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Karoli P, Mayige M, Kagaruki G, Mori A, Macha E, Mutagaywa R, Momba A, Peter H, Willilo R, Chillo P, Banduka A, Sunguya B, Ramaiya K, Majaliwa E, Malangahe S, Nyarubamba R, Mtumbuka E, Mallya E, Soka D, Urasa S, Rutahoile W, Magoma B, Donald E, Mwenesano D, Kilonzo K. Mid-level healthcare workers knowledge on non-communicable diseases in Tanzania: a district-level pre-and post-training assessment. BMC Health Serv Res 2024; 24:612. [PMID: 38725061 PMCID: PMC11084094 DOI: 10.1186/s12913-024-11078-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/06/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Over the past two decades, Tanzania's burden of non-communicable diseases has grown disproportionately, but limited resources are still prioritized. A trained human resource for health is urgently needed to combat these diseases. However, continuous medical education for NCDs is scarce. This paper reports on the mid-level healthcare workers knowledge on NCDs. We assessed the knowledge to measure the effectiveness of the training conducted during the initiation of a Package for Essential Management of Severe NCDs (PEN Plus) in rural district hospitals in Tanzania. METHODS The training was given to 48 healthcare employees from Dodoma Region's Kondoa Town Council District Hospital. For a total of five (5) days, a fundamental course on NCDs featured in-depth interactive lectures and practical workshops. Physicians from Tanzania's higher education institutions, tertiary university hospitals, research institutes, and medical organizations served as trainers. Before and after the training, a knowledge assessment comprising 28 questions was administered. Descriptive data analysis to describe the characteristics of the specific knowledge on physiology, diagnosis and therapy of diabetes mellitus, rheumatic fever, heart disease, and sickle cell disease was done using Stata version 17 (STATA Corp Inc., TX, USA). RESULTS Complete assessment data for 42 out of the 48 participants was available. Six participants did not complete the training and the assessment. The mean age of participants was 36.9 years, and slightly above half (52%) were above 35 years. Two-thirds (61.9%) were female, and about half (45%) were nurses. The majority had the experience of working for more than 5 years, and the average was 9.4 years (+/- 8.4 years). Overall, the trainees' average scores improved after the training (12.79 vs. 16.05, p < 0.0001) out of 28 possible scores. Specifically, trainees' average scores were better in treatment than in diagnosis, except for sickle cell disease (1.26 vs. 1.83). Most were not able to diagnose rheumatic heart disease (47.6% able) compared to diabetes mellitus (54.8% able) or sickle cell disease (64.3% able) at baseline. The proportion of trainees with adequate knowledge of the treatment of sickle cell disease and diabetes mellitus was 35% and 38.1%, respectively, and there was a non-statistical difference after training. Those working for less than 5 years had a higher proportion of adequate knowledge (30.8%) compared to their more experienced colleagues (6.9%). After the training, participants' knowledge of NCDs increased by three times (i.e., aPR 3, 95% CI = 1.1, 1.5, and 6.0). CONCLUSION AND RECOMMENDATIONS PEN Plus training improved the knowledge of healthcare workers at Kondoa Town Council District Hospital. Training is especially needed among nurses and those with a longer duration of work. Continuing education for human resources for health on the management of NCDs is highly recommended in this setting.
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Grants
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- 126365 Brigham and Women's Hospital, USA.
- Brigham and Women’s Hospital, USA.
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Affiliation(s)
- Peter Karoli
- National Institute for Medical Research-Tanzania (NIMR), Dar es Salaam, Tanzania.
| | - Mary Mayige
- National Institute for Medical Research-Tanzania (NIMR), Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Gibson Kagaruki
- National Institute for Medical Research-Tanzania (NIMR), Dar es Salaam, Tanzania
- Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
| | - Amani Mori
- National Institute for Medical Research-Tanzania (NIMR), Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- University of Bergen, Bergen, Norway
| | | | - Reuben Mutagaywa
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Jakaya Kikwete Cardiac Institute (JKCI), Dar es Salaam, Tanzania
| | | | | | | | - Pilly Chillo
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Jakaya Kikwete Cardiac Institute (JKCI), Dar es Salaam, Tanzania
| | - Aidan Banduka
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | | | - Edna Majaliwa
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Muhimbili National Hospital (MNH), Tanzania, Muhimbili National Hospital (MNH)
| | | | - Renatus Nyarubamba
- The Tanzania NCD Alliance (TANCDA), Dar es Salaam, Tanzania
- Tanzania Diabetes Association (TDA), Dar es Salaam, Tanzania
| | - Esther Mtumbuka
- Clinton Health Access Initiative (CHAI), Dar es Salaam, Tanzania
| | - Elizabeth Mallya
- National Institute for Medical Research-Tanzania (NIMR), Dar es Salaam, Tanzania
| | - Deogratias Soka
- Tanzania Sickle Cell Disease Foundation (TANSCDF),, Sickle Cell Disease Foundation (TANSCDF), Dar es Salaam, Tanzania
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
| | | | | | | | | | - Kajiru Kilonzo
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Christian Medical Center (KCMC), Moshi, Kilimanjaro, Tanzania
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Lyimo A, Mmbaga B, Mahmoud A, Eliamini WS, Ngowi NB, Mitao M, Pancras G, Malindisa E, Kidayi P, Conserve DF, Bartlett J, Sunguya B, Lyamuya E, Kidenya B, Balandya E, Ngocho JS. Efficacy of mobile phone intervention to increase male partner antenatal care attendance for HIV testing in Moshi municipal, Tanzania: a randomized controlled trial. BMC Pregnancy Childbirth 2024; 24:306. [PMID: 38658860 PMCID: PMC11040948 DOI: 10.1186/s12884-024-06337-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND HIV partner counselling and testing in antenatal care (ANC) is a crucial strategy to raise the number of males who know their HIV status. However, in many settings like Tanzania, male involvement in antenatal care remains low, and there is a definite need for innovative strategies to increase male partner involvement. This study was designed to evaluate the efficacy of mobile phone intervention increase male partner ANC attendance for HIV testing in Moshi municipal, Tanzania. METHODS Between April and July 2022, we enrolled pregnant women presenting to a first ANC visit at Majengo and St. Joseph reproductive health facilities without their male partners. Eligible pregnant women were randomly assigned to invitation of their male partners either via phone calls, text messages from clinic staff and verbal invites from pregnant partners (intervention arm) or verbal invites only from the pregnant partners (control arm). Neither healthcare provider nor participant were blinded. The primary outcome was the proportion of male partners who attended ANC with their pregnant partners during a follow-up period of two consecutive visits. The secondary outcome measure was HIV testing among male partners following the invitation. Participants were analyzed as originally assigned (intention to treat). RESULTS A total of 350 pregnant women presenting to ANC for the first time were enrolled, with 175 women enrolled in each arm. The efficacy of male attendance with their pregnant women following the invitations was 83.4% (147/175) in the intervention arm and 46.3% (81/175) in the control arm. Overall, the results suggest a positive and statistically significant average treatment effect among men who received mobile phone intervention on ANC attendance. For the secondary outcome, the percent of male partners who accepted HIV counselling and testing was 99.3% (146/147) in the intervention arm and 93.8% (76/81) in the control arm. Married men were having higher odds of ANC attendance compared with single men (aOR:6.40(3.26-12.56), Males with multigravida women were having lower odds of ANC attendance compared with primigravida women (aOR:0.17(0.09-0.33). CONCLUSION The study demonstrates that supplementing verbal invitations with mobile phone calls and text messages from clinic staff can significantly increase male partner ANC attendance and HIV testing. This combined approach is recommended in improving ANC attendance and HIV testing of male partners who do not accompany their pregnant partners to antenatal clinics in the first visits. TRIAL REGISTRATION PACTR202209769991162.
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Affiliation(s)
- Angela Lyimo
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania.
| | - Blandina Mmbaga
- Kilimanjaro Clinical Research Institute, Box 2236, Moshi, Tanzania
| | - Ashraf Mahmoud
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | - Wilson Saimon Eliamini
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | | | - Modesta Mitao
- Kilimanjaro Clinical Research Institute, Box 2236, Moshi, Tanzania
| | - Godwin Pancras
- Muhimbili University of Health and Allied Science, Box 65001, Dar es Salam, Tanzania
| | | | - Paulo Kidayi
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | - Donaldson F Conserve
- Milken Institute of Public Health, The George Washington University, Washington, DC, USA
| | | | - Bruno Sunguya
- Muhimbili University of Health and Allied Science, Box 65001, Dar es Salam, Tanzania
| | - Eligius Lyamuya
- Muhimbili University of Health and Allied Science, Box 65001, Dar es Salam, Tanzania
| | - Benson Kidenya
- Catholic University of Health and Allied Science, Box 1464, Mwanza, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Science, Box 65001, Dar es Salam, Tanzania
| | - James Samwel Ngocho
- Department of Epidemiology and Applied Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
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Barabona G, Ngare I, Kamori D, Nkinda L, Kosugi Y, Mawazo A, Ekwabi R, Kinasa G, Chuwa H, Sato K, Sunguya B, Ueno T. Neutralizing immunity against coronaviruses in Tanzanian health care workers. Sci Rep 2024; 14:5508. [PMID: 38448564 PMCID: PMC10917759 DOI: 10.1038/s41598-024-55989-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
The ongoing vaccination efforts and exposure to endemic and emerging coronaviruses can shape the population's immunity against this group of viruses. In this study, we investigated neutralizing immunity against endemic and emerging coronaviruses in 200 Tanzanian frontline healthcare workers (HCWs). Despite low vaccination rates (19.5%), we found a high SARS-CoV-2 seroprevalence (94.0%), indicating high exposure in these HCWs. Next, we determined the neutralization capacity of antisera against human coronavirus NL63, and 229E, SARS-CoV-1, MERS-CoV and SARS-CoV-2 (including Omicron subvariants: BA.1, BQ.1.1 and XBB.1.5) using pseudovirus neutralization assay. We observed a broad range of neutralizing activity in HCWs, but no neutralization activity detected against MERS-CoV. We also observed a strong correlation between neutralizing antibody titers for SARS-CoV-2 and SARS-CoV-1, but not between other coronaviruses. Cross-neutralization titers against the newer Omicron subvariants, BQ.1.1 and XBB.1.5, was significantly reduced compared to BA.1 and BA.2 subvariants. On the other hand, the exposed vaccinated HCWs showed relatively higher median cross-neutralization titers against both the newer Omicron subvariants and SARS-CoV-1, but did not reach statistical significance. In summary, our findings suggest a broad range of neutralizing potency against coronaviruses in Tanzanian HCWs with detectable neutralizing immunity against SARS-CoV-1 resulting from SARS-CoV-2 exposure.
