CDC in Zambia

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CDC Zambia Staff. Photo by Yvonne Chona.

The Centers for Disease Control and Prevention (CDC) has worked with the Ministry of Health (MOH), Zambia National Public Health Institute (ZNPHI), and provincial health offices since 2000 to address HIV, tuberculosis (TB), malaria, COVID-19, and other infectious diseases. CDC also supports national program efforts to strengthen health systems, including disease surveillance, laboratory, and health information systems, public health workforce capacity strengthening, establishing the ZNPHI, and public health emergency preparedness.

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CDC Impact in Zambia

Field Epidemiology Training Program (FETP)

CDC helped establish Zambia’s FETP in 2014 to strengthen workforce capacities to investigate and respond to disease outbreaks. FETP trains epidemiologists to perform disease surveillance and contain outbreaks of diseases like HIV, tuberculosis, and COVID-19. Participants learn critical skills for data collection and analysis and using data to inform action. The program has a sustainable home within ZNPHI. Zambia’s FETP graduates have conducted early COVID-19 vaccine effectiveness studies, implemented the first SARS-CoV-2 prevalence study in Africa, investigated false positive HIV diagnoses to inform national policy, and investigated outbreaks related to consumption of a maize homebrew.

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With CDC support, Zambia FETP graduates have responded to cholera, polio, measles, typhoid, anthrax, salmonella, and COVID-19 epidemics since 2014

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24 Zambians completed the two-year Advanced FETP

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136 Zambians completed the three-month Frontline FETP since 2016

COVID-19

The first cases of COVID-19 in Zambia were confirmed on March 18, 2020. Since the pandemic was declared, CDC has supported Zambia with disease surveillance strategy and contact tracing, leveraging the existing laboratory network as the backbone of the COVID-19 laboratory network, developing COVID-19 clinical guidelines for case management, health informatics, science-based public health communication for Zambians, and epidemiologic studies. CDC also supported the COVID-19 vaccination campaign with vaccination strategies, safety surveillance, and integrating COVID-19 vaccination into existing health structures.

FETP residents and graduates have filled critical positions in the country’s COVID-19 response as they lead outbreak surveillance and response activities. FETP residents have also conducted epidemiologic investigations that impacted policy and public health action.

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Zambia adapted the CDC-supported HIV laboratory infrastructure for hundreds of thousands of COVID-19 tests. This contributed to Zambia achieving one of the highest COVID-19 testing rates in Africa

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CDC helped train more than 500 public health workers and more than 1,000 clinicians in COVID-19 prevention, response, mitigation, and management

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CDC led early research into long-term effects of COVID-19 symptoms in Africa

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CDC and partners pioneered integration of COVID-19 vaccination in HIV clinics across Zambia

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CDC supported development of COVID-19 prevention messages in collaboration with the MOH Risk Communication and Engagement team

Health Systems Strengthening

CDC supports public health systems strengthening in Zambia by engaging in:

  • Workforce development, including expanded academic and clinical training programs in the University of Zambia and the University Teaching Hospital and using the ECHO (Extension for Community Healthcare Outcomes) platform to enhance training and mentorship
  • Enhancement of epidemiology, disease surveillance, health information systems, and program monitoring
  • Establishment and continued support of the Zambia NPHI to strengthen public health surveillance and the capacities to detect and respond to health threats and serve as an NPHI Center of Excellence, supporting other NPHIs in the region
  • Evaluations to assess program impact and inform rapid adjustments to address the evolving HIV epidemic
  • Support of the Government of Zambia to lead public health responses
  • Support of local organizations to provide health services at the national and community level
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CDC supported strengthening of IDSR (Integrated Disease Surveillance and Response), establishment of a national rapid response team at the ZNPHI, cholera and polio outbreak responses, and Ebola preparedness

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CDC helped seven Zambian laboratories achieve ISO 15189 accreditation and continues to support the country’s commitment to quality diagnostic services

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In just four years, the ECHO program expanded to 311 health facilities across all of Zambia’s 10 provinces

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Since 2018, more than 7,000 individuals participated in the ECHO network

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In 2020 and 2021, Zambia coordinated and launched several ECHO programs, including a Southern Africa Region program focused on COVID-19, and programs focused on advanced HIV disease, cervical cancer, and hepatitis B

