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Rwabiyago OE, Katale A, Bingham T, Grund JM, Machangu O, Medley A, Nkomela ZM, Kayange A, King'ori GN, Juma JM, Ismail A, Kategile U, Akom E, Mlole NT, Schaad N, Maokola W, Nyagonde N, Magesa D, Kazitanga JC, Maruyama H, Temu F, Kimambo S, Sando D, Mbatia R, Chalamila ST, Ogwang BE, Njelekela MA, Kazaura K, Wong VJ, Gongo R, Njau PF, Mbunda A, Nondi J, Bateganya M, Greene J, Breda M, Mgomella G, Rwebembera A, Swaminathan M. Social network strategy (SNS) for HIV testing: a new approach for identifying individuals with undiagnosed HIV infection in Tanzania. AIDS Care 2024:1-10. [PMID: 38502602 DOI: 10.1080/09540121.2024.2307383] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/10/2024] [Indexed: 03/21/2024]
Abstract
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.
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Affiliation(s)
- Oscar Ernest Rwabiyago
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Allen Katale
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Trista Bingham
- United States Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, Georgia, USA
| | - Jonathan M Grund
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Ona Machangu
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Amy Medley
- United States Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, Georgia, USA
| | - Zeye M Nkomela
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Alick Kayange
- United States Walter Reed Army Institute of Research/Department of Defense (WRAIR/DOD), Dar es Salaam, Tanzania
| | - Galal Naphtal King'ori
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - James McOllogi Juma
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Abbas Ismail
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Upendo Kategile
- United States Agency for International Development, Dar es Salaam, Tanzania
| | - Eniko Akom
- U.S. Military HIV Research Program (MHRP), Walter Reed Army Institute of Research, Silver Spring, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Neema Tabian Mlole
- President's Office, Regional Administration and Local Government, Dodoma, Tanzania
| | - Nicolas Schaad
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Werner Maokola
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Nyagonde Nyagonde
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Daniel Magesa
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Jaiving C Kazitanga
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | | | | | - Sajida Kimambo
- USAID Afya Yangu Northern Project, Dar es Salaam, Tanzania
| | - David Sando
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | | | | | | | - Kokuhumbya Kazaura
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Vincent J Wong
- United States Agency for International Development, Office of HIV/AIDS, Washington DC, USA
| | - Ramadhani Gongo
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Prosper Faustine Njau
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Andrea Mbunda
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Joseph Nondi
- United States Walter Reed Army Institute of Research/Department of Defense (WRAIR/DOD), Dar es Salaam, Tanzania
| | - Moses Bateganya
- United States Agency for International Development, Dar es Salaam, Tanzania
| | | | - Mark Breda
- United States Walter Reed Army Institute of Research/Department of Defense (WRAIR/DOD), Dar es Salaam, Tanzania
| | - George Mgomella
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Anath Rwebembera
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Mahesh Swaminathan
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
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Clarke‐Deelder E, Eliakimu E, Mbatia R, Bohren MA, Mashasi I, Larson E. Measuring user experience of care among caregivers of sick children: validation and descriptive analysis in a sample of 75 health facilities in rural Tanzania. Trop Med Int Health 2022; 27:317-329. [DOI: 10.1111/tmi.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emma Clarke‐Deelder
- Department of Epidemiology and Public Health Swiss Tropical and Public Health Institute Basel Switzerland
| | - Eliudi Eliakimu
- Health Quality Assurance Unit Ministry of Health, Community Development Gender, Elderly and Children Dodoma Tanzania
| | | | - Meghan A. Bohren
- Gender and Women’s Health Unit Centre for Health Equity School of Population and Global Health University of Melbourne Melbourne Australia
| | - Irene Mashasi
- Management and Development for Health Dar es Salaam Tanzania
| | - Elysia Larson
- Department of Obstetrics and Gynecology Beth Israel Deaconess Medical Center and Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School Boston USA
