Adolescents and young people living with HIV (AYPLHIV) experience substantial mental health and psychosocial challenges, yet information on youth-responsive service availability is often limited for routine planning. We mapped mental health and psychosocial support services in Lusaka and Shibuyunji districts of Zambia and assessed alignment with AYPLHIV antiretroviral therapy (ART) program burden using treatment current (TX-CURR) ages 15-24 data. We conducted a cross-sectional mapping survey (10-21 February 2025) of facilities providing any mental health/psychosocial service to characterize service modalities, operating days, eligibility/consent requirements, privacy infrastructure, and ownership. We linked mapped facilities to ART sites and September 2024 TX-CURR using standardized facility names and districts, and calculated burden-weighted coverage among linked sites. As of September 2024, 16,550 AYPLHIV (15-24) were on ART across 87 sites, with 97.7% of burden in Lusaka. We mapped 88 facilities (73 Lusaka; 15 Shibuyunji); 58.0% were government-owned and 40.9% privately owned. Counseling was widely available (97.7%), whereas group therapy (31.8%), medication (37.5%), and medical supervision [observed medication] (38.6%) were less common; medication was frequently referral-based. Weekend availability was reported by 60.2% and parental/guardian consent requirements by 28.4%. Routine data readiness was higher in Lusaka than Shibuyunji (93.2% vs 66.7%; OR 6.8, 95% CI 1.7-27.7; p = 0.011). Forty-seven facilities were linked to ART sites representing 11,194 AYPLHIV: burden-weighted coverage was 40.7% for weekend services, 47.2% for referral medication, and 23.0% for a composite package (weekend availability + on-site counseling + referral medication). AYPLHIV burden is concentrated in Lusaka, but key access features (weekend options, privacy) and biomedical support beyond counseling often depend on referral pathways and are not consistently aligned with high-burden sites. Strengthening youth-friendly service organization, referral functionality, and routine monitoring at high-burden sites may improve equitable access to mental health and psychosocial support.

Background:Adolescents and young people living with HIV (AYPLHIV) experience a high burden of depression, anxiety, behavioral difficulties, and psychosocial distress. These challenges undermine antiretroviral therapy (ART) adherence and long-term HIV outcomes. In Zambia, mental health services remain fragmented, centralized, and weakly integrated with HIV care. Expert consensus is needed to prioritize feasible system, service, and digital strategies to strengthen mental health access for AYPLHIV. Methods:We conducted a two-round Delphi study with ten Zambian mental health experts (psychiatry, psychology, nursing, HIV program management, and digital health). Round One (September 1-10 2025) collected open-ended responses on barriers, facilitators, and mobile health (mHealth) strategies. Responses were thematically analyzed in Ligre 6.5.1 and synthesized into 29 candidate statements. In Round Two (September 15-20, 2025), experts rated each statement on a five-point Likert scale (1-5). Consensus was defined a priori as ≥70% rating a statement 4-5 and an interquartile range (IQR) ≤1. Results:Consensus was reached for 27 of 29 statements (93%). Experts identified HIV- and mental-health-related stigma, poverty and transport costs, limited decentralization, low mental health literacy, harmful gender norms, and shortages of trained providers as key barriers to AYPLHIV accessing care. Priority facilitators included decentralizing services to primary and community levels, integrating mental health into ART clinics, strengthening youth-friendly and confidential counseling, expanding peer-support models, and improving multisector collaboration. mHealth solutions were strongly endorsed as confidential, scalable tools if they ensured robust data protection, offline or low-data functionality, multilingual and audio-visual content, and clear referral pathways to facility-based services. Conclusions:This Delphi process generated clear expert consensus on pragmatic priorities for expanding youth mental health care within Zambia's HIV program. The findings provide a framework for policymakers and implementers to integrate mental health and mHealth into HIV prevention, treatment, and care for AYPLHIV and to guide implementation and scale-up of youth-focused mental health interventions.

