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Mtei M, Mboya IB, Mgongo M, Manongi R, Amour C, Bilakwate JS, Nyaki AY, Ngocho J, Jonas N, Farah A, Amour M, Kalolo A, Kengia JT, Tinuga F, Ngalesoni F, Bakari AH, Kirakoya FB, Araya A, Kapologwe NA, Msuya SE. Confidence in COVID-19 vaccine effectiveness and safety and its effect on vaccine uptake in Tanzania: A community-based cross-sectional study. Hum Vaccin Immunother 2023; 19:2191576. [PMID: 37017234 PMCID: PMC10088920 DOI: 10.1080/21645515.2023.2191576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
COVID-19 is a major public health threat associated with increased disease burden, mortality, and economic loss to countries and communities. Safe and efficacious COVID-19 vaccines are key in halting and reversing the pandemic. Low confidence in vaccines has been one of the factors leading to hesitancy. We aimed to assess the COVID-19 vaccine confidence (safety and effectiveness), associated factors, and its effects on vaccine uptake among general community members in Tanzania. This was a community-based cross-sectional survey conducted from December 2021 to April 2022 in six regions of Tanzania mainland and two regions in Zanzibar. Participants were interviewed using an electronic questionnaire. Multiple logistic regression models estimated odds ratios (ORs) and 95% confidence interval (CI) for factors associated with vaccine confidence. All analyses were performed using SPSS version 25.0. The study enrolled 3470 general Tanzanian community members; their mean age was 40.3 (standard deviation ±14.9) years, and 34% were males. The proportion of COVID-19 vaccine confidence was 54.6%. Geographical region, residence area, COVID-19 disease risk perception, and good knowledge of COVID-19 vaccines were significantly associated with COVID-19 vaccine confidence. Confidence in COVID-19 vaccines was associated with over three times higher odds of vaccine uptake. Confidence in COVID-19 vaccines was low in Tanzania. Innovative community engagement strategies and region-specific interventions are needed to improve comprehensive knowledge and address community perceptions and attitudes toward COVID-19 vaccines.
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Affiliation(s)
- Monica Mtei
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Faculty of epidemiology and population health, London School of Hygiene and Tropical Medicine, London, UK
| | - Innocent B Mboya
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Translational Medicine, Lund University, Malmo, Sweden
| | - Melina Mgongo
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rachel Manongi
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Caroline Amour
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Julieth S Bilakwate
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ahmed Y Nyaki
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - James Ngocho
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Norman Jonas
- Internal Medicine Department, Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Amina Farah
- Joint Malaria Program, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Maryam Amour
- Department of community health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Albino Kalolo
- Department of Public Health, St. Francis University College of Health and Allied Sciences, Morogoro, Tanzania
| | - James T Kengia
- Department of health, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Florian Tinuga
- Ministry of Health, Immunization and Vaccine Development Department, Dodoma, Tanzania
| | - Frida Ngalesoni
- Department of Health, African Medical and Research Foundation, Dar-es-salaam, Tanzania
| | - Abdalla H Bakari
- School of Natural Science, The State University of Zanzibar, Zanzibar, Tanzania
| | | | - Awet Araya
- Department of Health, UNICEF, Tanzania Office, Dar-es-salaam, Tanzania
| | - Ntuli A Kapologwe
- Department of health, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Sia E Msuya
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Community Health Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Isangula K, Philbert D, Ngari F, Ajeme T, Kimaro G, Yimer G, Mnyambwa NP, Muttamba W, Najjingo I, Wilfred A, Mshiu J, Kirenga B, Wandiga S, Mmbaga BT, Donard F, Okelloh D, Mtesha B, Mohammed H, Semvua H, Ngocho J, Mfinanga S, Ngadaya E. Implementation of evidence-based multiple focus integrated intensified TB screening to end TB (EXIT-TB) package in East Africa: a qualitative study. BMC Infect Dis 2023; 23:161. [PMID: 36918800 PMCID: PMC10013287 DOI: 10.1186/s12879-023-08069-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/09/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) remains a major cause of morbidity and mortality, especially in sub-Saharan Africa. We qualitatively evaluated the implementation of an Evidence-Based Multiple Focus Integrated Intensified TB Screening package (EXIT-TB) in the East African region, aimed at increasing TB case detection and number of patients receiving care. OBJECTIVE We present the accounts of participants from Tanzania, Kenya, Uganda, and Ethiopia regarding the implementation of EXIT-TB, and suggestions for scaling up. METHODS A qualitative descriptive design was used to gather insights from purposefully selected healthcare workers, community health workers, and other stakeholders. A total of 27, 13, 14, and 19 in-depth interviews were conducted in Tanzania, Kenya, Uganda, and Ethiopia respectively. Data were transcribed and translated simultaneously and then thematically analysed. RESULTS The EXIT-TB