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Larson E, Gage AD, Mbaruku GM, Mbatia R, Haneuse S, Kruk ME. Effect of a maternal and newborn health system quality improvement project on the use of facilities for childbirth: a cluster-randomised study in rural Tanzania. Trop Med Int Health 2019; 24:636-646. [PMID: 30767422 PMCID: PMC6499631 DOI: 10.1111/tmi.13220] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives Reduction in maternal and newborn mortality requires that women deliver in high quality health facilities. However, many facilities provide sub‐optimal quality of care, which may be a reason for less than universal facility utilisation. We assessed the impact of a quality improvement project on facility utilisation for childbirth. Methods In this cluster‐randomised experiment in four rural districts in Tanzania, 12 primary care clinics and their catchment areas received a quality improvement intervention consisting of in‐service training, mentoring and supportive supervision, infrastructure support, and peer outreach, while 12 facilities and their catchment areas functioned as controls. We conducted a census of all deliveries within the catchment area and used difference‐in‐differences analysis to determine the intervention's effect on facility utilisation for childbirth. We conducted a secondary analysis of utilisation among women whose prior delivery was at home. We further investigated mechanisms for increased facility utilisation. Results The intervention led to an increase in facility births of 6.7 percentage points from a baseline of 72% (95% Confidence Interval: 0.6, 12.8). The intervention increased facility delivery among women with past home deliveries by 18.3 percentage points (95% CI: 10.1, 26.6). Antenatal quality increased in intervention facilities with providers performing an additional 0.5 actions across the full population and 0.8 actions for the home delivery subgroup. Conclusions We attribute the increased use of facilities to better antenatal quality. This increased utilisation would lead to lower maternal mortality only in the presence of improvement in care quality.
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Affiliation(s)
- Elysia Larson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anna D Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Mbatia R, Cohen J, Zuakulu M, Bukuku A, Chandarana S, Eliakimu E, Moshi S, Larson E. Basic Accountability to Stop Ill-Treatment (BASI); Study Protocol for a Cluster Randomized Controlled Trial in Rural Tanzania. Front Public Health 2018; 6:273. [PMID: 30320053 PMCID: PMC6165889 DOI: 10.3389/fpubh.2018.00273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/03/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Poor health system experiences negatively affect the lives of poor people throughout the world. In East Africa, there is a growing body of evidence of poor quality care that in some cases is so poor that it is disrespectful or abusive. This study will assess whether community feedback through report cards (with and without non-financial rewards) can improve patient experience, which includes aspects of patient dignity, autonomy, confidentiality, communication, timely attention, quality of basic amenities, and social support. Methods/Design: This cluster-randomized controlled study will randomize 75 primary health care facilities in rural Pwani Region, Tanzania to one of three arms: private feedback (intervention), social recognition reward through public reporting (intervention), or no feedback (control). Within both intervention arms, we will give the providers at the study facilities feedback on the quality of patient experience the facility provides (aggregate results from all providers) using data from patient surveys. The quality indicators that we report will address specific experiences, be observable by patients, fall into well-identified domains of patient experience, and be within the realm of action by healthcare providers. For example, we will measure the proportion of patients who report that providers definitely “explained things in a way that was easy to understand.” This feedback will be delivered by a medical doctor to all the providers at the facility in a small group session. A formal discussion guide will be used. Facilities randomized to the social recognition intervention reward arm will have two additional opportunities for social recognition. First, a poster that displays their achieved level of patient experience will be publicly posted at the health facility and village government offices. Second, recognition from senior officials at the local NGO and/or the Ministry of Health will be given to the facility with the best or most-improved patient experience ratings at endline. We will use surveys with parents/guardians of sick children to measure patient experience, and surveys with healthcare providers to assess potential mechanisms of effect. Conclusion: Results from this study will provide evidence for whether, and through what mechanisms, patient reported feedback can affect interpersonal quality of care. Pan African Clinical Trials Registry (PACTR): 201710002649121 Protocol version 7, November 8, 2017
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Affiliation(s)
| | - Jessica Cohen
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Martin Zuakulu
- Tanzania Health Promotion Support (THPS), Msasani, Tanzania
| | | | - Shikha Chandarana