Abstract Background Mental health (MH) disorders remain a major global public health concern, disproportionately affecting adolescents and young people living with HIV (AYPLHIV). Limited access to MH services, stigma, and a shortage of trained professionals hinder effective care, particularly in low-resource settings. Mobile health (mHealth) applications have emerged as accessible and scalable tools for improving MH support and reducing disparities in service delivery. This systematic review assessed the effectiveness of mHealth applications in improving access to MH services and outcomes among AYPLHIV and comparable populations globally. Methods A systematic search was conducted across PubMed, PsycINFO, Web of Science, and the Cochrane Library for studies published between January 2020 and March 2025. Eligible studies evaluated mobile or app-based interventions designed to enhance MH access, engagement, or outcomes. Systematic reviews, meta-analyses, SMS-only interventions, and non-empirical studies were excluded. Two independent reviewers (CM and PS) screened articles, extracted data, and assessed study quality using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Data were synthesized narratively following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework. Results Of 265 records identified, 16 empirical studies met the inclusion criteria. The studies covered Africa (Ethiopia, Kenya), Asia (Indonesia, Vietnam, Iran, Malaysia), Europe (Spain, Poland, United Kingdom), North America (USA), and Oceania (Australia), and employed randomized controlled trials, mixed-methods, pre–post, and cross-sectional designs. Across studies, mobile interventions consistently improved user engagement, accessibility, and MH outcomes, including significant reductions in depression, anxiety, and stress symptoms (p < 0.05). Peer-based models delivered via WhatsApp demonstrated high feasibility and acceptability among AYPLHIV, while cognitive behavioral therapy (CBT) and mindfulness-based apps such as IntelliCare and Headspace produced outcomes comparable to traditional care in several settings. Key facilitators included personalization, app usability, and human or AI-enabled feedback (e.g., chatbot support), while barriers included privacy concerns, connectivity constraints, and low digital literacy. Conclusions mHealth applications substantially improve access to and delivery of MH services for AYPLHIV and related groups. Integration of these tools into existing health systems, combined with culturally tailored design, ethical AI use, and sustainability strategies, can strengthen MH care globally. Future research should address long-term impact, cost-effectiveness, and equity in implementation.

In light of global commitments to eradicate poliovirus and ensure strict laboratory containment, Zambia conducted a nationwide laboratory inventory and survey in November 2024 to identify facilities handling or retaining poliovirus infectious materials (IMs) or potentially infectious materials (PIMs). This effort followed previous surveys conducted in 2015 and 2019 (WHO, 2020), amid recurring vaccine-derived poliovirus (cVDPV2) outbreaks and cross-border risks (WHO, 2021). A total of 42 laboratories across all 10 provinces were surveyed using the Open Data Kit (ODK) tool (CDC, 2020). Of these, 18 laboratories reported handling samples classified as PIMs, and three facilities UTH Virology, ZNPHRL, and TDRC were found to retain 95,455 PIMs (including stool and nasopharyngeal samples), while no facility retained infectious materials (IMs). The UTH Virology Lab remains the only WHO-accredited national polio lab authorized to retain such samples (WHO, 2015). Data were collected and analyzed using SQL Server and GIS tools, providing detailed insights into material distribution and lab categorization. Despite challenges with survey tool limitations and access to centralized databases, the findings underscore Zambia's continued vigilance in poliovirus containment, with only 0.03% of unusable OPV2 vials unaccounted for (WHO, 2021). The survey confirms that Zambia maintains a low risk of poliovirus spread and emphasizes the need for periodic verification visits, refined survey tools, and real-time inventory tracking to uphold global containment standards (Matapo, 2012).

Measles & Rubella (MR) zero-dose children (unvaccinated for measles-rubella) cluster in underserved communities can sustain measles transmission. We estimated MR zero-dose prevalence after Zambia's 2024 MR Supplementary Immunisation Activity (SIA) and identified associated risk factors and barriers. A coverage survey (two-stage stratified cluster design) across all 10 provinces, was conducted from 27th December 2024-16th January 2025, involved interviewing caregivers of children aged 9-59 months; vaccination status was verified by card (11.7%) or recall (88.3%). Data were analysed using survey-weighted methods and logistic regression, adjusting for stratification, clustering, and sampling weights. Among 8,634 children, MR zero-dose prevalence was 11.97% (95% CI: 11.03-12.91), highest in Central (19.15%) and Western (17.71%), lowest in Copperbelt (6.69%). Urban residence reduced odds by 24% vs. rural (aOR 0.76, 95% CI: 0.63-0.92). Risks rose with age (>36 months: aOR 1.60, 95% CI: 1.27-2.00), maternal absence (aOR 1.74, 95% CI: 1.33-2.27), or death (aOR 2.40, 95% CI: 1.23-4.68). Most zero-dose children (88.75%) lacked other vaccines, indicating systemic gaps. Key barriers included unawareness (42.58%) and travel time (>2 hours: aOR 3.20, 95% CI: 1.43-7.16). Nearly one in eight Zambian children remained MR zero-dose post-2024 SIA, concentrated in rural, high-prevalence areas, older children, and motherless households. Priorities include health worker-led awareness campaigns, mobile services to cut travel time, and integrated SIA-Routine Immunisation (RI) strategies (microplanning, tracing, catch-up) to address systemic gaps, supporting global measles elimination under Immunisation Agenda 2030.