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Affiliation(s)
- Godfrey Barabona
- Division of Infection and Immunity, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Isaac Ngare
- Division of Infection and Immunity, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Doreen Kamori
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Collaboration Unit for Infection, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Lilian Nkinda
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yusuke Kosugi
- Division of Systems Virology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ambele Mawazo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rayi Ekwabi
- Amana Regional Referral Hospital, Dar es Salaam, Tanzania
| | | | | | - Kei Sato
- Collaboration Unit for Infection, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- Division of Systems Virology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
- International Research Center for Infectious Diseases, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- International Vaccine Design Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- CREST, Japan Science and Technology Agency, Kawaguchi, Japan
| | - Bruno Sunguya
- Collaboration Unit for Infection, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Takamasa Ueno
- Division of Infection and Immunity, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan.
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Nkuwi E, Judicate GP, Tan TS, Barabona G, Toyoda M, Sunguya B, Kamori D, Ueno T. Relative resistance of patient-derived envelope sequences to SERINC5-mediated restriction of HIV-1 infectivity. J Virol 2023; 97:e0082323. [PMID: 37768085 PMCID: PMC10617508 DOI: 10.1128/jvi.00823-23] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023] Open
Abstract
IMPORTANCE Pathogenesis of HIV-1 is enhanced through several viral-encoded proteins that counteract a range of host restriction molecules. HIV-1 Nef counteracts the cell membrane protein SERINC5 by downregulating it from the cell surface, thereby enhancing virion infectivity. Some subtype B reference Envelope sequences have shown the ability to bypass SERINC5 infectivity restriction independent of Nef. However, it is not clear if and to what extent circulating HIV-1 strains can exhibit resistance to SERINC5 restriction. Using a panel of Envelope sequences isolated from 50 Tanzanians infected with non-B HIV-1 subtypes, we show that the lentiviral reporters pseudotyped with patient-derived Envelopes have reduced sensitivity to SERINC5 and that this sensitivity differed among viral subtypes. Moreover, we found that SERINC5 sensitivity within patient-derived Envelopes can be modulated by separate regions, highlighting the complexity of viral/host interactions.
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Affiliation(s)
- Emmanuel Nkuwi
- Division of Infection and Immunity, Joint Research Center for Human Retrovirus Infection Kumamoto University, Kumamoto, Japan
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Department of Microbiology and Parasitology, The University of Dodoma, Dodoma, Tanzania
| | - George P. Judicate
- Division of Infection and Immunity, Joint Research Center for Human Retrovirus Infection Kumamoto University, Kumamoto, Japan
| | - Toong Seng Tan
- Division of Infection and Immunity, Joint Research Center for Human Retrovirus Infection Kumamoto University, Kumamoto, Japan
| | - Godfrey Barabona
- Division of Infection and Immunity, Joint Research Center for Human Retrovirus Infection Kumamoto University, Kumamoto, Japan
| | - Mako Toyoda
- Division of Infection and Immunity, Joint Research Center for Human Retrovirus Infection Kumamoto University, Kumamoto, Japan
| | - Bruno Sunguya
- Collaboration Unit for Infection, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Doreen Kamori
- Collaboration Unit for Infection, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Takamasa Ueno
- Division of Infection and Immunity, Joint Research Center for Human Retrovirus Infection Kumamoto University, Kumamoto, Japan
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Mboya E, Mizinduko M, Balandya B, Mushi J, Sabasaba A, Amani DE, Kamori D, Ruhago G, Faustine P, Maokola W, Sambu V, Nyamuhagata M, Jullu BS, Juya A, Rugemalila J, Mgomella G, Asiimwe S, Pembe AB, Sunguya B. HIV burden and the global fast-track targets progress among pregnant women in Tanzania calls for intensified case finding: Analysis of 2020 antenatal clinics HIV sentinel site surveillance. PLoS One 2023; 18:e0285962. [PMID: 37824470 PMCID: PMC10569580 DOI: 10.1371/journal.pone.0285962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND For successful HIV response, updated information on the burden and progress toward HIV elimination targets are required to guide programmatic interventions. We used data from the 2020 HIV sentinel surveillance to update on the burden and factors associated with HIV infection, HIV status awareness, and ART coverage among pregnant women in Tanzania mainland. METHODOLOGY We conducted the surveillance in 159 antenatal clinics (ANC) from all 26 regions of Tanzania's mainland from September to December 2020. This cross-sectional study included all pregnant women (≥15 years) on their first ANC visit in the current pregnancy during the survey period. Routine HIV counselling and testing were done at the facility. A multivariable logistic regression model accounting for the survey design was used to examine factors associated with HIV infections. RESULTS 38,783 pregnant women were enrolled (median age (IQR) = 25 (21-30) years). HIV prevalence was 5.9% (95%CI: 5.3% - 6.6%), ranging from 1.9% in the Manyara region to 16.4% in the Njombe region. Older age, lower and no education, not being in a marital union, and living in urban or semi-urban areas were associated with higher odds of HIV infection. HIV status awareness among women who tested positive was 70.9% (95% CI: 67.5%- 74.0%). ART coverage among those aware of their status was 91.6% (86.5%- 94.9%). Overall, 66.6% (95% CI: 62.4%- 70.6%) of all pregnant women who tested positive for HIV knew their HIV status and were on ART. CONCLUSION HIV is increasingly prevalent among pregnant women in Tanzania mainland especially among older, those with lower or no formal education, those outside marital union, and pregnant women living in urban and semi-urban areas. Behind the global fast-target to end HIV/ AIDS, about a third of pregnant women living with HIV initiating ANC were not on ART. Interventions to increase HIV testing and linkage to care among women of reproductive age should be intensified.
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Affiliation(s)
- Erick Mboya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mucho Mizinduko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Belinda Balandya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Amon Sabasaba
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Davis Elias Amani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Doreen Kamori
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - George Ruhago
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | | | | | - Boniphace S. Jullu
- St. Francis University College of Health and Allied Sciences, Morogoro, Tanzania
| | - Amir Juya
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | | | - George Mgomella
- Centre for Diseases Control, Country Office, Dar es Salaam, Tanzania
| | | | - Andrea B. Pembe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Munishi C, Ndumwa HP, Massawe JE, Njiro BJ, Ngowi J, Suhartono S, Busse A, Campello G, Garofalo G, Cipolla P, Nyandindi C, Ubuguyu O, Sunguya B. Acceptability of using mobile Health (mHealth) as an intervention tool for people with drug use disorders in Tanga, Tanzania. PLOS Digit Health 2023; 2:e0000257. [PMID: 37756266 PMCID: PMC10530012 DOI: 10.1371/journal.pdig.0000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/02/2023] [Indexed: 09/29/2023]
Abstract
Evidence on the additional benefit in treatment and recovery process among PWDUD using digital health interventions is lacking. This study aimed to describe the acceptability of using a digital intervention to increase information access for PWDUD in Tanga region, Tanzania. This study was conducted among 465 participants in Tanga, a coastal region on the Northeast of Tanzania has the second highest number of PWDUD in Tanzania. This cross-sectional descriptive study used both quantitative and qualitative approaches. The majority of the PWDUD 67.6% do not own mobile phones. Out of the 156 participants with mobile phones, only 6.4% owned a smartphone. Most of the participants, 83.6%, reported living with someone who owns a mobile phone. Importantly, a significant number of participants, 98.5% from both areas showed readiness to use mobile phones to access information about the harmful use of substance and substance use disorder treatment options. Participants described how mobile phones can be useful to them in accessing information related to treatment and access to treatment options. The findings of this study helped to inform the target audience for the developed Huru App that should not be only PWDUD but the community at large.
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Affiliation(s)
- Castory Munishi
- Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Harrieth P. Ndumwa
- Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Josephine E. Massawe
- Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Belinda J. Njiro
- Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Jackline Ngowi
- Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Sanita Suhartono
- Prevention, Treatment and Rehabilitation Section, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Anja Busse
- Prevention, Treatment and Rehabilitation Section, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Giovanna Campello
- Prevention, Treatment and Rehabilitation Section, United Nations Office on Drugs and Crime, Vienna, Austria
| | | | | | | | | | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
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7
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Sunguya B, Mboya EA, Mizinduko M, Balandya B, Sabasaba A, Amani DE, Kamori D, Ruhago G, Mkumbwa R, Faustine P, Maokola W, Sambu V, Mushi J, Nyamuhagata M, Jullu BS, Juya A, Rugemalila J, Mgomella G, Asiimwe S, Pembe AB. Epidemiology of syphilis infections among pregnant women in Tanzania: Analysis of the 2020 national representative sentinel surveillance. PLoS One 2023; 18:e0285069. [PMID: 37651360 PMCID: PMC10470872 DOI: 10.1371/journal.pone.0285069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Syphilis has detrimental effects on the health of the mother and that of both fetuses and newborns exposed in utero or at delivery. Understanding its local epidemiology is essential for policies, planning, and implementation of targeted preventive interventions. Using data from the 2020 National Sentinel Surveillance of pregnant women attending antenatal clinics (ANCs) in Tanzania we determined the prevalence and determinants of syphilis among pregnant women in Tanzania mainland. METHODOLOGY The ANC surveillance was conducted in 159 ANC sites from all 26 regions of Tanzania's mainland from September to December 2020. It included all pregnant women 15 years and above on their first ANC visit in the current pregnancy during the survey period. Counseling for syphilis was done using standard guidelines at the ANC and testing was done using rapid SD Bioline HIV/Syphilis Duo test kits. Analysis was done using both descriptive statistics to determine the prevalence and characteristics of syphilis, whereas, logistic regressions were used to examine the independent association between syphilis and dependent variables. RESULTS A total of 38,783 women [median age (Interquartile range (IQR)) = 25 (21-30) years] participated in the surveillance. Of them, 582 (1.4%) tested positive for syphilis. A wide regional variation was observed with the highest burden in Kagera (4.5%) to the lowest burden in Kigoma (0.3%). The odds of syphilis infections were higher among older women and those with no formal education. Compared with primigravids, women with 1-2, those with 3-4 and those with more than four previous pregnancies had 1.8 (aOR = 1.8, 95% CI: 1.2-2.5), 2.1 (aOR = 2.1, 95% CI: 1.4-3.1) and 2.6 (aOR = 2.6, 95% CI: 1.7-3.9) higher odds of syphilis infection respectively. CONCLUSION Syphilis is still prevalent among pregnant women in Tanzania with a wide regional disparity. Efforts to prevent new infections, screen pregnant women, and treat those infected should be strategized to include all regions and renewed emphasis on regions with high burden, and importantly among women who are multipara, with a low level of education, and advanced age.