project was described to contribute to increased TB case detection, improved detection of Multidrug-resistant TB patients, reduced delays and waiting time for diagnosis, raised the index of TB suspicion, and improved decision-making among HCWs. The attributes of TB case detection were: (i) free X-ray screening services; (ii) integrating TB case-finding activities in other clinics such as Reproductive and Child Health clinics (RCH), and diabetic clinics; (iii), engagement of CHWs, policymakers, and ministry level program managers; (iv) enhanced community awareness and linkage of clients; (v) cooperation between HCWs and CHWs, (vi) improved screening infrastructure, (vii) the adoption of the new simplified screening criteria and (viii) training of implementers. The supply-side challenges encountered ranged from disorganized care, limited space, the COVID-19 pandemic, inadequate human resources, inadequate knowledge and expertise, stock out of supplies, delayed maintenance of equipment, to absence of X-ray and GeneXpert machines in some facilities. The demand side challenges ranged from delayed care seeking, inadequate awareness, negative beliefs, fears towards screening, to financial challenges. Suggestions for scaling up ranged from improving service delivery, access to diagnostic equipment and supplies, and infrastructure, to addressing client fears and stigma. CONCLUSION The EXIT-TB package appears to have contributed towards increasing TB case detection and reducing delays in TB treatment in the study settings. Addressing the challenges identified is needed to maximize the impact of the EXIT-TB intervention.
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Affiliation(s)
- Kahabi Isangula
- Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania
- School of Nursing and Midwifery, Aga Khan University, Dar Es Salaam, Tanzania
| | - Doreen Philbert
- Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania
| | - Florence Ngari
- Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania
| | - Tigest Ajeme
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Godfather Kimaro
- Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania
| | - Getnet Yimer
- Center for Global Genomics & Health Equity, Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
| | - Nicholaus P. Mnyambwa
- Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania
- Alliance for Africa Health and Research (A4A), Dar Es Salaam, Tanzania
| | - Winters Muttamba
- Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St. Andrews, UK
| | - Irene Najjingo
- Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Aman Wilfred
- Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania
| | - Johnson Mshiu
- Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania
| | - Bruce Kirenga
- Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Francis Donard
- Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania
| | | | - Benson Mtesha
- Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Hussen Mohammed
- College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Hadija Semvua
- Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - James Ngocho
- Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sayoki Mfinanga
- Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania
| | - Esther Ngadaya
- Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania
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Mandima P, Baltrusaitis K, Montepiedra G, Aaron L, Mathad J, Onyango-Makumbi C, Nyati M, Ngocho J, Chareka G, Ponatshego P, Masheto G, McCarthy K, Jean-Philippe P, Gupta A, Stranix-Chibanda L. Prevalence of neurotoxicity symptoms among postpartum women on isoniazid preventive therapy and efavirenz-based treatment for HIV: an exploratory objective of the IMPAACT P1078 randomized trial. BMC Pregnancy Childbirth 2023; 23:34. [PMID: 36650479 PMCID: PMC9847058 DOI: 10.1186/s12884-022-05341-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This exploratory analysis investigates the prevalence and risk factors of neurocognitive toxicity in postpartum women on HIV treatment in response to a concern of an Isoniazid Preventive Therapy (IPT)/Efavirenz interaction. TRIAL DESIGN Pregnant women on HIV treatment from countries with high TB prevalence were randomized in IMPAACT P1078 to 28 weeks of IPT started either during pregnancy or at 12 weeks postpartum. Partway through study implementation, the Patient Health Questionnaire 9, the cognitive complaint questionnaire, and the Pittsburg Sleep Quality Index were added to evaluate depression, cognitive function, and sleep quality at postpartum weeks. Screening for peripheral neuropathy was conducted throughout the study. METHODS We summarized percentages of women with depression symptoms, cognitive dysfunction, poor sleep quality and peripheral neuropathy and assessed the association of 11 baseline risk factors of neurotoxicity using logistic regression, adjusted for gestational age stratum. RESULTS Of 956 women enrolled, 749 (78%) had at least one neurocognitive evaluation. During the postpartum period, the percentage of women reporting at least mild depression symptoms, cognitive complaint and poor sleep quality peaked at 13%, 8% and 10%, respectively, at 12 weeks, and the percentage of women reporting peripheral neuropathy peaked at 13% at 24 weeks. There was no evidence of study arm differences in odds of all four neurotoxic symptoms. CONCLUSIONS Timing of IPT initiation and EFV use were not associated with symptoms of neurotoxicity. Further study is advised to formally assess risk factors of neurotoxicity.