The COVID-19 pandemic had a devastating impact on childhood routine immunization programs, resulting in increased measles mortalities and complications. In Zambia, the likelihood of measles-related deaths and complications in children was possibly increased because of high rates of unvaccinated children, late diagnosis, and poor case management, which could have been a consequence of exclusive focus on COVID-19 interventions. This study aimed at examining the effect of the COVID-19 pandemic on measles mortality and its predictors among patients seen at health facilities in Zambia. We used longitudinal data (January 2020 to August 2023) from outbreak investigations and time series data from 2017 to 2023 to understand the impact of COVID-19 on measles immunization and know the predictors of measles mortalities. The period running from January 2017 to February 2020, just before the first reported COVID-19 case, was defined as pre-COVID-19, and March 2020 to December 2023 as post-COVID-19. Multivariable logistic regression analysis was used to determine predictors of mortality. A segmented Poisson regression model was used to determine the correlation between the underlying patterns of measles mortality and the commencement of the COVID-19 pandemic. A total of 3429 measles cases were reported during the study period. Of these, 1261 had complete metadata and were included in the analysis. The median age was 3 years (IQR, 1–7). Out of the 1261 enrolled, 54 (4.3

Approximately 40 million people globally are living with HIV (PLWH) and more than 50

Abstract Objective HIV incidence is not well documented where health services are delivered as a result failure of better understanding current transmission of HIV in a community. The aim was to determine the incidence of HIV-1 and factors associated with recent infection in Livingstone district using the HIV-1 recent infection testing algorithm, using the Rapid test for recent infection with HIV viral load testing to identify true HIV recent patients infected within 12 months. Results This was a laboratory based cross sectional study in which samples of newly diagnosed HIV positive adults sent to LUTH PCR laboratory for Recency testing and HIV VL testing were used. In our study participants, the younger age group were more likely to have been infected in the past 12 months, median age: recently infected 28 (23, 37.5) vs long term 33 (27, 40) p-value = 0.002. Out of the 768 clients subjected to RITA, 18.75% were true HIV recent, with the majority of them being female at 59.51%. 50.74% of the clients classified as recent were virally unsuppressed, p- value =0.000. Mahatima Gandhi clinic had a high number of recent infections relative to other facilities at 17.36%. Majority of the clients were captured under index modality with a percentage of HIV recent patients at 47.22%. Adjusted analysis indicated a significant association between age, HIV VL and recent infection (OR 0.97; 95%CI 0.95-0.99; p- value=0.002) and (OR 0.32; 95%CI 0.22-0.48; p- value =0.000). A high HIV incidence of recent infection with a 50.74% HIV VL unsuppressed clients was observed suggestive of high HIV transmission rate in the community. The majority of clients were captured under index testing indicating that most clients are less likely to seek medical care for HIV testing. Being virally unsuppressed and age were associated with recent infection. Facilities servicing low income areas may be hot spot zones where preventive and treatment interventions should be prioritized in the district.

Globally, tuberculosis (TB) testing and treatment have declined dramatically during the COVID-19 pandemic. We quantified the change in TB visits, testing, and treatment compared with a 12-month pre-pandemic baseline at the national referral hospital's TB Clinic in Lusaka, Zambia, in the first year of the pandemic. We stratified the results into early and later pandemic periods. In the first 2 months of the pandemic, the mean number of monthly TB clinic visits, prescriptions, and positive TB polymerase chain reaction (PCR) tests decreased as follow: -94.1% (95% CI: -119.4 to -68.8%), -71.4% (95% CI: -80.4 to -62.4%), and -73% (95% CI: -95.5 to -51.3%), respectively. TB testing and treatment counts rebounded in the subsequent 10 months, although the number of prescriptions and TB-PCR tests performed remained significantly lower than pre-pandemic. The COVID-19 pandemic significantly disrupted TB care in Zambia, which could have long-lasting impacts on TB transmission and mortality. Future pandemic preparedness planning should incorporate strategies developed over the course of this pandemic to safeguard consistent, comprehensive TB care.