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Affiliation(s)
- Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | | | - Mucho Mizinduko
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Belinda Balandya
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Amon Sabasaba
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Davis Elias Amani
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Doreen Kamori
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - George Ruhago
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Rebecca Mkumbwa
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | | | | | | | | | | | - Boniphace S. Jullu
- St. Francis University College of Health and Allied Sciences, Morogoro, Tanzania
| | - Amir Juya
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | | | | | | | - Andrea B. Pembe
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
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Ndumwa HP, Mboya EA, Amani DE, Mashoka R, Nicholaus P, Haniffa R, Beane A, Mfinanga J, Sunguya B, Sawe HR, Baker T. Correction: The burden of respiratory conditions in the emergency department of Muhimbili National Hospital in Tanzania in the first two years of the COVID-19 pandemic: A cross sectional descriptive study. PLOS Glob Public Health 2023; 3:e0002125. [PMID: 37363890 PMCID: PMC10292689 DOI: 10.1371/journal.pgph.0002125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
[This corrects the article DOI: 10.1371/journal.pgph.0000781.].
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9
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Malindisa E, Balandya E, Njelekela M, Kidenya BR, Francis F, Mmbaga BT, Dika H, Lyamuya E, Sunguya B, Bartlett J, PrayGod G. Metabolic syndrome among people living with HIV on antiretroviral therapy in Mwanza, Tanzania. BMC Endocr Disord 2023; 23:88. [PMID: 37085806 PMCID: PMC10120112 DOI: 10.1186/s12902-023-01340-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/13/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND HIV and antiretroviral drugs, particularly protease inhibitors and nucleoside reverse transcriptase inhibitors, may increase the risk of Metabolic Syndrome (MetS) among people living with HIV (PLHIV). However, following the introduction of better drugs like dolutegravir, data on the burden of MetS are limited. This study aimed to assess the prevalence of MetS and associated factors among PLHIV on antiretroviral therapy (ART) in Tanzania. METHODS This was a cross-sectional study among PLHIV aged ≥ 18 years on antiretroviral therapy for ≥ 1 year at Bugando Medical Centre in Mwanza conducted in 2020. Demographic and healthy-lifestyle-related non-communicable disease risk factors data were collected. Additionally, data on lipid profile, blood glucose, blood pressure, and waist circumference were collected for analysis of MetS according to the International Diabetes Federation criteria. Factors associated with MetS were assessed using logistic regression. A P ≤ 0.05 was considered statistically significant. RESULTS Data for 223 participants were analyzed. The mean (SD) age was 44 (± 12) years and 79.8% (178) were females. A majority 78% (174) were on a tenofovir, lamivudine,and dolutegravir regimen. About 12.1% (27) were either current or past smokers, 45.3% (101) were past alcohol drinkers, 22.9% (51) were current drinkers, 12.1% (27) reported taking ≥ 5 servings of vegetables and fruits per day and 5.8% (13) were physically inactive. The prevalence of MetS was 22.9%. The only factors that were associated with Mets were fat mass index and adequate intake of vegetables and fruits, (adjusted odds ratio (aOR) 2.9, 95% CI 1.0, 7.9, P = 0.04) and (aOR1.2, 95% CI 1.0, 1.3, P = 0.02), respectively). CONCLUSION The prevalence of MetS remains high among PLHIV. Adiposity and adequate fruit and vegetable intake increased the risk. The introduction of new ART regimens shows no effect on MetS prevalence. Research is needed to understand how lifestyle changes could reduce MetS in PLHIV.
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Affiliation(s)
- Evangelista Malindisa
- Department of Physiology, Catholic University of Health and Allied Sciences Bugando, P.O. Box 1464, Mwanza, Tanzania.
- Mwanza Research Centre, National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania.
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Marina Njelekela
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
- Deloitte Consulting Limited, P.O. Box 1559, Dar Es Salaam, Tanzania
| | - Benson R Kidenya
- Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences Bugando, P.O. Box 1464, Mwanza, Tanzania
| | - Filbert Francis
- Tanga Research Centre, National Institute for Medical Research, P.O. Box 5004, Tanga, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania
| | - Haruna Dika
- Department of Physiology, Catholic University of Health and Allied Sciences Bugando, P.O. Box 1464, Mwanza, Tanzania
| | - Eligius Lyamuya
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - John Bartlett
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
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10
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Mundamshimu JS, Malale K, Kidenya BR, Gunda DW, Bwemelo L, Mwashiuya M, Omar SS, Mlowe N, Kiyumbi M, Ngocho JS, Balandya E, Sunguya B, Mshana SE, Mteta K, Bartlett J, Lyamuya E, Mmbaga BT, Kalluvya S. Failure to Attain HIV Viral Suppression After Intensified Adherence Counselling-What Can We Learn About Its Factors? Infect Drug Resist 2023; 16:1885-1894. [PMID: 37020794 PMCID: PMC10069435 DOI: 10.2147/idr.s393456] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
Background Introduction and expansion of antiretroviral therapy (ART) have turned the tide of HIV pandemic, thus helping people living with HIV (PLHIV) achieve viral suppression. This success may need to be complemented by intensified adherence counseling (IAC) to improve adherence to treatment. However, some PLHIV still face higher than acceptable viral loads despite being on treatment. Purpose We investigated the factors associated with the failure to suppress HIV viral load after three months of IAC sessions. Patients and Methods This cross-sectional study analyzed secondary data from PLHIV-attended care and treatment clinics in Mwanza between January 2018 and December 2019 who had unsuppressed VL after being on ART for at least six months. We identified PLHIV in first-line ART with viral load evaluation before receiving IAC and had viral load results done at 90 days after IAC. We conducted descriptive statistics to examine the magnitude of viral suppression. Wilcoxon signed-rank test used to compare the median viral load before and after IAC sessions, and logistic regressions predicted the factors associated with failure. Results This study included 212 subjects. After intervention, most participants 85.9% (182) had significantly improved adherence compared to baseline. More than half 75.5% (160) of the participants had viral suppression after the intervention. Participants aged 18-25 years (AOR = 5.6, 95% CI, 1.1-29.6), unstable client during ART initiation (AOR = 0.3, 95% CI, 0.13-0.62), and poor adherence to ART (AOR = 4, 95% CI, 1.3-12.3) remained the main predictors of virological failure after IAC intervention. Conclusion Even though virological suppression is influenced by ART adherence, the findings in this study have shown co-existence of other factors to be addressed. Unstable during ART initiation is a new factor identified in this study.
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Affiliation(s)
| | - Kija Malale
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Benson R Kidenya
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Daniel W Gunda
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Logious Bwemelo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | - Neema Mlowe
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Magwa Kiyumbi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - James S Ngocho
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kien Mteta
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Bartlett
- Kilimanjaro Christian Medical University College, Mosh, Tanzania
- Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
| | - Eligius Lyamuya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Samuel Kalluvya
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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11
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Kamori D, Barabona G, Rugemalila J, Maokola W, Masoud SS, Mizinduko M, Sabasaba A, Ruhago G, Sambu V, Mushi J, Mgomella GS, Mcollogi JJ, Msafiri F, Mugusi S, Boniface J, Mutagonda R, Mlunde L, Amani D, Mboya E, Mahiti M, Rwebembera A, Ueno T, Pembe A, Njau P, Mutayoba B, Sunguya B. Emerging integrase strand transfer inhibitor drug resistance mutations among children and adults on ART in Tanzania: findings from a national representative HIV drug resistance survey. J Antimicrob Chemother 2023; 78:779-787. [PMID: 36680436 DOI: 10.1093/jac/dkad010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite the scale-up of ART and the rollout in Tanzania of dolutegravir, an integrase strand transfer inhibitor (INSTI), treatment success has not been fully realized. HIV drug resistance (HIVDR), including dolutegravir resistance, could be implicated in the notable suboptimal viral load (VL) suppression among HIV patients. OBJECTIVES To determine the prevalence and patterns of acquired drug resistance mutations (DRMs) among children and adults in Tanzania. METHODS A national cross-sectional HIVDR survey was conducted among 866 children and 1173 adults. Genotyping was done on dried blood spot and/or plasma of participants with high HIV VL (≥1000 copies/mL). HIV genes (reverse transcriptase, protease and integrase) were amplified by PCR and directly sequenced. The Stanford HIVDR Database was used for HIVDR interpretation. RESULTS HIVDR genotyping was performed on blood samples from 137 participants (92 children and 45 adults) with VL ≥ 1000 copies/mL. The overall prevalence of HIV DRMs was 71.5%, with DRMs present in 78.3% of children and 57.8% of adults. Importantly, 5.8% of participants had INSTI DRMs including major DRMs: Q148K, E138K, G118R, G140A, T66A and R263K. NNRTI, NRTI and PI DRMs were also detected in 62.8%, 44.5% and 8% of participants, respectively. All the participants with major INSTI DRMs harboured DRMs targeting NRTI backbone drugs. CONCLUSIONS More than 7 in 10 patients with high HIV viraemia in Tanzania have DRMs. The early emergence of dolutegravir resistance is of concern for the efficacy of the Tanzanian ART programme.
