal of interest in looking at what has been accomplished to date, understanding the effect HIV programs have had on the trajectory of the epidemic and how such information may be used to modify the response to the epidemic in the coming years. Household-based, population-level surveys will address these key areas by using biologic markers to measure HIV prevalence, incidence and to estimate access to prevention, care and treatment services. The findings from these surveys will provide a deeper understanding of the impact of the HIV response at a national level and will guide future investments and help target programs and resources for priority populations at greatest risk and in most need of services.

“We have an important opportunity to gather and use population-based data, much like a census focused on HIV, to get a better picture of the HIV epidemic in Africa,” said Dr. Jessica Justman, principal investigator and senior technical director at ICAP. “This project will yield a body of evidence and lessons learned to inform HIV programs over the next decade.”

The PHIA Project, led by ICAP, includes other key partners: the African Society for Laboratory Medicine, ICF International, Statistical Center for HIV/AIDS Research and Prevention at the Fred Hutchinson Cancer Center, University of California San Francisco’s Global Health Sciences and Westat. The team has presence in each of the 20 countries and will work in collaboration with local and regional governments in the survey planning and implementation, as well as analysis and dissemination of results.

ICAP will provide technical support to strengthen data collection systems and enhance laboratory infrastructure in the countries where the surveys will be conducted. An additional and important aspect of this project is enhancing capacity within countries to design, conduct, and analyze PHIAs and to use findings in policy development and program design.

“This is an opportune moment to take stock of what has been achieved in confronting theHIV epidemic in Africa and to use rigorous methods to collect the type of information we need to guide the way forward,” added Wafaa El-Sadr, ICAP director. An External Advisory Group of distinguished academic, policy and organizational leaders from the global north and south will provide guidance to the project and help generate and disseminate global and local HIV programmatic and policy recommendations.

The PHIA Project builds on ICAP’s previous experience in designing and implementing similar HIV surveys in Tanzania, Zambia and in the conduct of a large-scale population survey in Swaziland that included over 13,000 participating households. ICAP launched theSwaziland HIV Incidence Measurement Survey website earlier this year, making select data and survey findings available online to researchers.

Founded in 2004, ICAP at Columbia University supports programs and research that address major health issues such as HIV, malaria, tuberculosis, maternal and child health and non-communicable diseases. ICAP works in collaboration with partners around the world to support high-performing health system strengthening initiatives and implements innovative and sustainable health solutions. ICAP, situated at the Columbia Mailman School of Public Health, works in partnership with governmental and non-governmental organizations and is currently working in more than 3,300 health facilities across 21 countries.