Abstract Objective Zambia has embarked on improving the diagnostic capacity by setting up high throughput and accurate machines in the testing process and introduction of dried blood spot (DBS) as a sample type. This was a cross sectional study to verify dried blood spot as a sample type for HIV viral load and early infant diagnosis (EID) on Hologic Panther platform and Evaluate the analytical performance (precision, linearity and measurement of uncertainty) of the Hologic Panther. Results The specificity and sensitivity of EID performance of Aptima Quant Dx assay on Hologic panther machine against the gold standard machine COBAS Taqman (CAP/CTM) was 100% with an overall agreement of 100%. The quantitative HIV Viral Load (VL) accuracy had a positive correlation of (0.96) obtained against the gold standard (plasma samples) run on COBAS4800 platform. Analytical performance of the Hologic panther machine was evaluated; Precision low positive repeatability 3.50154 and within lab 2.268915 at mean 2.88 concentration and precision high positive repeatability 1.116955 and within lab 2.010677 at mean 5.09 concentration were obtained confirming manufacturers claims. Uncertainty of measurement for this study was found to be ± 71 copies/ml. Linearity studies were determined and all points were within acceptable limits. We therefore recommend DBS as a sample type alternative to plasma for the estimation of HIV-1 viral load and EID diagnosis on the Hologic panther machine.

During a COVID-19 outbreak in a prison in Zambia from December 14 to 19, 2021, a case-control study was done to measure vaccine effectiveness (VE) against infection and symptomatic infection, when the Omicron variant was the dominant circulating variant. Among 382 participants, 74.1% were fully vaccinated, and the median time since full vaccination was 54 days. There were no hospitalizations or deaths. COVID-19 VE against any SARS-CoV-2 infection was 64.8%, and VE against symptomatic SARS-CoV-2 infection was 72.9%. COVID-19 vaccination helped protect incarcerated persons against SARS-CoV-2 infection during an outbreak while Omicron was the dominant variant in Zambia. These findings provide important local evidence that might be used to increase COVID-19 vaccination in Zambia and other countries in Africa.

This study aims to quantify the prevalence of forced sex, pressured sex, and related pregnancy among adolescent girls and young women in five low- and middle-income countries. Nationally representative, cross-sectional household surveys were conducted in Haiti, Malawi, Nigeria, Zambia, and Uganda among girls and young women aged 13 to 24 years. A stratified three-stage cluster sample design was used. Respondents were interviewed to assess prevalence of sexual violence, pregnancy related to the first or most recent experience of forced or pressured sex, relationship to perpetrator, mean age at sexual debut, mean age at pregnancy related to forced or pressured sex, and prevalence of forced/coerced sexual debut. Frequencies, weighted percentages, and weighted means are presented. The lifetime prevalence of forced or pressured sex ranged from 10.4% to 18.0%. Among these adolescent girls and young women, the percentage who experienced pregnancy related to their first or most recent experience of forced or pressured sex ranged from 13.2% to 36.6%. In three countries, the most common perpetrator associated with the first pregnancy related to forced or pressured sex was a current or previous intimate partner. Mean age at pregnancy related to forced or pressured sex was similar to mean age at sexual debut in all countries. Preventing sexual violence against girls and young women will prevent a significant proportion of adverse effects on health, including unintended pregnancy. Implementation of strategies to prevent and respond to sexual violence against adolescent girls and young women is urgently needed.