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Affiliation(s)
- Doreen Kamori
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Godfrey Barabona
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania.,Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Joan Rugemalila
- Internal Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Werner Maokola
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Salim S Masoud
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Mucho Mizinduko
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Amon Sabasaba
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - George Ruhago
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Veryeh Sambu
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Jeremiah Mushi
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - George S Mgomella
- Division of Global HIV & Tuberculosis, US Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - James J Mcollogi
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Frank Msafiri
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Sabina Mugusi
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Jullu Boniface
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Ritah Mutagonda
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Linda Mlunde
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Davis Amani
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Erick Mboya
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Macdonald Mahiti
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Anath Rwebembera
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Takamasa Ueno
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania.,Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Andrea Pembe
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Prosper Njau
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Beatrice Mutayoba
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania.,Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
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Rugemalila J, Kamori D, Kunambi P, Mizinduko M, Sabasaba A, Masoud S, Msafiri F, Mugusi S, Mutagonda R, Mlunde L, Amani D, Mboya E, Mahiti M, Ruhago G, Mushi J, Sambu V, Mgomella G, Jullu B, Maokola W, Njau P, Mutayoba B, Barabona G, Ueno T, Pembe A, Nagu T, Sunguya B, Aboud S. HIV virologic response, patterns of drug resistance mutations and correlates among adolescents and young adults: A cross-sectional study in Tanzania. PLoS One 2023; 18:e0281528. [PMID: 36821538 PMCID: PMC9949668 DOI: 10.1371/journal.pone.0281528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The emergence of HIV drug resistance mutations (DRMs) is of significant threat to achieving viral suppression (VS) in the quest to achieve global elimination targets. We hereby report virologic outcomes and patterns of acquired DRMs and its associated factors among adolescents and young adults (AYA) from a broader HIV drug resistance surveillance conducted in Tanzania. METHODS Data of AYA was extracted from a cross-sectional study conducted in 36 selected facilities using a two-stage cluster sampling design. Dried blood spot (DBS) samples were collected and samples with a viral load (VL) ≥1000 copies/mL underwent genotyping for the HIV-1 pol gene. Stanford HIV database algorithm predicted acquired DRMs, Fisher's exact test and multivariable logistic regression assessed factors associated with DRMs and VS, respectively. FINDINGS We analyzed data of 578 AYA on antiretroviral therapy (ART) for 9-15 and ≥ 36 months; among them, 91.5% and 88.2% had VS (VL<1000copies/mL) at early and late time points, respectively. Genotyping of 64 participants (11.2%) who had VL ≥1000 copies/ml detected 71.9% of any DRM. Clinically relevant DRMs were K103N, M184V, M41L, T215Y/F, L210W/L, K70R, D67N, L89V/T, G118R, E138K, T66A, T97A and unexpectedly absent K65R. Participants on a protease inhibitor (PI) based regimen were twice as likely to not achieve VS compared to those on integrase strand transfer inhibitors (INSTI). The initial VL done 6 months after ART initiation of ≥1000copies/mL was the primary factor associated with detecting DRMs (p = .019). CONCLUSIONS VS amongst AYA is lower than the third UNAIDs target. Additionally, a high prevalence of ADR and high levels of circulating clinically relevant DRMs may compromise the long-term VS in AYA. Furthermore, the first VL result of ≥1000copies/ml after ART initiation is a significant risk factor for developing DRMs. Thus, strict VL monitoring for early identification of treatment failure and genotypic testing during any ART switch is recommended to improve treatment outcomes for AYA.
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Affiliation(s)
- Joan Rugemalila
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
- * E-mail:
| | - Doreen Kamori
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Peter Kunambi
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mucho Mizinduko
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Amon Sabasaba
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Salim Masoud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frank Msafiri
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sabina Mugusi
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rita Mutagonda
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Linda Mlunde
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Davis Amani
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Erick Mboya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Macdonald Mahiti
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - George Ruhago
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Veryeh Sambu
- National AIDS Control Programme, Dodoma, Tanzania
| | - George Mgomella
- Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Boniface Jullu
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Prosper Njau
- National AIDS Control Programme, Dodoma, Tanzania
| | | | - Godfrey Barabona
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Takamasa Ueno
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Andrea Pembe
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tumaini Nagu
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mrema D, Ngocho JS, Mremi A, Amour M, Machange R, Shayo BC, Alloyce JP, Ndosi E, Shirima BT, Fande D, Shehoza R, Balandya E, Sunguya B, Mshana SE, Mteta AK, Lyamuya E, Bartlett J, Mmbaga BT. Cervical cancer in Northern Tanzania-What do women living with HIV know. Front Oncol 2023; 12:957325. [PMID: 36698389 PMCID: PMC9868899 DOI: 10.3389/fonc.2022.957325] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023] Open
Abstract
Background Cervical cancer (CC) is more prevalent in women living with human immunodeficiency virus (HIV) infection compared to the general population. The magnitude is high among all countries burdened with HIV-Tanzania is no exception. Despite the unprecedented risk, women living with HIV (WLHIV) may not be aware of the risk and might have unfounded beliefs thereof. This study aimed to determine the knowledge, awareness, and beliefs on CC screening among WLHIV attending a clinic at the Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. Methods This hospital-based cross-sectional study was conducted among 327 WLHIV attending care and treatment clinic (CTC) at KCMC. A pre-tested questionnaire was used to collect quantitative data. Both descriptive and regression methods were used to determine CC knowledge, awareness, and beliefs as well as factors associated with knowledge of CC among WLHIV using SPSS version 23. Results Participants' mean age was 46 ± 10.4 years. Although just half (54.7%) of WLHIV had insufficient knowledge of CC, the majority of the participants (83.5%) were able to recognize at least three risk factors, but with limited understanding of symptoms and prevention. The majority held positive beliefs on CC and screening practices. Factors associated with good knowledge of CC included being married (AOR: 3.66, 95% CI: 1.84-7.28), having used ART for at least 2 years (AOR: 4.08, 95% CI: 1.36-12.21), and having previously screened for CC (AOR: 1.62, 95% CI: 1.01-2.59). Conclusion WLHIV attending care and treatment center had insufficient knowledge about CC screening. To further improve screening and treatment for CC, at both facility and community levels, targeted awareness and education campaigns are warranted.
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Affiliation(s)
- Dorah Mrema
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - James Samwel Ngocho
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
| | - Alex Mremi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Maryam Amour
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Rogathe Machange
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
| | - Benjamin C. Shayo
- Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Baylor College of Medicine, Houston, TX, United States
| | - Julius P. Alloyce
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Evaline Ndosi
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Beatus T. Shirima
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Device Fande
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Rahma Shehoza
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Stephen E. Mshana
- Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
| | - Alfred K. Mteta
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Eligius Lyamuya
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - John Bartlett
- Duke Global Health Institute, Duke University Medical Center, Durham, NC, United States
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania
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14
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Morris BM, Nyamhagata M, Tarimo E, Sunguya B. Eliminating mother-to-child transmission of HIV in Tanzania calls for efforts to address factors associated with a low confirmatory test. PLOS Glob Public Health 2023; 3:e0001218. [PMID: 36963073 PMCID: PMC10021727 DOI: 10.1371/journal.pgph.0001218] [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] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/28/2022] [Indexed: 03/14/2023]
Abstract
Option B+ approach for prevention of mother-to-child transmission (PMTCT) has demonstrated the potential to eliminate pediatric HIV infections. Its success depends on early infant diagnosis (EID) of HIV among the exposed infants within the first 6 weeks, and a subsequent confirmatory HIV test within 18 months. However, most mothers enrolling in option B+ in Tanzania do not come for such confirmatory tests. We examined factors associated with the turning-up of mother-baby pairs on the PMTCT program for a confirmatory HIV testing 18 months post-delivery in Tanzania. This study utilized longitudinal data collected between 2015 and 2017, from 751 mother-baby pairs enrolled in the PMTCT-option B+ approach in 79 health facilities from the 12 regions of Tanzania-mainland. Only 44.2% of 751 mother-baby records observed received the HIV confirmatory test by the 18th month. Mothers aged 25 years or above (adults' mothers) were 1.44 more likely to turn up for confirmatory HIV testing than young mothers; mothers with partners tested for HIV were 1.74 more likely to have confirmatory HIV testing compared with partners not tested for HIV. Newly diagnosed HIV-positive mothers were 28% less likely to bring their babies for a confirmatory HIV-testing compared to known HIV-positive mothers. Mothers with treatment supporters were 1.58 more likely to receive confirmatory HIV-testing compared to mothers without one. Mother-baby pairs who collected DBS-PCR-1 were 3.61 more likely to have confirmatory HIV-testing than those who didn't collect DBS-PCR-1. In conclusion, the confirmatory HIV testing within 18 months among mother-baby pairs enrolled in the Option B+ approach is still low in Tanzania. This is associated with low maternal age, having a male partner not tested for HIV, lack of experience with HIV services, lack of treatment supporters, and failure to take the DBS-PCR-1 HIV test within the first two months post-delivery.
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Affiliation(s)
- Baraka M Morris
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | | | - Edith Tarimo
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
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Njau T, Ngakongwa F, Sunguya B, Kaaya S, Fekadu A. Development of a Psychological Intervention to Improve Depressive Symptoms and Enhance Adherence to Antiretroviral Therapy among Adolescents and Young People Living with HIV in Dar es Salaam Tanzania. Healthcare (Basel) 2022; 10:healthcare10122491. [PMID: 36554015 PMCID: PMC9778412 DOI: 10.3390/healthcare10122491] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Interventions that simultaneously target depression and antiretroviral therapy (ART) medication adherence are recommended for improving HIV treatment outcomes and quality of life for adolescents living with HIV. However, evidence is scarce on culturally feasible and acceptable interventions that can be implemented for HIV-positive adolescents in Tanzania. We, therefore, developed a manualized brief psychological intervention that utilizes evidence-based strategies to address depression and ART adherence in adolescents living with HIV in Tanzania. Methods: We used the Theory of Change Enhanced Medical Research Council framework (TOCMRC) for developing complex interventions in health care to develop the intervention in five phases. First, the literature was reviewed to identify potential intervention components. Second, we conducted a situational analysis using qualitative interviews with adolescents living with HIV, health care providers, and caregivers. Third, we conducted a mental health expert workshop; and fourth, theory of change workshops with representatives from the Ministry of Health, mental health professionals, HIV implementing partners, adolescents, and healthcare providers. Lastly, we synthesized results to finalize the intervention and a theory of change map showing the causal pathway for how we expect the developed intervention to achieve its impact. Results: Adolescents living with HIV in Tanzania experience several unmet mental health needs ranging from overwhelming depressive symptoms to not feeling understood by healthcare providers who lack mental health knowledge. Participants perceived psychological intervention that utilizes a task-shifting approach to be acceptable and beneficial to addressing those problems. The novel components of the NITUE intervention included incorporating evidence-based intervention components, namely, cognitive-behavioral therapy, motivational interviewing, and problem solving. In addition, caregiver inclusion in the treatment was essential to ensure access to care, compliance, and improved outcomes. Conclusions: A culturally appropriate brief psychological intervention that utilizes a task-shifting approach to address depression and medication adherence for adolescents living with HIV in Dar es Salaam, Tanzania, was developed. The intervention will be piloted for appropriateness, feasibility, and acceptability and will provide material for a future trial to determine its effectiveness.
