Zambia-Emory HIV Research Project

Since 1994, the Zambia-Emory HIV Research Project (ZEHRP) has offered couples’ voluntary counseling and testing (CVCT) services to over 20,000 couples in Lusaka, Zambia. ZEHRP maintains three CVCT sites in different districts of Lusaka, as well as a mobile unit which changes location monthly. 

The Zambia-Emory HIV Research Project is a tax-exempt, registered NGO established by Dr. Susan Allen in 1994 in Lusaka, Zambia. As with its sister site, Projet San Francisco (PSF) in Kigali, Rwanda, ZEHRP has been funded exclusively by grants awarded to Dr. Allen. ZEHRP has an on-site couples’ voluntary counseling and testing facility, medical clinic, laboratory and pharmacy, and currently employs 150 medical and support staff, between five and 10 expatriate interns and project coordinators, and rotating junior physicians from the University Teaching Hospital. ZEHRP is based on the PSF model and promotes couples’ VCT as a method of HIV prevention and as an entry-point into HIV clinical care, including prevention of mother-to-child transmission and antiretroviral therapy programs. Of the 20,000 couples seen, ZEHRP has diagnosed over 13,000 HIV-infections and treated 6,000 syphilis infections. As part of heterosexual transmission studies and clinical trials of HIV prevention strategies, over 2,000 HIV-discordant couples and 600 HIV+ concordant couples participate in ongoing observational studies and received outpatient care at the ZEHRP clinic. Study participation includes quarterly follow-up at the ZEHRP clinic, physical examinations, STI screening, diagnosis and treatment of opportunistic infections, and family planning services.

ZEHRP’s infrastructure is based on five departments: administration, CVCT, data, lab and medical. Please see Research Initiatives for further information regarding studies and funding at ZEHRP.

ZEHRP Administration Department

What does the administration department do?

The administration department at ZEHRP oversees the finances, logistics, transportation, hygiene, security, procurement and distribution of supplies for all five ZEHRP sites. With an administrative staff of approximately fifty employees, the administration intern manages the administration assistants, drivers, general workers and security guards. The administration assistants monitor and supply daily cash needs at the main site, order and distribute office and cleaning supplies, coordinate immigration paperwork for visitors and interns, compile the weekly field letters, and assist with general tasks as needed for other departments. The drivers carry clients to and from CVCT sites and the University Teaching Hospital in Lusaka, pay bills and run errands with the administration assistants, transport ZEHRP staff members for project meetings, and help track the condition of the project vehicles. The general workers are spread between all five sites to do maintenance work, clean the sites and provide child care to children of clients. The security guards are directly managed by a private company but the administration department oversees their performance and provides them with a meal each day. Security guards are responsible for monitoring who enters and exits from the project and assisting with caring for the project dogs.

What does an administration intern do?

The administration intern is responsible for the allocation and accounting of all finances and resources at the five project sites. The intern distributes cash on a weekly basis to the four satellite sites, pays the bills for all sites, monitors the bank accounts in country, and oversees the final preparation of the weekly field letters. The admin intern handles all human resource issues for the Zambian staff including contract negotiations and signings, healthcare benefits, policies and codes for disciplinary measures and grievances procedures; and prepares calendars to track annual leave and other issues as they arise. The intern is also responsible for human resource issues for the expatriate staff, such as organizing housing, health insurance, phone plans, drivers’ licenses, etc., and is the point person for many issues related to the Project Management Group, an external Zambian-based review committee, and the Zambian physicians who work at the main site. It is crucial for the administration intern to be in regular communication with RZHRG’s U.S. offices for all financial issues.

ZEHRP CVCT Department

What does the CVCT department do?

The CVCT department manages three couples’ voluntary counseling and testing sites in Lusaka, Zambia. These sites recruit couples to the clinics by identifying eligible couples to enroll in the various research projects at ZEHRP. The CVCT department has approximately 30 staff members (counselors and support staff) as well as changing cohorts of Influence Network Agents (INAs). The CVCT department is overseen by 1-2 interns. Cohorts of INAs are recruited every month at each site. These individuals work for ZEHRP for four months and are primarily responsible for recruiting couples to visit the three ZEHRP voluntary HIV testing and counseling clinics. The daily duties of the counselors include an educational group discussion and pre- and post-test counseling. CVCT counselors also rotate at the main site to assist in enrollment and lead group discussions. Each CVCT site has an administrative counselor who assists the interns and manages the site when the intern is not present. The CVCT department works closely with reception, data and laboratory departments to ensure success in couples’ voluntary counseling and testing.

What does a CVCT intern do?