Background Coronavirus disease 2019 (COVID-19) vaccines are highly effective for reducing severe disease and mortality. However, vaccine effectiveness data are limited from Sub-Saharan Africa. We report COVID-19 vaccine effectiveness against progression to in-hospital mortality in Zambia. Methods We conducted a retrospective cohort study among admitted patients at 8 COVID-19 treatment centers across Zambia during April 2021 through March 2022, when the Delta and Omicron variants were circulating. Patient demographic and clinical information including vaccination status and hospitalization outcome (discharged or died) were collected. Multivariable logistic regression was used to assess the odds of in-hospital mortality by vaccination status, adjusted for age, sex, number of comorbid conditions, disease severity, hospitalization month, and COVID-19 treatment center. Vaccine effectiveness of ≥1 vaccine dose was calculated from the adjusted odds ratio. Results Among 1653 patients with data on their vaccination status and hospitalization outcome, 365 (22.1%) died. Overall, 236 (14.3%) patients had received ≥1 vaccine dose before hospital admission. Of the patients who had received ≥1 vaccine dose, 22 (9.3%) died compared with 343 (24.2%) among unvaccinated patients (P < .01). The median time since receipt of a first vaccine dose (interquartile range) was 52.5 (28-107) days. Vaccine effectiveness for progression to in-hospital mortality among hospitalized patients was 64.8% (95% CI, 42.3%-79.4%). Conclusions Among patients admitted to COVID-19 treatment centers in Zambia, COVID-19 vaccination was associated with lower progression to in-hospital mortality. These data are consistent with evidence from other countries demonstrating the benefit of COVID-19 vaccination against severe complications. Vaccination is a critical tool for reducing the consequences of COVID-19 in Zambia.

Objective: To assess the knowledge, attitude and Practices among healthcare workers towards covid 19 preventive measures at Women and New-born Hospital of the University Teaching Hospitals in Lusaka. Methods: Cross-sectional study conducted at WNH-UTH, Lusaka. Convenient sample of 264 frontline healthcare workers responded to self-administered questionnaire to determine their knowledge, attitudes and practices on COVID 19 preventive measures. Results: Majority (31.9%) of the respondents were aged 25 : 29 years. The study revealed that 63.4% had a good knowledge, 60.3% had positive attitudes and 59.9% had a good practice. Attitude was positively related with practice (r = 0.524, p < 0.001) and knowledge (r = 0.469; p < 0.001). Further, knowledge was positively correlated with practice (r = 0.51; p < 0.001). Bivariate analysis results showed that only high knowledge score (75.6%; p < 0.001) and high attitude score (77.6%; p < 0.001) was associated with an increase in good practice among healthcare workers towards Covid 19 preventive measures. Conclusion: The study showed the need for continued assessment of Knowledge Attitude and Practice among healthcare workers towards Covid 19 preventive measures. It further showed the need of designing interventions aimed at encouraging sustained compliance to preventive measures among healthcare workers to prevent COVID 19 transmission.

ABSTRACTOBJECTIVEThe study aimed at identifying socio-economic and environmental factors that were associated with stunting among children aged 0-59 months in Zambia.BACKGOUNDHitherto, stunting continues to be a Public Health problem worldwide. A child is ‘stunted’ if his or her height is less than negative two standard deviations below the World Health Organization (WHO) standard. The study aimed to explore determinants of stunting in Zambia among children (< 5 years of age) using the Zambia Demographic and Health Survey (ZDHS) 2018-2019 database.METHODSA total of 7, 045 Zambian children with complete anthropometric measurements and aged 0–59 months were included in the study. Nutritional status was evaluated using anthropometric; height-for-age, as a proxy measure of stunting. Univariate and multivariate binary logistic regression were used to examine the association between stunting and selected environmental, maternal-socio-demographic and child level variables.RESULTSA total of 2, 479 children under the age of five found to be stunted representing a prevalence of 34.9%. Stunting was higher among male children as compared to female children (38.5% vs 31.3% respectively). Additional analysis revealed that children from households whose source of drinking water was improved (34%) were less likely to be stunted compared to children from households whose source of drinking water was non-improved (40%). Stunting was statistically significant associated with sex and age of a child; birth size; breastfeeding; residence; maternal education; wealth index; twin births and the birth interval among siblings. Children born to mothers whose previous birth interval is less than 24 months (aOR= 1.34 95%CI: 1.13-1.58; p<0.001), children from lower index households (aOR= 1.65 95%CI: 1.32-2.08; p<0.001), twin births (aOR=2.65 95%CI: 1.61-4.36; p<0.001), children whose mothers had primary education (aOR=1.16 95%CI 1.00-1.35; p=0.046), children coming from households whose source of drinking water was non-improved (aOR= 1.30 95%CI: 1.09-1.5: p=0.003), child not breastfed (aOR= 1.20 95%CI: 1.04-1.38; p=0.015) were more likely to be stunted.CONCLUSIONThe study established that the major predictors of stunting among children under 5 years old in Zambia were sex and age of the child; birth weight; maternal education; wealth status; source of drinking water; twin births, breastfeeding, residence and the birth interval among siblings. Therefore, to reduce the burden of stunting interventions that can address these factors are required such as community based education and targeted nutritional interventions.ARTICLE SUMMARYStrengths and limitations of the studyThe study utilised the ZDHS data as a proxy to establish the national burden of stunting in Zambia during 2018/2019, hence contributing to the body of knowledge.Many variables perataining to food intakes were not covered in ZDHS of 2018/2019 hence exluded from the study. Food intakes are very critical in measuring stunting levels.