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Affiliation(s)
- Tasiana Njau
- Department of Psychiatry and Mental Health, The Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West 11103, Dar es Salaam 65001, Tanzania
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa 9086, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia
- Correspondence: ; Tel.: +255-717547606
| | - Fileuka Ngakongwa
- Department of Psychiatry and Mental Health, Muhimbili National Hospital, Dar es Salaam 65000, Tanzania
| | - Bruno Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West 11103, Dar es Salaam 65001, Tanzania
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, The Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West 11103, Dar es Salaam 65001, Tanzania
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa 9086, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia
- Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
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Bedwell GJ, Dias P, Hahnle L, Anaeli A, Baker T, Beane A, Biccard BM, Bulamba F, Delgado-Ramirez MB, Dullewe NP, Echeverri-Mallarino V, Haniffa R, Hewitt-Smith A, Hoyos AS, Mboya EA, Nanimambi J, Pearse R, Pratheepan AP, Sunguya B, Tolppa T, Uruthirakumar P, Vengadasalam S, Vindrola-Padros C, Stephens TJ. Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study. Anesth Analg 2022; 135:1217-1232. [PMID: 36005395 DOI: 10.1213/ane.0000000000006113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Provision of timely, safe, and affordable surgical care is an essential component of any high-quality health system. Increasingly, it is recognized that poor quality of care in the perioperative period (before, during, and after surgery) may contribute to significant excess mortality and morbidity. Therefore, improving access to surgical procedures alone will not address the disparities in surgical outcomes globally until the quality of perioperative care is addressed. We aimed to identify key barriers to quality perioperative care delivery for 3 "Bellwether" procedures (cesarean delivery, emergency laparotomy, and long-bone fracture fixation) in 5 low- and middle-income countries (LMICs). METHODS Ten hospitals representing secondary and tertiary facilities from 5 LMICs were purposefully selected: 2 upper-middle income (Colombia and South Africa); 2 lower-middle income (Sri Lanka and Tanzania); and 1 lower income (Uganda). We used a rapid appraisal design (pathway mapping, ethnography, and interviews) to map out and explore the complexities of the perioperative pathway and care delivery for the Bellwether procedures. The framework approach was used for data analysis, with triangulation across different data sources to identify barriers in the country and pattern matching to identify common barriers across the 5 LMICs. RESULTS We developed 25 pathway maps, undertook >30 periods of observation, and held >40 interviews with patients and clinical staff. Although the extent and impact of the barriers varied across the LMIC settings, 4 key common barriers to safe and effective perioperative care were identified: (1) the fragmented nature of the care pathways, (2) the limited human and structural resources available for the provision of care, (3) the direct and indirect costs of care for patients (even in health systems for which care is ostensibly free of charge), and (4) patients' low expectations of care. CONCLUSIONS We identified key barriers to effective perioperative care in LMICs. Addressing these barriers is important if LMIC health systems are to provide safe, timely, and affordable provision of the Bellwether procedures.
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Affiliation(s)
- Gillian J Bedwell
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Priyanthi Dias
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Lina Hahnle
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Tim Baker
- Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Abi Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Bruce M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Fred Bulamba
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martha B Delgado-Ramirez
- Departments of Clinical Epidemiology and Biostatistics.,Anesthesia, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Bogota, Bogota, Colombia
| | - Nilmini P Dullewe
- Post Basic School of Nursing, Colombo, Sri Lanka.,Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
| | | | - Rashan Haniffa
- Anesthesia, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Bogota, Bogota, Colombia
| | - Adam Hewitt-Smith
- Elgon Centre for Health, Research and Innovation, Mbale' Uganda.,Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alejandra Sanin Hoyos
- Anesthesia, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Bogota, Bogota, Colombia
| | - Erick A Mboya
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Juliana Nanimambi
- Department of Anaesthesia and Critical Care, Faculty of Health Sciences, Busitema University, Mbale, Uganda.,Elgon Centre for Health, Research and Innovation, Mbale' Uganda
| | - Rupert Pearse
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Anton Premadas Pratheepan
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Jaffna Teaching Hospital, Jaffna, Sri Lanka
| | - Bruno Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Timo Tolppa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Powsiga Uruthirakumar
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | | | | | - Timothy J Stephens
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
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Ndumwa HP, Munishi C, Ngowi JE, Njiro BJ, Mabusi M, Suhartono S, Busse A, Campello G, Garofalo G, Cipolla P, Nyandindi C, Ubuguyu O, Sunguya B. Drug use and associated factors in a North Eastern region of Tanzania: a cross-sectional study. Pan Afr Med J 2022; 43:70. [PMID: 36523290 PMCID: PMC9733460 DOI: 10.11604/pamj.2022.43.70.35059] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/27/2022] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Tanzania has experienced an increase in the number of people who use drugs (PWUDs) and people who inject drugs (PWIDs). Understanding the characteristics of PWUDs is crucial to addressing the increasing burden of drug use in Tanzania. This study was set to examine drug use and its related factors among PWUDs in a North Eastern region of Tanzania. METHODS a cross-sectional study conducted among 481 PWUDs in Tanga region, Tanzania. R statistical language was used for analysis and plotting. Logistic regression was performed to establish associations between knowledge and practice scores with drug use. A p-value of < 0.05 was considered statistically significant. RESULTS people who inject drugs comprised mostly of male (97.5%) and those with primary level education (71.1%). About three in four PWUDs had poor knowledge and practices towards drug use. Factors associated with adequate knowledge and practices towards drug use included residing in urban setting (aOR: 0.47, 95% CI; 0.29 - 0.74, p=0.001) while low level of education and use of drugs for less than 10 years were independent predictors for poor practices. CONCLUSION drug use poses a significant threat among male and individuals with low education in Tanga region. Poor knowledge and practices towards drug use was more pronounced among rural and lowly educated PWUDs. Owing to variabilities of predictors, tailored and innovative interventions are needed to curb this growing drug use and associated effects in Tanga and other settings with similar contexts.
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Affiliation(s)
- Harrieth Peter Ndumwa
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Castory Munishi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Jackline Eugene Ngowi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Belinda Jackson Njiro
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Mangaro Mabusi
- Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Sanita Suhartono
- United Nations Office on Drugs and Crime, A 1400 Vienna, Austria
| | - Anja Busse
- United Nations Office on Drugs and Crime, A 1400 Vienna, Austria
| | | | | | - Pietro Cipolla
- Association Casa Famiglia Rosetta, Caltanissetta, Sicilia, Italy
| | - Cassian Nyandindi
- Drug Control and Enforcement Authority (DCEA), P.O. Box 80327, Dar es Salaam, Tanzania
| | - Omary Ubuguyu
- Directorate of Curative Services, Ministry of Health, P.O Box 743, Dodoma, Tanzania
| | - Bruno Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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18
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Balandya E, Sunguya B, Kidenya B, Nyamhanga T, Minja IK, Mahande M, Mmbaga BT, Mshana SE, Mteta K, Bartlett J, Lyamuya E. Joint Research Mentoring Through the Community of Young Research Peers: A Case for a Unifying Model for Research Mentorship at Higher Learning Institutions. Adv Med Educ Pract 2022; 13:355-367. [PMID: 35478975 PMCID: PMC9038151 DOI: 10.2147/amep.s356678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/15/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Mentorship is pivotal for sustainability of a successful research culture at higher learning institutions. Various models have been proposed for provision of research mentorship in health sciences but are challenged by utilizing predominantly hierarchical mentoring, as well as being centred on one discipline or one institution. This paper describes the approach and successes of an inclusive mentorship model employed in a resource-limited setting in sub-Saharan Africa. METHODS Through the NIH-funded Transforming Health Professions Education in Tanzania (THET) project, a consortium of three prominent health sciences higher learning institutions in Tanzania (MUHAS, CUHAS and KCMUCo) and two collaborating US institutions (UCSF and Duke University) was formed. Within THET, the Community of Young Research Peers (CYRP) was constituted, comprised two cohorts of undergraduate students and young faculty (fellows), and senior scientists. Besides mentorship and research training, fellows received funded research awards and in turn mentored undergraduate students. RESULTS By the first quarter of project year four, the number of fellows and mentored undergraduate students had increased from 12 to 24 and from 41 to 67, respectively. Fellows in the second cohort (junior fellows) included medical doctors, nurses, dentist, biomedical scientist, sociologist and education psychologist. In fostering peer-to-peer mentoring, the cross-institutional pairs of fellows from the first cohort (senior fellows) were assigned to reciprocal pairs of junior fellow mentees and took a leading role in research training. Furthermore, the senior fellows had made significant strides, including eight enrolled in PhD programmes, eight publications from mentored research projects, and six small to medium-size research grants won. CONCLUSION The unifying model of research mentorship employed by the CYRP has been demonstrated as an effective model for joint research mentorship of the diverse group of young investigators from collaborating higher learning institutions in Tanzania. This model is recommended for scale-up, particularly in sub-Saharan Africa.
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Affiliation(s)
- Emmanuel Balandya
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
| | - Bruno Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
| | - Benson Kidenya
- Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Tumaini Nyamhanga
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
| | - Irene K Minja
- Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
| | - Michael Mahande
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T Mmbaga
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kien Mteta
- Department of Urology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Bartlett
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Eligius Lyamuya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
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Msanga DR, Silago V, Massoza T, Kidenya BR, Balandya E, Mirambo MM, Sunguya B, Mmbaga BT, Lyamuya E, Bartlet J, Mshana SE. High Fecal Carriage of Multidrug Resistant Bacteria in the Community among Children in Northwestern Tanzania. Pathogens 2022; 11:pathogens11030379. [PMID: 35335702 PMCID: PMC8955874 DOI: 10.3390/pathogens11030379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/24/2022] [Accepted: 03/03/2022] [Indexed: 02/01/2023] Open
Abstract
Colonization of multidrug resistant (MDR) bacteria is associated with subsequent invasive infections in children with comorbidities. This study aimed to determine the resistance profile and factors associated with MDR pathogen colonization among HIV−and HIV+ children below five years of age in Mwanza, Tanzania. A total of 399 (HIV− 255 and HIV+ 144) children were enrolled and investigated for the presence of MDR bacteria. The median [IQR] age of children was 19 (10–36) months. Out of 27 Staphylococcus aureus colonizing the nasal cavity, 16 (59.5%) were methicillin resistant while 132/278 (47.2%) of Enterobacteriaceae from rectal swabs were resistant to third generation cephalosporins, with 69.7% (92/132) exhibiting extended spectrum beta lactamase (ESBL) phenotypes. The proportion of resistance to gentamicin, amoxicillin/clavulanic acid and meropenem were significantly higher among HIV+ than HIV− children. A history of antibiotic use in the last month OR 2.62 [1.1, 6.9] (p = 0.04) and history of a relative admitted from the same household in the past three months OR 3.73 [1.1, 13.2] (p = 0.03) independently predicted ESBL rectal colonization. HIV+ children had significantly more fecal carriage of isolates resistant to uncommonly used antibiotics. There is a need to strengthen antimicrobial stewardship and Infection Prevention and Control (IPC) programs to prevent the emergence and spread of MDR pathogens in children.