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Eliudi Eliakimu
- Ministry of Health, Community Development, Gender, Elderly and Children-MoHCDGEC, Dodoma, Tanzania
| | - Sisty Moshi
- Tanzania Health Promotion Support (THPS), Msasani, Tanzania
| | - Elysia Larson
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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Larson E, Vail D, Mbaruku GM, Mbatia R, Kruk ME. Beyond utilization: measuring effective coverage of obstetric care along the quality cascade. Int J Qual Health Care 2017; 29:104-110. [PMID: 27920246 DOI: 10.1093/intqhc/mzw141] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/16/2016] [Indexed: 11/12/2022] Open
Abstract
Objective To determine the effective coverage of obstetric care in a rural Tanzanian region and to assess differences in effective coverage by wealth. Design Cross-sectional structured interviews. Setting Pwani Region, Tanzania. Participants The study includes 24 rural, government-managed, primary healthcare clinics and their catchment populations. From January-April 2016, we conducted a household survey of a census of women with recent deliveries, health worker knowledge surveys and facility audits. Main Outcome Measures We explored the proportion of women receiving quality care through the cascade and conducted an equity analysis by wealth. Results In total, 2,910 of 3,564 women (81.6%) reported delivering their most recent child in a health facility, 1,096 of whom delivered in a study facility. Using a minimum threshold of quality, the effective coverage of obstetric care was 25%. Quality was lowest in the emergency care dimensions, with the average score on the provider knowledge tests at 47% and the average provision of basic emergency obstetric services below 50%. The wealthiest 20% of women were 4.1 times as likely to deliver in facilities offering at least the minimum threshold of quality care through the cascade compared to the poorest 80% of women (95% confidence interval: 1.5-11.3). Conclusions Effective coverage of delivery care is very low, particularly among poorer women. Health worker knowledge caused the sharpest decline in effective coverage. Measures of effective coverage are a better performance measure of under-resourced health systems than utilization. Equity analyses can further identify important discrepancies in quality across socio-economic levels. Trial Registration ISRCTN 17107760.
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Affiliation(s)
- Elysia Larson
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Bldg 1, 11th floor, Boston, MA 02115, USA
| | - Daniel Vail
- Stanford University School of Medicine, 291 Campus Drive, Palo Alto, CA 94305, USA
| | - Godfrey M Mbaruku
- Ifakara Health Institute, P.O. Box 78373, Plot 463, Kiko Avenue, Mikocheni A, Mwai Kibaki Road, Dar es salaam, United Republic of Tanzania
| | - Redempta Mbatia
- Tanzania Health Promotion Support, 3rd Floor, Coco Plaza Bldg, Plot 254, Masaki Dar es Salaam, United Republic of Tanzania
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Bldg 1, 11th floor, Boston, MA 02115, USA
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Larson E, Rabkin M, Mbaruku GM, Mbatia R, Kruk ME. Missed Opportunities to Improve the Health of Postpartum Women: High Rates of Untreated Hypertension in Rural Tanzania. Matern Child Health J 2017; 21:407-413. [PMID: 28120288 DOI: 10.1007/s10995-016-2229-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/29/2022]
Abstract
Objectives To assess the prevalence of high blood pressure amongst postpartum women in rural Tanzania, and to explore factors associated with hypertension prevalence, awareness, treatment, and control. Methods 1849 women in Tanzania's Pwani Region who delivered a child in the prior year participated in the study. We measured blood pressure, administered a structured questionnaire and assessed factors associated with the prevalence, awareness, treatment, and control of hypertension (HTN) using bivariable and multivariable logistic regressions. Findings 26.7% of women had high blood pressure and/or were taking antihypertensive medication. Women were on average 27.5 years old (range 15-54). Nearly all women (99.5%) reported contact with the health system during their pregnancy and delivery, with an average of 5.2 visits for their own care in the past year. Only 23.5% of those with HTN were aware of their diagnosis, 17.4% were taking medication, and only 10.5% had controlled blood pressure. In multivariable analysis, facility delivery, health insurance, and increased distance from a hospital were associated with increased likelihood of HTN awareness; facility delivery and hospital distance were associated with current hypertensive treatment; younger age and increased hospital distance were associated with control of HTN. Conclusion The prevalence of high blood pressure in this postpartum population was high, and despite frequent recent contacts with the health system, awareness, treatment and control of HTN were low. These findings highlight an important missed opportunity to improve women's health during antenatal and postnatal care.