The first laboratory-confirmed cases of coronavirus disease 2019 (COVID-19), the illness caused by SARS-CoV-2, in Zambia were detected in March 2020 (1). Beginning in July, the number of confirmed cases began to increase rapidly, first peaking during July-August, and then declining in September and October (Figure). After 3 months of relatively low case counts, COVID-19 cases began rapidly rising throughout the country in mid-December. On December 18, 2020, South Africa published the genome of a SARS-CoV-2 variant strain with several mutations that affect the spike protein (2). The variant included a mutation (N501Y) associated with increased transmissibility.†,§ SARS-CoV-2 lineages with this mutation have rapidly expanded geographically.¶,** The variant strain (PANGO [Phylogenetic Assignment of Named Global Outbreak] lineage B.1.351††) was first detected in the Eastern Cape Province of South Africa from specimens collected in early August, spread within South Africa, and appears to have displaced the majority of other SARS-CoV-2 lineages circulating in that country (2). As of January 10, 2021, eight countries had reported cases with the B.1.351 variant. In Zambia, the average number of daily confirmed COVID-19 cases increased 16-fold, from 44 cases during December 1-10 to 700 during January 1-10, after detection of the B.1.351 variant in specimens collected during December 16-23. Zambia is a southern African country that shares substantial commerce and tourism linkages with South Africa, which might have contributed to the transmission of the B.1.351 variant between the two countries.

Since its first discovery in December 2019 in Wuhan, China, COVID-19, caused by the novel coronavirus SARS-CoV-2, has spread rapidly worldwide. While African countries were relatively spared initially, the initial low incidence of COVID-19 cases was not sustained for long due to continuing travel links between China, Europe and Africa. In preparation, Zambia had applied a multisectoral national epidemic disease surveillance and response system resulting in the identification of the first case within 48 h of the individual entering the country by air travel from a trip to France. Contact tracing showed that SARS-CoV-2 infection was contained within the patient’s household, with no further spread to attending health care workers or community members. Phylogenomic analysis of the patient’s SARS-CoV-2 strain showed that it belonged to lineage B.1.1., sharing the last common ancestor with SARS-CoV-2 strains recovered from South Africa. At the African continental level, our analysis showed that B.1 and B.1.1 lineages appear to be predominant in Africa. Whole genome sequence analysis should be part of all surveillance and case detection activities in order to monitor the origin and evolution of SARS-CoV-2 lineages across Africa.

Objective Dyslipidaemia and obesity have a synergistic effect on the development of cardiovascular diseases (CVDs). Anthropometric measurements have often been used as surrogate markers for obesity indices with diverse results. We evaluated the best obesity index for predicting dyslipidaemia among anthropometric measurements and body fat measurements with bio-electric impedance analysis (BIA). Results Among 116 adults, 62 (53.4%) were female. The median age was 39 years (quartile (Q)1, Q3: 20.8, 65.4). Waist circumference (odds ratio (OR) 4.54; 95% CI 1.56, 13.19; p=0.005) and total body fat percentage (OR 0.34; 95% CI 0.13, 0.91; p=0.031) measurements of obesity indices were significantly associated with dyslipidaemia.