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Affiliation(s)
- Delfina R. Msanga
- Department of Pediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
- Correspondence:
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (M.M.M.); (S.E.M.)
| | - Tulla Massoza
- Department of Pediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Benson R. Kidenya
- Department of Biochemistry, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Emmanuel Balandya
- Department of Physiology, School of Medicine, Muhimbili University of Health and Allied Sciences, Upanga West, Dar es Salaam P.O. Box 65001, Tanzania;
| | - Mariam M. Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (M.M.M.); (S.E.M.)
| | - Bruno Sunguya
- Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Upanga West, Dar es Salaam P.O. Box 65001, Tanzania;
| | - Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2236, Tanzania;
| | - Eligius Lyamuya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Upanga West, Dar es Salaam P.O. Box 65001, Tanzania;
| | - John Bartlet
- Duke Global Health Institute, Duke University Medical Center Durham, P.O. Box 3238, Durham, NC 27710, USA;
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (M.M.M.); (S.E.M.)
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Balandya E, Hyuha G, Mtaya M, Otieno J, Sunguya B, Frumence G, Muganyizi P, Lyamuya E, Urassa D, Kamuhabwa A, Pembe A. Advances in training of the specialized human resources for health in Tanzania: the case of Muhimbili University of Health and Allied Sciences. BMC Med Educ 2022; 22:55. [PMID: 35078466 PMCID: PMC8790923 DOI: 10.1186/s12909-022-03102-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/03/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Increasing the number of specialized human resources for health is paramount to attainment of the United Nations sustainable development goals. Higher learning institutions in low-and middle-income countries must address this necessity. Here, we describe the 5-years trends in accreditation of the clinical and non-clinical postgraduate (PG) programmes, student admission and graduation at the Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania, highlighting successes, challenges and opportunities for improvement. METHODS This was a retrospective longitudinal study describing trends in PG training at MUHAS between 2015 and 2016 and 2019-2020. Major interventions in the reporting period included university-wide short course training programme to faculty on curricula development and initiation of online application system. Data were collected through a review of secondary data from various university records and was analyzed descriptively. Primary outcomes were the number of accredited PG programmes, number of PG applicants as well as proportions of applicants selected, applicants registered (enrolled) and students graduated, with a focus on gender and internationalization (students who are not from Tanzania). RESULTS The number of PG programmes increased from 60 in 2015-2016 to 77 in 2019-2020, including programmes in rare fields such as cardiothoracic surgery, cardiothoracic anesthesia and critical care. The number of PG applications, selected applicants, registered applicants and PG students graduating at the university over the past five academic years had steadily increased by 79, 81, 50 and 79%, respectively. The average proportions of PG students who applied, were selected and registered as well as graduated at the university over the past five years by gender and internationalization has remained stably at 60% vs. 40% (male vs. female) and 90% vs. 10% (Tanzanian vs. international), respectively. In total, the university graduated 1348 specialized healthcare workers in the five years period, including 45 super-specialists in critical fields, through a steady increase from 200 graduates in 2015-2016 to 357 graduates in 2019-2020. Major challenges encountered include inadequate sponsorship, limited number of academic staff and limited physical infrastructure for teaching. CONCLUSION Despite challenges encountered, MUHAS has made significant advances over the past five years in training of specialized and super-specialized healthcare workforce by increasing the number of programmes, enrollment and graduates whilst maintaining a narrow gender gap and international relevance. MUHAS will continue to be the pillar in training of the specialized human resources for health and is thus poised to contribute to timely attainment of the health-related United Nations sustainable development goals in Tanzania and beyond, particularly within the Sub-Saharan Africa region.
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Affiliation(s)
- Emmanuel Balandya
- Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania.
| | - Gimbo Hyuha
- Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Matilda Mtaya
- Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Joseph Otieno
- Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Gasto Frumence
- Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Projestine Muganyizi
- Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Eligius Lyamuya
- Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - David Urassa
- Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Appolinary Kamuhabwa
- Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Andrea Pembe
- Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
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21
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Ndumwa HP, Munishi C, Ngowi JE, Njiro BJ, Mabusi M, Suhartono S, Busse A, Campello G, Garofalo G, Cipolla P, Nyandindi C, Ubuguyu O, Sunguya B. Drug use and associated factors in a North Eastern region of Tanzania: a cross-sectional study. Pan Afr Med J 2022. [DOI: 10.11604/pamj.2022.43.70.36039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ndumwa HP, Mboya EA, Amani DE, Mashoka R, Nicholaus P, Haniffa R, Beane A, Mfinanga J, Sunguya B, Sawe HR, Baker T. The burden of respiratory conditions in the emergency department of Muhimbili National Hospital in Tanzania in the first two years of the COVID-19 pandemic: A cross sectional descriptive study. PLOS Glob Public Health 2022; 2:e0000781. [PMID: 36962777 PMCID: PMC10021642 DOI: 10.1371/journal.pgph.0000781] [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] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022]
Abstract
Globally, respiratory diseases cause 10 million deaths every year. With the COVID-19 pandemic, the burden of respiratory illness increased and led to significant morbidity and mortality in both high- and low-income countries. This study assessed the burden and trend of respiratory conditions among patients presenting to the emergency department of Muhimbili National Hospital in Tanzania and compared with national COVID-19 data to determine if this knowledge may be useful for the surveillance of disease outbreaks in settings of limited specific diagnostic testing. The study used routinely collected data from the electronic information system in the Emergency Medical Department (EMD) of Muhimbili National Hospital in Tanzania. All patients presenting to the EMD in a 2-year period, 2020 and 2021 with respiratory conditions were included. Descriptive statistics and graphical visualizations were used to describe the burden of respiratory conditions and the trends over time and to compare to national Tanzanian COVID-19 data during the same period. One in every four patients who presented to the EMD of the Muhimbili National Hospital had a respiratory condition- 1039 patients per month. Of the 24,942 patients, 52% were males, and the median age (IQR) was 34.7 (21.7, 53.7) years. The most common respiratory diagnoses were pneumonia (52%), upper respiratory tract infections (31%), asthma (4.8%) and suspected COVID-19 (2.5%). There were four peaks of respiratory conditions coinciding with the four waves in the national COVID-19 data. We conclude that the burden of respiratory conditions among patients presenting to the EMD of Muhimbili National Hospital is high. The trend shows four peaks of respiratory conditions in 2020-2021 seen to coincide with the four waves in the national COVID-19 data. Real-time hospital-based surveillance tools may be useful for early detection of respiratory disease outbreaks and other public health emergencies in settings with limited diagnostic testing.
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Affiliation(s)
- Harrieth P Ndumwa
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Erick A Mboya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Davis Elias Amani
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ramadhani Mashoka
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Paulina Nicholaus
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- University College London Hospitals, London, United Kingdom
| | - Abi Beane
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Juma Mfinanga
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hendry R Sawe
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tim Baker
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
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Nkinda L, Buberwa E, Memiah P, Ntagalinda A, George M, Msafiri F, Joachim A, Majigo M, Ramaiya K, Sunguya B. Impaired fasting glucose levels among perinatally HIV-infected adolescents and youths in Dar es Salaam, Tanzania. Front Endocrinol (Lausanne) 2022; 13:1045628. [PMID: 36561566 PMCID: PMC9763284 DOI: 10.3389/fendo.2022.1045628] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study assessed impaired fasting glucose and associated factors among perinatally HIV-infected adolescents and youths in Dar es salaam Tanzania. BACKGROUND Impaired fasting glucose is a marker of heightened risk for developing type 2 diabetes among perinatally HIV-infected individuals. Therefore, identifying individuals at this stage is crucial to enable early intervention. Therefore, we assessed impaired fasting glucose (IFG) and associated factors among perinatally HIV-infected population in Dar es salaam Tanzania. METHODS A cross-sectional study was conducted among 152 adolescents and youth attending HIV clinic at Muhimbili National Hospital and Infectious Disease Centre from July to August 2020. Fasting blood glucose (>8 hours) was measured using one-touch selects LifeScan, CA, USA. We also examined C-Reactive Protein and interleukin-6 inflammatory biomarkers in relation to impaired fasting glucose (IFG). Associations between categorical variables were explored using Chi-square, and poison regression with robust variance was used to calculate the prevalence ratios. RESULTS Of the 152 participants, the majority were male (n=83[54.6%]), and the median age was 15(14-18) years. Overweight or obesity was prevalent in 16.4%, while more than one in ten (13.2%) had high blood pressure (≥149/90mmHg). All participants were on antiretroviral therapy (ART); 46% had used medication for over ten years, and about one in three had poor medication adherence. Among the recruited participants, 29% had impaired fasting glucose. The odds of IFG were two times higher in males compared to females (PR, 2.07, 95% CI 1.19 -3.59 p=0.001). Moreover, we found with every increase of Interleukin 6 biomarker there was a 1.01 probability increase of impaired fasting glucose (PR, 1.01, 95% CI 1.00 - 1.02 p=0.003). CONCLUSION About one in three perinatally HIV-infected youths had impaired fasting glucose in Dar es Salaam, Tanzania, with males bearing the biggest brunt. Moreover, with every increase of 1.101 of the probability of having IFG increased. This calls for urgent measures to interrupt the progression to diabetes disease and prevent the dual burden of disease for this uniquely challenged population.