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Affiliation(s)
- Patricia Mandima
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe.
| | - Kristin Baltrusaitis
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Grace Montepiedra
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lisa Aaron
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jyoti Mathad
- Weill Cornell Medical College, New York, NY, USA
| | | | - Mandisa Nyati
- Chris Hani Baragwanath Hospital, Johannesburg, Soweto, South Africa
| | - James Ngocho
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gift Chareka
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | | | | | | | - Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Lynda Stranix-Chibanda
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Moorthy GS, Madut D, Kilonzo KG, Lwezaula B, Mbwasi R, Mmbaga B, Ngocho J, Saganda W, Officer C, Bonnewell JP, Carugati M, Egger JR, Hertz J, Maze MJ, Maro V, Crump JA, Rubach M. 1164. Antibacterial Utilization for Febrile Illnesses and Laboratory-Confirmed Bloodstream Infections in Northern Tanzania. Open Forum Infect Dis 2022. [PMCID: PMC9752995 DOI: 10.1093/ofid/ofac492.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Antimicrobial resistance is an important cause of morbidity and mortality globally; low- and middle-income countries (LMICs) face an especially high burden. Ineffective antimicrobial prescriptions and use of broad-spectrum agents contribute to resistance. We describe antibacterial prescribing patterns in patients with febrile illnesses and bloodstream infections (BSI) in northern Tanzania. Methods We compared data from two hospital-based prospective cohort studies, cohort 1 (2011-2014) and cohort 2 (2016-2019), both enrolled febrile pediatric and adult inpatients in Moshi, Tanzania. Aerobic blood culture was obtained in all patients and standard methods were used to determine isolate antimicrobial susceptibility. To describe management of febrile illness, we analyzed antibacterial drug prescription prior to and after enrollment. Broad-spectrum antibacterials were categorized using published frameworks. Treatments were categorized as discordant if a blood culture isolate was not susceptible to the patient’s antibacterial regimen. We performed descriptive statistics and logistic regression to understand predictors of receiving an antibacterial. Results In total, 2,176 febrile inpatients were enrolled. Antibacterials were administered to 430 (42.0%) and 501 (45.1%) patients prior to enrollment, and 930 (89.1%) and 1,060 (93.6%) during admission in cohorts 1 and 2, respectively. Infancy and duration of fever were associated with higher antibacterial prescribing prior to enrollment (Table 2). Broad-spectrum antibacterials were administered to 548 (52.5%) in cohort 1 and 682 (60.2%) in cohort 2. Laboratory-confirmed bacteremia was detected in 87 (4%) patients. Susceptibility results were available in 73 patients; of these, 41 (56.2%) received discordant antibacterials.
![]() ![]() ![]() Conclusion Antibacterials were commonly administered for febrile illness in outpatient and inpatient settings; over half of patients received broad-spectrum antibacterials. A high proportion of patients with culture-positive BSI were treated with ineffective antimicrobials. Improved laboratory diagnostics for febrile illness, antimicrobial stewardship interventions, context-specific clinical guidelines, and provider education may improve prescribing practices. Disclosures Julian Hertz, MD, Roche Diagnostics: Grant/Research Support.