Zambia is a landlocked, lower-middle income country in southern Africa, with a population of 17 million (1). The first known cases of coronavirus disease 2019 (COVID-19) in Zambia occurred in a married couple who had traveled to France and were subject to port-of-entry surveillance and subsequent remote monitoring of travelers with a history of international travel for 14 days after arrival. They were identified as having suspected cases on March 18, 2020, and tested for COVID-19 after developing respiratory symptoms during the 14-day monitoring period. In March 2020, the Zambia National Public Health Institute (ZNPHI) defined a suspected case of COVID-19 as 1) an acute respiratory illness in a person with a history of international travel during the 14 days preceding symptom onset; or 2) acute respiratory illness in a person with a history of contact with a person with laboratory-confirmed COVID-19 in the 14 days preceding symptom onset; or 3) severe acute respiratory illness requiring hospitalization; or 4) being a household or close contact of a patient with laboratory-confirmed COVID-19. This definition was adapted from World Health Organization (WHO) interim guidance issued March 20, 2020, on global surveillance for COVID-19 (2) to also include asymptomatic contacts of persons with confirmed COVID-19. Persons with suspected COVID-19 were identified through various mechanisms, including port-of-entry surveillance, contact tracing, health care worker (HCW) testing, facility-based inpatient screening, community-based screening, and calls from the public into a national hotline administered by the Disaster Management and Mitigation Unit and ZNPHI. Port-of-entry surveillance included an arrival screen consisting of a temperature scan, report of symptoms during the preceding 14 days, and collection of a history of travel and contact with persons with confirmed COVID-19 in the 14 days before arrival in Zambia, followed by daily remote telephone monitoring for 14 days. Travelers were tested for SARS-CoV-2, the virus that causes COVID-19, if they were symptomatic upon arrival or developed symptoms during the 14-day monitoring period. Persons with suspected COVID-19 were tested as soon as possible after evaluation for respiratory symptoms or within 7 days of last known exposure (i.e., travel or contact with a confirmed case). All COVID-19 diagnoses were confirmed using real-time reverse transcription-polymerase chain reaction (RT-PCR) testing (SARS-CoV-2 Nucleic Acid Detection Kit, Maccura) of nasopharyngeal specimens; all patients with confirmed COVID-19 were admitted into institutional isolation at the time of laboratory confirmation, which was generally within 36 hours. COVID-19 patients were deemed recovered and released from isolation after two consecutive PCR-negative test results ≥24 hours apart. A Ministry of Health memorandum was released on April 13, 2020, mandating testing in public facilities of 1) all persons admitted to medical and pediatric wards regardless of symptoms; 2) all patients being admitted to surgical and obstetric wards, regardless of symptoms; 3) any outpatient with fever, cough, or shortness of breath; and 4) any facility or community death in a person with respiratory symptoms, and 5) biweekly screening of all HCWs in isolation centers and health facilities where persons with COVID-19 had been evaluated. This report describes the first 100 COVID-19 cases reported in Zambia, during March 18-April 28, 2020.

INTRODUCTION:Coerced and forced sexual initiation (FSI) can have detrimental effects on children and youth. Understanding health outcomes that are associated with experiences of FSI is important for developing appropriate strategies for prevention and treatment of FSI and its consequences. METHODS:The Violence Against Children Surveys were conducted in Nigeria, Uganda, and Zambia in 2014 and 2015. We examined the prevalence of FSI and its consequences (sexual high-risk behaviors, violence experiences, mental health outcomes, and sexually transmitted infections (STI)) associated with FSI among youth aged 13-24 years in three countries in sub-Saharan Africa. RESULTS:Over one in ten youth aged 13-24 years who had ever had sex experienced FSI in Nigeria, Uganda, and Zambia. In multivariable logistic regression, FSI was significantly associated with infrequent condom use (OR = 1.4, 95%CI = 1.1-2.1), recent experiences of sexual violence (OR = 1.6, 95%CI: 1.1-2.3), physical violence (OR = 2.2, 95%CI: 1.6-3.0), and emotional violence (OR = 2.0, 95%CI: 1.3-2.9), moderate/serious mental distress (OR = 1.5, 95%CI: 1.1-2.0), hurting oneself (OR = 2.0, 95%CI: 1.3-3.1), and thoughts of suicide (OR = 1.5, 95%CI: 1.1-2.3), after controlling for demographic characteristics. FSI was not statistically associated with engaging in transactional sex, having multiple sex partners, or having a STI. CONCLUSION:FSI is associated with infrequent condom use, recent experiences of violence and mental health outcomes among youth in sub-Saharan Africa, which may increase the risk for HIV and other consequences. Developing strategies for prevention is important for reducing the prevalence of FSI and its effects on children and youth.