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Affiliation(s)
- Lilian Nkinda
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- *Correspondence: Lilian Nkinda,
| | - Eliud Buberwa
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Alieth Ntagalinda
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martin George
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frank Msafiri
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Agricola Joachim
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mtebe Majigo
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kaushik Ramaiya
- Department of Internal Medicine, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Department of Community Health, School of Public Health and Social Science, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Kikula AI, Pembe AB, Sunguya B. Short inter-pregnancy interval: why is it still high among women in Dar es Salaam? Pan Afr Med J 2021; 40:17. [PMID: 34733385 PMCID: PMC8531956 DOI: 10.11604/pamj.2021.40.17.29770] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/16/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction in Tanzania, for the past decade, there has been a rising trend of women with short inter-pregnancy interval (IPI) (16% to 19%). Short IPI is associated with poor maternal and neonatal outcomes. We aimed to determine the factors associated with short IPI among women attending antenatal clinic (ANC) at Mnazi Mmoja Hospital, Dar es Salaam, Tanzania. Methods a cross-sectional study was conducted in September 2018 at Mnazi Mmoja hospital among women receiving ante-natal care. A total of 530 women were included in the analysis. Analysis was conducted through SPSS version 24 computer program using descriptive analyses to determine the IPI and characteristics thereof, and logistic regression analysis to examine factors associated with IPI among pregnant women. Associations with a p-value < 0.05 were considered statistically significant. Results twenty-two percent of the women attending ANC in Mnazi Mmoja hospital had short IPI. Short IPI was associated with young (<25years) age (AOR=2.67, 95% CI=1.23-5.79); non-use of a contraceptive method (AOR=2.05, 95%CI=1.22-3.45); breastfeeding for less than 6 months (AOR=3.45, 95% CI=1.17-10.13) and having an antecedent dead child at the time of index conception (AOR=3.38, 95% CI=1.15-9.93). Conclusion about 1 in every 5 women attending ANC in Dar es Salaam had a short IPI. Addressing short IPI will complement the government´s efforts to improve maternal indicators in Tanzania and areas with similar contexts. Such efforts should emphasize in adherence to recommended infant feeding practices, women at a younger reproductive age group, those with a history of pregnancy loss, and strengthening contraception use among women of reproductive age.
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Affiliation(s)
- Amani Idris Kikula
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea Barnabas Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mwakyandile T, Shayo G, Mugusi S, Sunguya B, Sasi P, Moshiro C, Mugusi F, Lyamuya E. Effect of aspirin on HIV disease progression among HIV-infected individuals initiating antiretroviral therapy: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e049330. [PMID: 34728445 PMCID: PMC8565540 DOI: 10.1136/bmjopen-2021-049330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION An increase in cardiovascular disease (CVD) among people living with HIV infection is linked to platelet and immune activation, a phenomenon unabolished by antiretroviral (ARV) drugs alone. In small studies, aspirin (acetylsalicylic acid [ASA]) has been shown to control immune activation, increase CD4+ count, halt HIV disease progression and reduce HIV viral load (HVL). We present a protocol for a larger ongoing randomised placebo controlled trial on the effect of an addition of ASA to ARV drugs on HIV disease progression. METHODS AND ANALYSIS A single-centre phase IIA double-blind, parallel-group randomised controlled trial intends to recruit 454 consenting ARV drug-naïve, HIV-infected adults initiating ART. Participants are randomised in blocks of 10 in a 1:1 ratio to receive, in addition to ARV drugs, 75 mg ASA or placebo for 6 months. The primary outcome is the proportion of participants attaining HVL of <50 copies/mL by 8, 12 and 24 weeks. Secondary outcomes include proportions of participants with HVL of >1000 copies/mL at week 24, attaining a >30% rise of CD4 count from baseline value at week 12, experiencing adverse events, with normal levels of biomarkers of platelet and immune activation at weeks 12 and 24 and rates of morbidity and all-cause mortality. Intention-to-treat analysis will be done for all study outcomes. ETHICS AND DISSEMINATION Ethical approval has been obtained from institutional and national ethics review committees. Findings will be submitted to peer-reviewed journals and presented in scientific conferences. TRIAL REGISTRATION NUMBER PACTR202003522049711.
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Affiliation(s)
- Tosi Mwakyandile
- Department of Clinical Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Grace Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sabina Mugusi
- Department of Clinical Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Dar es Salaam, Tanzania
| | - Philip Sasi
- Department of Clinical Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eligius Lyamuya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Barabona G, Mahiti M, Toyoda M, Kamori D, Masoud S, Judicate GP, Sunguya B, Lyamuya E, Ueno T. Advanced baseline immunosuppression is associated with elevated levels of plasma markers of fungal translocation and inflammation in long-term treated HIV-infected Tanzanians. AIDS Res Ther 2021; 18:55. [PMID: 34446039 PMCID: PMC8394626 DOI: 10.1186/s12981-021-00381-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/17/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND For over a decade, antiretroviral therapy (ART) in resource-limited countries was only recommended for patients with advanced HIV disease. We investigated this group of patients in order to determine any relationship between degree of immunosuppression during treatment initiation and the subsequent levels of inflammatory biomarkers, reservoir size and plasma marker of fungal translocation after achieving long-term virological control. METHODS We analyzed 115 virally suppressed (female 83.5%) and 40 untreated (female 70%) subjects from Dar es Salaam, Tanzania. The size of HIV latent reservoir (proviral DNA copy) was determined using quantitative PCR. Inflammatory biomarkers; IL-6, IL-10, and soluble CD14 (sCD14), were measured using multiplex cytometric beads array. Antibody titers for Cytomegalovirus (CMV) and Epstein Barr virus (EBV), plasma level of 1-3-beta-D-Glucan (BDG) was measured using ELISA. High-sensitivity C-reactive protein (hsCRP) was measured using nephelometric method. RESULTS The median age was 36 (IQR 32-44) and 47 (IQR 43-54) years in untreated and virally suppressed patients respectively. Median duration of treatment for virally suppressed patients was 9 years (IQR 7-12) and median baseline CD4 count was 147 cells/mm3 (IQR 65-217). Virally suppressed patients were associated with significantly lower plasma levels of IL-10, sCD14 and BDG (P < 0.05) when compared to untreated patients. However, plasma level of IL-6 was similar between the groups. Baseline advanced level of immunosuppression (CD4 < 100cells/cm3) was associated with significantly higher plasma level of IL-6 (P = 0.02), hsCRP (P = 0.036) and BDG (P = 0.0107). This relationship was not seen in plasma levels of other tested markers. Degree of baseline immunosuppression was not associated with the subsequent proviral DNA copy. In addition, plasma levels of inflammatory marker were not associated with sex, CMV or EBV antibody titers, treatment duration or regimen. CONCLUSIONS Our data suggest that advanced immunosuppression at ART initiation is associated with severity of inflammation and elevated fungal translocation marker despite long term virological control. Further studies are needed to evaluate the potential increased burden of non-AIDS comorbidities that are linked to elevated inflammatory and fungal translocation markers as a result of the policy of HIV treatment at CD4 count < 200 cells/cm3 implemented for over a decade in Tanzania.
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Affiliation(s)
- Godfrey Barabona
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, 2-2-1 Chuo-ku, Honjo, Kumamoto, 860-0811, Japan
| | - Macdonald Mahiti
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mako Toyoda
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, 2-2-1 Chuo-ku, Honjo, Kumamoto, 860-0811, Japan
| | - Doreen Kamori
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Salim Masoud
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - George P Judicate
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, 2-2-1 Chuo-ku, Honjo, Kumamoto, 860-0811, Japan
| | - Bruno Sunguya
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, 2-2-1 Chuo-ku, Honjo, Kumamoto, 860-0811, Japan
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eligius Lyamuya
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, 2-2-1 Chuo-ku, Honjo, Kumamoto, 860-0811, Japan
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Takamasa Ueno
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, 2-2-1 Chuo-ku, Honjo, Kumamoto, 860-0811, Japan.
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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27
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Affiliation(s)
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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28
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Mawalla WF, Njiro BJ, Bwire GM, Nasser A, Sunguya B. No evidence of SARS-CoV-2 transmission through transfusion of human blood products: A systematic review. ACTA ACUST UNITED AC 2021; 2:601-606. [PMID: 34518827 PMCID: PMC8426699 DOI: 10.1002/jha2.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/23/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 01/24/2023]
Abstract
The presence of viral nucleic material in the circulation poses a theoretical risk of transmission through transfusion. However, little is known about the possibility of the actual transmission through transfusion or transplantation of blood products. A PROSPERO registered systematic review pooled evidence from PubMed/MEDLINE, Google Scholar and CINAHL. The search included studies on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission through human blood products. In total 537 studies were extracted, and only eight articles (1.5%) were eligible for the final analysis. A total of 14 patients received blood products from coronavirus disease‐2019 (COVID‐19) virus‐positive donors, and six (42.9%) tested negative for COVID‐19 RT‐PCR for up to 14 days post‐transfusion/transplantation. There were no documented clinical details on the COVID‐19 test for eight (57.1%) blood products recipients. Of the eight patients, none of them developed any COVID‐19‐related symptoms. In conclusion, there is limited evidence of transfusion transmission of SARS‐CoV‐2 via human blood products. Consolidation of further evidence, as it emerges, is warranted.
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Affiliation(s)
- William Frank Mawalla
- School of Medicine Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Belinda J Njiro
- School of Public Health and Social Services Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - George M Bwire
- School of Pharmacy Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Ahlam Nasser
- School of Medicine Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Bruno Sunguya
- School of Public Health and Social Services Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
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29
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Judicate GP, Barabona G, Kamori D, Mahiti M, Tan TS, Ozono S, Mgunya AS, Kuwata T, Matsushita S, Sunguya B, Lyamuya E, Tokunaga K, Ueno T. Phenotypic and Genotypic Co-receptor Tropism Testing in HIV-1 Epidemic Region of Tanzania Where Multiple Non-B Subtypes Co-circulate. Front Microbiol 2021; 12:703041. [PMID: 34305873 PMCID: PMC8292895 DOI: 10.3389/fmicb.2021.703041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
HIV human immunodeficiency virus type I (HIV-1) entry inhibitor potency is dependent on viral co-receptor tropisms and thereby tropism determination is clinically important. However, phenotypic tropisms of HIV-1 non-B subtypes have been poorly investigated and the genotypic prediction algorithms remain insufficiently validated. To clarify this issue, we recruited 52 treatment-naïve, HIV-1-infected patients in Tanzania, where multiple HIV-1 non-B subtypes co-circulate. Sequence analysis of 93 infectious envelope clones isolated from their plasma viral RNA revealed the co-circulation of subtypes A1, C, D, and inter-subtype recombinant forms (isRFs). Phenotypic tropism assays revealed that lentivirus reporters pseudotyped with 75 (80.6%) and 5 (5.4%) envelope clones could establish infection toward U87.CD4 cells expressing CCR5 (R5) and CXCR4 (X4), respectively; whereas the remaining 13 (14%) clones could infect both cells. Genotypic analyses by widely used algorithms including V3 net charge, Geno2pheno, WebPSSM, and PhenoSeq showed that almost all phenotypic X4-tropic clones and only 15 of 75 phenotypic R5-tropic clones were concordantly predicted. However, the remaining 60 phenotypic R5-tropic clones were discordantly predicted by at least one algorithm. In particular, 2 phenotypic R5-tropic clones were discordantly predicted by all algorithms tested. Taken together, the results demonstrate the limitation of currently available genotypic algorithms for predicting co-receptor inference among co-circulating multiple non-B subtypes and emerging isRFs. Also, the phenotypic tropism dataset presented here could be valuable for retraining of the widely used genotypic prediction algorithms to enhance their performance.