CVCT interns are responsible for the management of three CVCT sites. Each intern is responsible for one of the two satellite clinics and all interns share the managerial duties for the main CVCT site. CVCT interns are generally responsible for the daily management of ZEHRP’s CVCT centers. Interns monitor CVCT counseling and support staff in order to guarantee clients receive the highest standard of care and support possible. Interns are responsible for quality control of data collected at each site to ensure complete data collection. In addition, interns organize the INA project, which includes recruitment, training and dissemination of new INAs into the surrounding communities for couples’ recruitment. Interns are also responsible for the promotion of CVCT in the community, which includes organizing meetings with community leaders and media promotion.

ZEHRP Data Department

What does the data department do?

The data department manages all data generated from the various studies at ZEHRP. The department is comprised of one data intern and 5-10 data staff members. The job duties of the data personnel include data entry and data clean-up. Currently, there are ten databases that require daily data entry, and data is either manually entered or scanned into the database via the TELEform system. The senior data personnel of the department assist the data intern with data clean-up activities while data personnel with an IT background assist with IT issues. The data department works in close conjunction with the community workers to follow-up with late clients and works with other departments to ensure and encourage proper data collection.

What does a data intern do?

The data intern is responsible for all data-related activities at ZEHRP. The intern ensures timely data entry and clean-up of all data generated from the various studies at ZEHRP through efficient staff management. Error reports are generated weekly and monthly to assist in identifying missing and illogical data and provides continual feedback to departments to improve the data collection process. The data intern responds to local data inquiries from all departments in addition to handling various data inquires from the U.S.-based office. In addition to managing data, the intern is responsible for the management of the community workers to ensure that late clients are visited in a timely manner. The data intern is responsible for the maintenance of all computers and management of the current network by handling any IT issues that may arise.

ZEHRP Medical Department

What does the medical department do?

The medical department is largely responsible for providing any medically related services to qualified study members and collecting data for the various studies at ZEHRP. The department usually consists of two medical interns as well as numerous clinical officers, nurses, pharmacists, receptionists, and quality control personnel. ZEHRP and University Teaching Hospital physicians rotate through the medical department each week to provide care for study participants. Quality control nurses manage the data immediately after it is collected to reduce errors or missing data. The medical staff conducts three month follow-up visits on a daily basis, collecting basic data and tracking changes in study participants’ physical health, HIV status and behavior. During these visits, pregnancy tests for women and STI tests for all participants are completed, including HIV tests for previously negative study participants. The medical staff holds a tuberculosis clinic each week to diagnose and provide treatment for study participants. The medical staff works closely with the laboratory, reception and data departments to ensure correct and complete data collection.

What does a medical intern do?

The medical intern is largely responsible for day-to-day activities of the department including staff management and quality control of the data collected during enrollment and follow-up visits. A medical intern must examine all data collected to reduce data errors. Since the medical department collects the majority of the data for ZEHRP, the interns must stay up-to-date on each department’s functions. Therefore, a medical intern liaises with all other departments. Each day the intern coordinates enrollment of study couples with CVCT staff. They also work very closely with the laboratory as the two departments ensure proper results are given in a timely manner. Besides working together with other departments, the medical intern schedules sick visits every afternoon.

ZEHRP Laboratory Department 

What does the Laboratory department do?

The ZEHRP laboratory is responsible for all medical tests and data generated at the main and satellite laboratory facilities. The laboratory is comprised of 10-15 laboratory technologists and managed usually by two laboratory interns. The technologists rotate daily through the various work areas in the main lab or on a weekly basis to one of the CVCT sites. Duties on these work areas include phlebotomy, hematology including erythrocyte sedimentation rates and hematocrit, serology consisting of HIV and syphilis rapid testing, microscopy that focuses on the identification of sexually transmitted infections and other parasitic and bacterial infections, pregnancy testing, and banking of samples to be sent to the USA for further testing. In addition, more advanced assays, such as p24 ELISA testing, HSV ELISA testing, and DNA extractions using a variety of methods, are preformed by senior technologists in the lab.

What does a lab intern do?

The laboratory interns are responsible for the quality control of all laboratory results produced at the main site lab as well as the satellite CVCT centers and all client samples that are collected for the studies conducted at ZEHRP. In addition, intern duties include staffing, customs clearance for all shipments and supplies, supply procurement, equipment maintenance, scheduling, and management of daily laboratory operations. Seroconversion, p24 positive client call backs, and clients with doubtful or discrepant result are also managed by the laboratory interns to insure that all samples are collected for the various studies and all laboratory tests are completed and results properly recorded. Finally, the laboratory interns work in collaboration with the U.S.-based office and lab as well as the labs in the Copperbelt and Rwanda.