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Affiliation(s)
- Elysia Larson
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, 11th floor, Boston, MA, 02115, USA.
| | - Miriam Rabkin
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Margaret E Kruk
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, 11th floor, Boston, MA, 02115, USA
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Antelman G, Medley A, Mbatia R, Pals S, Arthur G, Haberlen S, Ackers M, Elul B, Parent J, Rwebembera A, Wanjiku L, Muraguri N, Gweshe J, Mudhune S, Bachanas P. Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania. ACTA ACUST UNITED AC 2016; 41:e1. [PMID: 25512359 DOI: 10.1136/jfprhc-2013-100784] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 12/27/2022]
Abstract
AIM To describe factors associated with pregnancy desire and dual method use among people living with HIV in clinical care in sub-Saharan Africa. DESIGN Sexually active HIV-positive adults were enrolled in 18 HIV clinics in Kenya, Namibia and Tanzania. Demographic, clinical and reproductive health data were captured by interview and medical record abstraction. Correlates of desiring a pregnancy within the next 6 months, and dual method use [defined as consistent condom use together with a highly effective method of contraception (hormonal, intrauterine device (IUD), permanent)], among those not desiring pregnancy, were identified using logistic regression. RESULTS Among 3375 participants (median age 37 years, 42% male, 64% on antiretroviral treatment), 565 (17%) desired a pregnancy within the next 6 months. Of those with no short-term fertility desire (n=2542), 686 (27%) reported dual method use, 250 (10%) highly effective contraceptive use only, 1332 (52%) condom use only, and 274 (11%) no protection. Respondents were more likely to desire a pregnancy if they were from Namibia and Tanzania, male, had a primary education, were married/cohabitating, and had fewer children. Factors associated with increased likelihood of dual method use included being female, being comfortable asking a partner to use a condom, and communication with a health care provider about family planning. Participants who perceived that their partner wanted a pregnancy were less likely to report dual method use. CONCLUSIONS There was low dual method use and low use of highly effective contraception. Contraceptive protection was predominantly through condom-only use. These findings demonstrate the importance of integrating reproductive health services into routine HIV care.
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Affiliation(s)
- Gretchen Antelman
- Research and Evaluation Director (Tanzania), ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amy Medley
- Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Redempta Mbatia
- Executive Director, Tanzania Health Promotion Support, Dar es Salaam, United Republic of Tanzania
| | - Sherri Pals
- Mathematical Statistician, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gilly Arthur
- Associate Director of Science, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | - Sabina Haberlen
- Science Office Team Lead, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | - Marta Ackers
- HIV Care and Treatment Branch Chief, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Batya Elul
- Director of Strategic Information (ICAP) and Assistant Professor of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Julie Parent
