Social network strategy (SNS) for HIV testing: a new approach for identifying individuals with undiagnosed HIV infection in Tanzania

Social network strategy (SNS) testing uses network connections to refer individuals at high risk to HIV testing services (HTS). In Tanzania, SNS testing is offered in communities and health facilities. In communities, SNS testing targets key and vulnerable populations (KVP), while in health facilities it complements index testing by reaching unelicited index contacts. Routine data were used to assess performance and trends over time in PEPFAR-supported sites between October 2021 and March 2023. Key indicators included SNS social contacts tested, and new HIV-positives individuals identified. Descriptive and statistical analysis were conducted. Univariable and multivariable analysis were applied, and variables with P-values <0.2 at univariable analysis were considered for multivariable analysis. Overall, 121,739 SNS contacts were tested, and 7731 (6.4%) previously undiagnosed individuals living with HIV were identified. Tested contacts and identified HIV-positives were mostly aged ≥15 years (>99.7%) and females (80.6% of tests, 79.4% of HIV-positives). Most SNS contacts were tested (78,363; 64.7%) and diagnosed (6376; 82.5%) in communities. SNS tests and HIV-positives grew 11.5 and 6.1-fold respectively, from October-December 2021 to January-March 2023, with majority of clients reached in communities vs. facilities (78,763 vs. 42,976). These results indicate that SNS testing is a promising HIV case-finding approach in Tanzania.

Socio-economic status, urbanization, and cardiometabolic risk factors among middle-aged adults in Tanzania

OBJECTIVE

This study was conducted to examine the associations between socioeconomic status, urbanization, and cardio-metabolic risk factors in Tanzania.

METHODS

Participants were 209 adults (45-66 years) in Dar es Salaam, Tanzania. A structured questionnaire was used to evaluate socioeconomic status and behavioral characteristics, including income, education, occupation, residence (urban, rural, mixed), dietary factors, and smoking. Blood samples were collected and analyzed to measure lipid profiles and fasting glucose levels. Cardiometabolic risk factors were defined using World Health Organization criteria.

RESULTS

Urban residence and higher socioeconomic status were associated with decreased intake of traditional staple food (ugali), and increased consumption of meat products and beverages. Higher socioeconomic status was associated with a significant 3.5-kg/m2 higher BMI (p = 0.0001) and 8 cm higher waist circumference (p < 0.001), and a three-fold increase in the risk of obesity. Urban residence was associated with poorer lipid profile, including significantly higher total cholesterol, increased LDL cholesterol, but lower triglycerides, compared to rural residence. The prevalence of metabolic syndrome was high (38%), and was associated with increased socioeconomic status.

CONCLUSION

Urban residence and higher socioeconomic status were important correlates of cardiometabolic risk factors, including obesity and poorer lipid profile. Primary prevention and health screening strategies are needed to target cardiometabolic risk factors in urban areas, to reduce the burden of cardiovascular disease in Tanzania.

Obesity and lipid profiles in middle aged men and women in Tanzania

OBJECTIVE

To examine the relationship between obesity and lipid profiles and to compare the effects of total obesity and central adiposity on lipids in three locations in Tanzania.

DESIGN

Cross-sectional epidemiological study.

SETTING

Three areas in Tanzania: Dar es Salaam (urban), Handeni (rural) and Monduli (pastoralists), in August 1998.

SUBJECTS

Five hundred and forty five men and women from a random sample of 600 people aged 46-58 years.

MAIN OUTCOME MEASURES

Mean BMI, waist circumference, WHR, TC, HDL-C, LDL-C, TG and LDL/HDL ratio. Prevalence rates of overweight,obesity, central obesity and dyslipidaemia.

RESULTS

As compared to men, women had higher BMI (24.7 versus 22.5 kg/m2, p<0.0001), waist circumference (92.4 versus 89.1 cm, p<0.05), TC (4.9 versus 4.2 mmol/L, p<0.0001) and LDL-C (3.3 versus 2.6 mmol/L, p<0.0001). The urban population demonstrated higher levels of lipid factors than the rural population (TC, men 4.8 mmol/L; women 5.3 mmol/L, p<0.0001; TG, men 3.6 mmol/L; women 3.7 mmol/L, p<0.0001, LDL-C, men 2.8 mmol/L, p<0.0001). BMI and waist circumference correlated positively with serum TC, TG, and LDL-C in both genders. Stepwise regression analysis showed that BMI predicted triglyceride concentration in men (p<0.05) and women (p<0.0001). Waist circumference predicted levels of TC in women only (p<0.0001) and of LDL-C in both genders (men p<0.05, women p<0.0001). The prevalence of overweight, obesity and central obesity were significantly higher in urban than in rural areas in both men and women. Compared to lean subjects, obese men and women had significantly higher mean serum TC, TG, LDL-C and a higher prevalence of dyslipidaemia. The mean levels of TC, TG and LDL cholesterol increased across successive increases in BMI and waist circumference quintiles in both genders.

CONCLUSION

Subjects from the urban area had greater lipid abnormalities related to obesity than those from the rural area and that, central adiposity had a greater effect on total cholesterol and LDL cholesterol among women than was BMI.