HIV/AIDS and Tuberculosis (TB)

HIV is the leading cause of death in Zambia. Through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), CDC works with Zambia to build a sustainable, high-impact national HIV response to accelerate progress toward HIV epidemic control. CDC supports implementation of key HIV programs to reduce new HIV infections and HIV-related deaths in Lusaka and Southern, Eastern, and Western provinces. Key strategies used in meeting the UNAIDS 90:90:90 goals include targeted case finding, index testing, hot spot mapping and social networking testing, and strategies to retain clients on care. Zambia met the UNAIDS 90:90:90 goals in 2019 and is now focused on achieving the 95:95:95 goals for 2030.

Since TB is the leading cause of death among people living with HIV, CDC focuses on integrating HIV and TB case management. CDC supports the MOH to enhance TB testing platforms increase access of TB Preventive Therapy (TPT) for people living with HIV.

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With CDC support and strengthened laboratory infrastructure, the MOH doubled the number of HIV viral load tests performed to approximately one million tests per year

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As of December 2021, 88% of people living with HIV in Zambia were on antiretroviral therapy (ART)

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To help prevent HIV, more than 1.5 million medical male circumcisions were performed in PEPFAR-supported regions as of February 2022

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88% of the HIV positive recipients of care screened for TB in 2021

Health Information Systems

With PEPFAR funding, CDC supported development of SmartCare, a national Electronic Health Record (EHR) system. SmartCare supports clinical care and continuity of care by providing confidential portable health records to clients on a smart card. More than 2 million people are enrolled in the system at over 1,600 facilities. More than 260 high-volume facilities have gone paperless to use the system in real-time.

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Over 95% of people on ART have an electronic health record

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All SmartCare facilities routinely report HIV/AIDs and TB data electronically to improve program management

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The data management systems established for HIV monitoring and evaluation are now used in an integrated approach for TB and lower respiratory infection surveillance

Non-Communicable Diseases

Women living with HIV experience increased risk of human papillomavirus (HPV) and cervical cancer. Before the introduction of antiretroviral therapy (ART), women living with HIV were not screened for cervical cancer. With CDC support, Zambia launched a long-term, culturally appropriate, community-based training program in community health promotion to address cervical cancer. Through PEPFAR, CDC also provides policy and clinical guidance for hypertension, diabetes, mental health, and other comorbidities for people living with HIV.

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As of 2022, cervical cancer screening services are available in nearly 213 health facilities across the country

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More than 850,000 women screened for cervical cancer in 2021

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More than 250,000 adolescent girls have been fully vaccinated against HPV in Zambia since 2018

Malaria

Malaria is a leading cause of death and disease in many countries, with young children and pregnant women as the most affected groups. Under the U.S. President’s Malaria Initiative, CDC assigned a resident advisor to the malaria-endemic country of Zambia to support implementation of malaria prevention and control activities. CDC contributes to the development and monitoring and evaluation of activities, including:

  • Providing long-lasting insecticide-treated nets and indoor residual spraying
  • Preventing malaria in pregnancy
  • Enhancing diagnostics and case management
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CDC supported implementation of the 2018 and 2021 Malaria Indicator Surveys

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To address malaria, CDC supported development and implementation of a national insecticide resistance-monitoring program since 2006

CDC Staff in Zambia
  • 15 U.S. Assignees
  • 61 Locally Employed
Zambia at a Glance
  • Population: > 18.3 million
  • Per capita income: $3,360
  • Life expectancy: F 67 / M 64 years
  • Infant mortality rate: 42/1,000 live births

Sources: World Bank 2020, Zambia; Population Reference Bureau 2021, Zambia

Zambia Top 10 Causes of Death
  1. HIV/AIDS
  2. Neonatal disorders
  3. Stroke
  4. Lower respiratory infections
  5. Diarrheal diseases
  6. Tuberculosis
  7. Ischemic heart disease
  8. Malaria
  9. Cirrhosis and other chronic kidney diseases
  10. Hypertensive heart disease

Source: GBD Compare 2019, Zambia

Page last reviewed: March 15, 2022
Content source: Global Health