- Study Coordinator, Ministry of Health and Social Services, Windhoek, Namibia
| | - Anath Rwebembera
- Pediatrician, Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania
| | - Lucy Wanjiku
- Senior Care and Treatment Medical Officer, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | - Justice Gweshe
- Chief Medical Officer and National Programme Manager, Ministry of Health and Social Services, Windhoek, Namibia
| | - Sandra Mudhune
- Senior M&E Officer, Research and Evaluation, The International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Pamela Bachanas
- Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Nuwagaba-Biribonwoha H, Kilama B, Antelman G, Khatib A, Almeida A, Reidy W, Ramadhani G, Lamb MR, Mbatia R, Abrams EJ. Reviewing progress: 7 year trends in characteristics of adults and children enrolled at HIV care and treatment clinics in the United Republic of Tanzania. BMC Public Health 2013; 13:1016. [PMID: 24160907 PMCID: PMC3937235 DOI: 10.1186/1471-2458-13-1016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 10/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the on-going scale-up of HIV programs, we assessed trends in patient characteristics at enrolment and ART initiation over 7 years of implementation. METHODS Data were from Optimal Models, a prospective open cohort study of HIV-infected (HIV+) adults (≥15 years) and children (<15 years) enrolled from January 2005 to December 2011 at 44 HIV clinics in 3 regions of mainland Tanzania (Kagera, Kigoma, Pwani) and Zanzibar. Comparative statistics for trends in characteristics of patients enrolled in 2005-2007, 2008-2009 and 2010-2011 were examined. RESULTS Overall 62,801 HIV + patients were enrolled: 58,102(92.5%) adults, (66.5% female); 4,699(7.5%) children.Among adults, pregnant women enrolment increased: 6.8%, 2005-2007; 12.1%, 2008-2009; 17.2%, 2010-2011; as did entry into care from prevention of mother-to-child HIV transmission (PMTCT) programs: 6.6%, 2005-2007; 9.5%, 2008-2009; 12.6%, 2010-2011. WHO stage IV at enrolment declined: 27.1%, 2005-2007; 20.2%, 2008-2009; 11.1% 2010-2011. Of the 42.5% and 29.5% with CD4+ data at enrolment and ART initiation respectively, median CD4+ count increased: 210 cells/μL, 2005-2007; 262 cells/μL, 2008-2009; 266 cells/μL 2010-2011; but median CD4+ at ART initiation did not change (148 cells/μL overall). Stavudine initiation declined: 84.9%, 2005-2007; 43.1%, 2008-2009; 19.7%, 2010-2011.Among children, median age (years) at enrolment decreased from 6.1(IQR:2.7-10.0) in 2005-2007 to 4.8(IQR:1.9-8.6) in 2008-2009, and 4.1(IQR:1.5-8.1) in 2010-2011 and children <24 months increased from 18.5% to 26.1% and 31.5% respectively. Entry from PMTCT was 7.0%, 2005-2007; 10.7%, 2008-2009; 15.0%, 2010-2011. WHO stage IV at enrolment declined from 22.9%, 2005-2007, to 18.3%, 2008-2009 to 13.9%, 2010-2011. Proportion initiating stavudine was 39.8% 2005-2007; 39.5%, 2008-2009; 26.1%, 2010-2011. Median age at ART initiation also declined significantly. CONCLUSIONS Over time, the proportion of pregnant women and of adults and children enrolled from PMTCT programs increased. There was a decline in adults and children with advanced HIV disease at enrolment and initiation of stavudine. Pediatric age at enrolment and ART initiation declined. Results suggest HIV program maturation from an emergency response.