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Affiliation(s)
| | | | - Kajiru G Kilonzo
- Kilimanjaro Christian Medial University College, moshi, Kilimanjaro, Tanzania
| | | | - Ronald Mbwasi
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Blandina Mmbaga
- Kilimanjaro Christian Medical Centre, Tumaini University, Moshi, Kilimanjaro, Tanzania
| | - James Ngocho
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | | | - Clinical Officer
- Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro, Tanzania
| | | | | | | | | | - Michael J Maze
- University of Otago, Christchurch, Canterbury, New Zealand
| | - Venance Maro
- Kilimanjaro Christian Medical Centre, Tumaini University, Moshi, Kilimanjaro, Tanzania
| | - John A Crump
- University of Otago, Christchurch, Canterbury, New Zealand
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Ruhago GM, Ngalesoni FN, Kapologwe NA, Kengia JT, Ngocho J, Kabusi SM, Kalolo A, Kitali EJ, Rwamiago E, Mtei G. Strengthening financial management systems at primary health care: Performance assessment of the Facility Financial Accounting and Reporting System (FFARS) in Tanzania. Front Health Serv 2022; 2:787940. [PMID: 36925885 PMCID: PMC10012670 DOI: 10.3389/frhs.2022.787940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/18/2022] [Indexed: 01/11/2023]
Abstract
Background Universal coverage remains a challenging pursuit around the world, even among the highest-income countries. Strengthening financial management capacity is essential towards attaining the three universal health coverage (UHC) goals, namely, expanded coverage, quality service, and financial protection. In this regard, Tanzania introduced the Facility Financial Accounting and Reporting System (FFARS) in line with the introduction of the Direct Health Facility Financing (DHFF) initiative in primary health care (PHC) in 2017-2018. We aim to assess the functionality of the FFARS in management, accounting, and reporting funds received and disbursed in the stride forward strengthening public financial management in PHC facilities towards UHC. Methods The study applied implementation research using a concurrent convergent mixed-methods design to assess sources of revenue, expenditure priorities, and changes of revenues and to explore the usability and benefits of FFARS in improving facility finance and reporting systems in more than 5,000 PHC facilities in Tanzania. Quantitative methods assessed the changes in revenues and expenditure between the financial years (FYs) 2017-2018 and 2018-2019, while the qualitative part explored the usability and the benefits FFARS offers in improving facility finances and reporting systems. Data analysis involved a thematic and descriptive analysis for qualitative and quantitative data, respectively. Results Of the 5,473 PHC facilities, 88% were in rural areas; however, the annual average revenue was higher in urban facilities in FYs 2017-2018 and 2018-2019. Overall, district hospitals showed an increase whereas health centers reported a decline of more than 40% in revenue. The user fee was the predominant source of revenue, particularly in urban facilities, while revenue from health insurance was not among the top three highest sources of revenue. Expenditure priorities leaned more towards drugs and supplies (25%) followed by allowances and training (21%); these did not differ by facility geographies. In health centers, expenditure on facility infrastructure was predominant. Key Informant Interviews revealed an overall satisfaction and positive experiences related to the system. Conclusion The implementation of FFARS in Tanzania demonstrated its high potential in improving facility financial management, including its ability to track revenue and expenditure at PHC facilities. Staffing shortages, ICT infrastructure, and limited opportunities for capacity building could be the limiting factors to reaching the potential of the implementation of FFARS and the attainment of its full impact on Tanzania's pursuit for UHC.
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Affiliation(s)
- George M Ruhago
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Frida N Ngalesoni
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.,Amref Health Africa, Dar Es Salaam, Tanzania
| | - Ntuli A Kapologwe
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - James T Kengia
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - James Ngocho
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Stephen M Kabusi
- Department of Public Health, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
| | - Albino Kalolo
- Department of Public Health, St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Erick J Kitali
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Elisa Rwamiago
- President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Gemini Mtei
- Abt Associates, Tanzania Public Sector Systems Strengthening Plus (PS3+) Project, Dar Es Salaam, Tanzania
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Theron G, Montepiedra G, Aaron L, McCarthy K, Chakhtoura N, Jean-Philippe P, Zimmer B, Loftis AJ, Chipato T, Nematadzira T, Nyati M, Onyango-Makumbi C, Masheto G, Ngocho J, Tongprasert F, Patil S, Lespinasse D, Weinberg A, Gupta A. Individual and Composite Adverse Pregnancy Outcomes in a Randomized Trial on Isoniazid Preventative Therapy Among Women Living With Human Immunodeficiency Virus. Clin Infect Dis 2021; 72:e784-e790. [PMID: 32997744 PMCID: PMC8315231 DOI: 10.1093/cid/ciaa1482] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1078, a randomized noninferiority study designed to compare the safety of starting isoniazid preventive therapy (IPT) in women living with human immunodeficiency virus (HIV) either during pregnancy or after delivery, showed that IPT during pregnancy increased the risk of composite adverse pregnancy outcomes, but not individual outcomes. Many known factors are associated with adverse pregnancy outcomes: these factors' associations and effect modifications with IPT and pregnancy outcomes were examined. METHODS Pregnant women living with HIV from 8 countries with tuberculosis incidences >60/100 000 were randomly assigned to initiate 28 weeks of IPT either during pregnancy or at 12 weeks after delivery. Using univariable and multivariable logistic regression and adjusting for factors associated with pregnancy outcomes, composite and individual adverse pregnancy outcome measures were analyzed. RESULTS This secondary analysis included 925 mother-infant pairs. All mothers were receiving antiretrovirals. The adjusted odds of fetal demise, preterm delivery (PTD), low birth weight (LBW), or a congenital anomaly (composite outcome 1) were 1.63 times higher among women on immediate compared to deferred IPT (95% confidence interval [CI], 1.15-2.31). The odds of fetal demise, PTD, LBW, or neonatal death within 28 days (composite outcome 2) were 1.62 times higher among women on immediate IPT (95% CI, 1.14-2.30). The odds of early neonatal death within 7 days, fetal demise, PTD, or LBW (composite outcome 3) were 1.74 times higher among women on immediate IPT (95% CI, 1.22-2.49). CONCLUSIONS We confirmed higher risks of adverse pregnancy outcomes associated with the initiation of IPT during pregnancy, after adjusting for known risk factors for adverse pregnancy outcomes.