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Lahuerta M, Selenic D, Mwakitosha G, Hokororo J, Ngonyani H, Kassa G, Mbatia R, Basavaraju SV, Courtenay-Quirk C, Liu Y, Simbeye D, Kazura K, Antelman G, Bock N. O029: Reporting and case management of bloodborne pathogen exposures among health care workers in Tanzania. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688099 DOI: 10.1186/2047-2994-2-s1-o29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- M Lahuerta
- ICAP-Columbia University, Mailman School of Public Health, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - D Selenic
- Divisions of Global HIV/AIDS, Centers for Disease Control and Prevention , Atlanta, USA
| | - G Mwakitosha
- ICAP-Columbia University, Mailman School of Public Health, USA
| | - J Hokororo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania, United Republic of
| | - H Ngonyani
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania, United Republic of
| | - G Kassa
- ICAP-Columbia University, Mailman School of Public Health, USA
| | - R Mbatia
- Tanzania Health Promotion Support (THPS), Dar es Salaam, Tanzania, United Republic of
| | - SV Basavaraju
- Divisions of Global HIV/AIDS, Centers for Disease Control and Prevention , Atlanta, USA
| | - C Courtenay-Quirk
- Divisions of Global HIV/AIDS, Centers for Disease Control and Prevention , Atlanta, USA
| | - Y Liu
- Divisions of Global HIV/AIDS, Centers for Disease Control and Prevention , Atlanta, USA
| | - D Simbeye
- US Centers for Disease Control and Prevention, Dar es Salaam, Tanzania, United Republic of
| | - K Kazura
- US Centers for Disease Control and Prevention, Dar es Salaam, Tanzania, United Republic of
| | - G Antelman
- ICAP-Columbia University, Mailman School of Public Health, USA
| | - N Bock
- Divisions of Global HIV/AIDS, Centers for Disease Control and Prevention , Atlanta, USA
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Kidder DP, Bachanas P, Medley A, Pals S, Nuwagaba-Biribonwoha H, Ackers M, Howard A, Deluca N, Mbatia R, Sheriff M, Arthur G, Katuta F, Cherutich P, Somi G. HIV prevention in care and treatment settings: baseline risk behaviors among HIV patients in Kenya, Namibia, and Tanzania. PLoS One 2013; 8:e57215. [PMID: 23459196 PMCID: PMC3581447 DOI: 10.1371/journal.pone.0057215] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 01/23/2013] [Indexed: 12/23/2022] Open
Abstract
HIV care and treatment settings provide an opportunity to reach people living with HIV/AIDS (PLHIV) with prevention messages and services. Population-based surveys in sub-Saharan Africa have identified HIV risk behaviors among PLHIV, yet data are limited regarding HIV risk behaviors of PLHIV in clinical care. This paper describes the baseline sociodemographic, HIV transmission risk behaviors, and clinical data of a study evaluating an HIV prevention intervention package for HIV care and treatment clinics in Africa. The study was a longitudinal group-randomized trial in 9 intervention clinics and 9 comparison clinics in Kenya, Namibia, and Tanzania (N = 3538). Baseline participants were mostly female, married, had less than a primary education, and were relatively recently diagnosed with HIV. Fifty-two percent of participants had a partner of negative or unknown status, 24% were not using condoms consistently, and 11% reported STI symptoms in the last 6 months. There were differences in demographic and HIV transmission risk variables by country, indicating the need to consider local context in designing studies and using caution when generalizing findings across African countries. Baseline data from this study indicate that participants were often engaging in HIV transmission risk behaviors, which supports the need for prevention with PLHIV (PwP).
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Affiliation(s)
- Daniel P Kidder
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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Reyburn H, Mbatia R, Drakeley C, Bruce J, Carneiro I, Olomi R, Cox J, Nkya WMMM, Lemnge M, Greenwood BM, Riley EM. Association of transmission intensity and age with clinical manifestations and case fatality of severe Plasmodium falciparum malaria. JAMA 2005; 293:1461-70. [PMID: 15784869 DOI: 10.1001/jama.293.12.1461] [Citation(s) in RCA: 215] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT There are concerns that malaria control measures such as use of insecticide-treated bed nets, by delaying acquisition of immunity, might result in an increase in the more severe manifestations of malaria. An understanding of the relationships among the level of exposure to Plasmodium falciparum, age, and severity of malaria can provide evidence of whether this is likely. OBJECTIVE To describe the clinical manifestations and case fatality of severe P falciparum malaria at varying altitudes resulting in varying levels of transmission. DESIGN, SETTING, AND PATIENTS A total of 1984 patients admitted for severe malaria to 10 hospitals serving populations living at levels of transmission varying from very low (altitude >1200 m) to very high (altitude <600 m) in a defined area of northeastern Tanzania, studied prospectively from February 2002 to February 2003. Data were analyzed in a logistic regression model and adjusted for potential clustering within hospitals. MAIN OUTCOME MEASURES Specific syndromes of severe malaria; mortality. RESULTS The median age of patients was 1 year in high transmission, 3 years in moderate transmission, and 5 years in low transmission areas. The odds of severe malarial anemia (hemoglobin <5 g/dL) peaked at 1 year of age at high transmission and at 2 years at moderate and low transmission intensities and then decreased with increasing age (P = .002). Odds were highest in infants (0-1 year: referent; 2-4 years: odds ratio [OR], 0.83; 95% confidence interval [CI], 0.72-0.96), 5 to <15 years: OR, 0.44; 95% CI, 0.27-0.72; > or =15 years: OR, 0.44; 95% CI, 0.27-0.73; P<.001) and high transmission intensity areas (altitude <600 m: referent; 600 m to 1200 m: OR, 0.55; 95% CI, 0.35-0.84; >1200 m: OR, 0.55; 95% CI, 0.26-1.15; P for trend = .03). The odds of cerebral malaria were significantly higher in low transmission intensity areas (altitude of residence <600 m: referent; 600 m to 1200 m: OR, 3.17; 95% CI, 1.32-7.60; >1200 m: OR, 3.76; 95% CI, 1.96-7.18; P for trend = .003) and with age 5 years and older (0-1 year: referent; 2-4 years: OR, 1.57; 95% CI, 0.82-2.99; 5 to <15 years: OR, 6.07; 95% CI, 2.98-12.38; > or =15 years: OR, 6.24; 95% CI, 3.47-11.21; P<.001). The overall case-fatality rate of 7% (139 deaths) was similar at high and moderate levels of transmission but increased to 13% in low transmission areas (P = .03), an increase explained by the increase in the proportion of cases with cerebral malaria. CONCLUSIONS Age and level of exposure independently influence the clinical presentation of severe malaria. Our study suggests that an increase in the proportion of cases with more fatal manifestations of severe malaria is likely to occur only after transmission has been reduced to low levels where the overall incidence is likely to be low.
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Affiliation(s)
- Hugh Reyburn
- London School of Hygiene and Tropical Medicine, London, England.
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Gosling R, Mbatia R, Savage A, Mulligan JA, Reyburn H. Prevalence of hospital-acquired infections in a tertiary referral hospital in northern Tanzania. Ann Trop Med Parasitol 2003; 97:69-73. [PMID: 12662424 DOI: 10.1179/000349803125002724] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hospital-acquired infections (HAI) are a major and largely preventable cause of morbidity and morbidity worldwide. Very few reports on the prevalence of HAI in sub-Saharan Africa have been published and most of those that have appeared in the press have focused on surgical-wound infection. In the present, questionnaire-based, point-prevalence study, in which the doctor on the ward round was used as the primary informant, the prevalences of all HAI among all the inpatients at a tertiary referral hospital in northern Tanzania were estimated. On the day of the study, there were 412 inpatients (in 15 ward areas) and 61 cases of HAI were identified, giving an overall HAI prevalence of 14.8%. The prevalences of HAI were particularly high in the medical intensive-care unit (40%), the surgical (orthopaedic and general surgery) wards (36.7%), and one of the general medical wards (22.2%). Factors associated with a patient having a HAI were hospitalization for >30 days [odds ratio (OR) = 4.07; 95% confidence interval (CI) = 2.07-7.99]; being a patient on the orthopaedic and general surgical ward known as 'Surgical 2' (OR = 2.14; CI = 1.02-4.46); and being referred from another health facility (OR = 1.90; CI = 1.02-3.42). The most commonly identified HAI in the hospital were urinary-tract infections (14 cases), followed by surgical-wound infections (10 cases) and then lower respiratory-tract infections (six cases). Twenty HAI were 'unspecified'. The study was rapid and cheap to carry out. The results not only gave a baseline estimate of HAI in the study setting but also identified key areas for interventions to reduce HAI.
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Affiliation(s)
- R Gosling
- Department of Medical Microbiology, Royal Free and University College London Medical School, Rowland Hill Street, Hampstead NW3 2PF, UK.
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