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Affiliation(s)
- Gerhard Theron
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Grace Montepiedra
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Lisa Aaron
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Nahida Chakhtoura
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | | | | | - Amy James Loftis
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tsungai Chipato
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Teacler Nematadzira
- University of Zimbabwe College of Health Sciences–Clinical Trials Research Centre, Harare, Zimbabwe
| | - Mandisa Nyati
- Perinatal Human Immunodeficiency Virus (HIV) Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - James Ngocho
- Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Fuanglada Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai, Thailand
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sandesh Patil
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | | | - Adriana Weinberg
- Departments of Pediatrics, Medicine and Pathology, University of Colorado Denver Anschutz Medical Center, Aurora, Colorado, USA
| | - Amita Gupta
- Center for Clinical Global Health Education, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Watt MH, Cichowitz C, Kisigo G, Minja L, Knettel BA, Knippler ET, Ngocho J, Manavalan P, Mmbaga BT. Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania. AIDS Care 2018; 31:687-698. [PMID: 30466304 DOI: 10.1080/09540121.2018.1550248] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Prevention of mother-to-child transmission of HIV (PMTCT) is a foundational component of a comprehensive HIV treatment program. In addition to preventing vertical transmission to children, PMTCT is an important catch-point for universal test-and-treat strategies that can reduce community viral load and slow the epidemic. However, systematic reviews suggest that care engagement in PMTCT programs is sub-optimal. This study enrolled a cohort of 200 women initiating PMTCT in Kilimanjaro, Tanzania, and followed them to assess HIV care engagement and associated factors. Six months after delivery, 42/200 (21%) of participants were identified as having poor care engagement, defined as HIV RNA >200 copies/mL or, if viral load was unavailable, being lost-to-follow-up in the clinical records or self-reporting being out of care. In a multivariable risk factor analysis, younger women were more likely to have poor postpartum care engagement; with each year of age, women were 7% less likely to have poor care engagement (aRR: 0.93; 95% CI: 0.89, 0.98). Additionally, women who had told at least one person about their HIV status were 47% less likely to have poor care engagement (aRR: .53; 95% CI: 0.29, 0.97). Among women who entered antenatal care with an established HIV diagnosis, those who were pregnant for the first time had increased risk of poor care engagement (aRR 4.16; 95% CI 1.53, 11.28). The findings suggest that care engagement remains a concern in PMTCT programs, and must be addressed to realize the goals of PMTCT. Comprehensive counseling on HIV disclosure, along with community-based stigma reduction programs to provide a supportive environment for people living with HIV, are crucial to address barriers to care engagement and support long-term treatment. Women presenting to antenatal care with an established HIV status require support for care engagement during the crucial period surrounding childbirth, particularly those pregnant for the first time.
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Affiliation(s)
- Melissa H Watt
- a Duke Global Health Institute , Duke University , Durham , NC , USA
| | - Cody Cichowitz
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,b School of Medicine, Johns Hopkins University , Baltimore , MD , USA
| | - Godfrey Kisigo
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,c Kilimanjaro Clinical Research Institute , Moshi , Tanzania
| | - Linda Minja
- c Kilimanjaro Clinical Research Institute , Moshi , Tanzania
| | - Brandon A Knettel
- a Duke Global Health Institute , Duke University , Durham , NC , USA
| | | | - James Ngocho
- d Kilimanjaro Christian Medical Centre , Moshi , Tanzania.,e Kilimanjaro Christian Medical University College , Moshi , Tanzania
| | - Preeti Manavalan
- a Duke Global Health Institute , Duke University , Durham , NC , USA
| | - Blandina T Mmbaga
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,c Kilimanjaro Clinical Research Institute , Moshi , Tanzania.,d Kilimanjaro Christian Medical Centre , Moshi , Tanzania.,e Kilimanjaro Christian Medical University College , Moshi , Tanzania
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