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Affiliation(s)
- George P Judicate
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Godfrey Barabona
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Doreen Kamori
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Macdonald Mahiti
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Toong Seng Tan
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Seiya Ozono
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Takeo Kuwata
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Shuzo Matsushita
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Bruno Sunguya
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eligius Lyamuya
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kenzo Tokunaga
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan.,Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takamasa Ueno
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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30
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Ngowi BN, Sunguya B, Herman A, Chacha A, Maro E, Rugarabamu LF, Bartlett J, Balandya E, Mteta KA, Mmbaga BT. Prevalence of Multidrug Resistant UTI Among People Living with HIV in Northern Tanzania. Infect Drug Resist 2021; 14:1623-1633. [PMID: 33911886 PMCID: PMC8075732 DOI: 10.2147/idr.s299776] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/11/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Bacterial urinary tract infection (BUTI) is the commonest urinary tract infection among people living with human immunodeficiency virus (PLHIV). It causes significant morbidity in this vulnerable group. Immunosuppression due to HIV can mask the signs and symptoms of infection leading to asymptomatic disease. There is limited evidence in Tanzania regarding BUTI and PLHIV. This study aimed to determine the prevalence, etiology, risk factors and susceptibility pattern of isolates causing asymptomatic UTI in PLHIV at Kilimanjaro Christian Medical Centre (KCMC). PATIENTS AND METHODS This cross-sectional study was conducted from July to September 2020 at Kilimanjaro Christian Medical Centre (KCMC) hospital. A questionnaire was used to collect social demographic data from patients' files together with necessary information required by this study. Urine samples were obtained from participants for urinalysis and urine culture and sensitivity. Data from 300 adults aged ≥18 years were analyzed using Statistical Package for Social Science (SPSS) version 22. Mean or median with their measure of dispersion were calculated for continuous variables. Logistic regression was used to determine associations between variables, where P-value <0.05 was considered to be significant. RESULTS Bacteriuria was prevalent in 37 (12.3%) of PLHIV. Positive nitrite in urine was associated with bacteriuria (P = 0.01). Gram-positive bacteria were the most common 25 (67.6%) isolates with high sensitivity to nitrofurantoin (88.2%) followed by gentamycin (69.2%). However, resistance was high against ciprofloxacin (77.8%). Multidrug resistance (MDR) was noted in 17 (45.9%). CONCLUSION One in eight of PLHIV attending CTC at KCMC referral hospital in Northern zone of Tanzania have BUTI. Presence of nitrites in urine is an important biomarker associated with BUTI. About two third of the isolates were Gram-positive bacteria, and nearly half of all isolates showed MDR to commonly used antibiotics.
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Affiliation(s)
| | - Bruno Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Upanga West, Dar es salaam, Tanzania
| | - Ayesiga Herman
- General Surgery Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Alfred Chacha
- Clinical Laboratory Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Eusebious Maro
- Obstetric and Gynecology Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | | | - Emmanuel Balandya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Upanga West, Dar es salaam, Tanzania
| | - Kien Alfred Mteta
- Urology Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Balandya E, Sunguya B, Gunda DW, Kidenya B, Nyamhanga T, Minja IK, Mahande M, Mmbaga BT, Mshana SE, Mteta K, Bartlett J, Lyamuya E. Building sustainable research capacity at higher learning institutions in Tanzania through mentoring of the Young Research Peers. BMC Med Educ 2021; 21:166. [PMID: 33731103 PMCID: PMC7967782 DOI: 10.1186/s12909-021-02611-0] [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] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/09/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Sustainability of research culture in Sub-Saharan Africa is threatened in part by the lack of a critical mass of young researchers with the requisite skills and interest to undertake research careers. This paper describes an intensive mentorship programme combining hierarchical (vertical) and peer-to-peer (horizontal) mentoring strategies among young researchers in a resource limited setting in Sub-Saharan Africa. METHODS A consortium of three partnering large Tanzanian health training institutions (MUHAS, CUHAS and KCMUCo) and two collaborating US institutions (UCSF and Duke University) was formed as part of the five-year Transforming Health Professions Education in Tanzania (THET) project, funded by the NIH through Health Professional Education Partnership Initiative (HEPI). Within THET, the Community of Young Research Peers (CYRP) was formed, comprising of inter-professional and cross-institutional team of 12 Master-level Young Research Peers and 10 co-opted fellows from the former MEPI-Junior Faculty (MEPI-JF) project. The Young Peers received mentorship from senior researchers from the consortium through mentored research awards and research training, and in turn provided reciprocal peer-to-peer mentorship as well as mentorship to undergraduate students. RESULTS At the end of the first 2 years of the project, all 12 Young Peers were proceeding well with mentored research awards, and some were at more advanced stages. For example, three articles were already published in peer reviewed journals and two other manuscripts were in final stages of preparation. All 12 Young Peers participated in CYRP-wide thematic training workshops on mentoring and secondary data analysis; 11 had undertaken at least three research training short courses in identified areas of need; 9 joined at least one other ongoing research project; 5 made at least one scientific presentation, and 5 participated in at least one submitted grant application. Half of the Young Peers have enrolled in PhD programmes. A collective total of 41 undergraduate students were actively mentored by the Young Peers in research. CONCLUSION The CYRP has demonstrated to be an effective model for dual vertical and horizontal mentorship in research to young investigators in resource-limited settings. This model is recommended to educators working on developing research competence of early career researchers, particularly in Sub-Saharan Africa.
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Affiliation(s)
- Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania.
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
| | - Daniel W Gunda
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Benson Kidenya
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Tumaini Nyamhanga
- Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
| | - Irene K Minja
- Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
| | - Michael Mahande
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kien Mteta
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | | | - Eligius Lyamuya
- Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
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Duggan CP, Kurpad A, Stanford FC, Sunguya B, Wells JC. Race, ethnicity, and racism in the nutrition literature: an update for 2020. Am J Clin Nutr 2020; 112:1409-1414. [PMID: 33274358 PMCID: PMC7727473 DOI: 10.1093/ajcn/nqaa341] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 01/06/2023] Open
Abstract
Social disparities in the US and elsewhere have been terribly highlighted by the current COVID-19 pandemic but also an outbreak of state-sponsored violence. The field of nutrition, like other areas of science, has commonly used 'race' to describe research participants and populations, without the recognition that race is a social, not a biologic, construct. We review the limitations of classifying participants by race, and recommend a series of steps for authors, researchers and policymakers to consider when producing and reading the nutrition literature. We recommend that biomedical researchers, especially those in the field of nutrition, abandon the use of racial categories to explain biologic phenomena but instead rely on a more comprehensive framework of ethnicity; that authors consider not just race and ethnicity but many social determinants of health, including experienced racism; that race and ethnicity not be conflated; that dietary pattern descriptions inform ethnicity descriptions; and that depersonalizating language be avoided.
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Affiliation(s)
- Christopher P Duggan
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Anura Kurpad
- Department of Nutrition, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, India
| | - Fatima C Stanford
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Bruno Sunguya
- Directorate of Research and Publications, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, University College London, London, United Kingdom
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Barabona G, Mahiti M, Masoud S, Mbelele P, Mgunya AS, Minja L, Sunguya B, Shigemi U, Matsuda M, Hachiya A, Iwatani Y, Lyamuya E, Ueno T. Pre-treatment and acquired HIV drug resistance in Dar es Salaam, Tanzania in the era of tenofovir and routine viral load monitoring. J Antimicrob Chemother 2020; 74:3016-3020. [PMID: 31273377 DOI: 10.1093/jac/dkz272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES We investigated the prevalence and patterns of pre-treatment and acquired HIV drug resistance mutations (DRMs) in Tanzania as a 'treat all' strategy, virological monitoring and the progressive increase in usage of tenofovir are being implemented in HIV treatment programmes. METHODS Viral RNA was isolated from plasma of 60 ART-naive and 166 treated-but-viraemic (>400 copies/mL) HIV-1-infected adults attending a care and treatment clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania, between June and October 2017. Viral genes encoding protease and reverse transcriptase were amplified by PCR and directly sequenced. RESULTS Viral genotyping of successfully amplified samples revealed pre-treatment DRMs in 14/47 (29.8%) ART-naive subjects. Of these, 7/47 (14.9%) harboured mutations that confer high-level resistance to at least one drug of the default first-line regimen. In treated-but-viraemic subjects, DRMs were found in 100/111 (90%), where DRMs against NNRTI, NRTI and PI were observed in 95/100 (95%), 92/100 (92%) and 13/100 (13%), respectively. Tenofovir-resistance mutations K65R and K70G/E or ≥3 thymidine analogue resistance mutations including M41L and L210W were found in 18/36 (50%) subjects on a tenofovir-containing regimen at failure. Four patients harboured multiple DRMs, which can confer resistance to all available ART regimens in Tanzania. CONCLUSIONS Taken together, pre-treatment and acquired DRMs were highly prevalent, which represents a major risk for the efficacy of ART programmes in Tanzania. Availability of a newer generation of antiretroviral drugs with a higher genetic barrier to resistance and robust treatment monitoring is warranted for effective and sustainable HIV treatment.
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Affiliation(s)
- Godfrey Barabona
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Macdonald Mahiti
- International Research Center for Medical Sciences, Kumamoto University, Kumamoto, Japan.,St Francis University College of Health and Allied Sciences, Ifakara, Tanzania.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Salim Masoud
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Peter Mbelele
- Kibong'oto Infectious Diseases Hospital, Moshi, Tanzania
| | | | - Lilian Minja
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Urara Shigemi
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Masakazu Matsuda
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Atsuko Hachiya
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yasumasa Iwatani
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.,Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eligius Lyamuya
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Takamasa Ueno
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan.,International Research Center for Medical Sciences, Kumamoto University, Kumamoto, Japan
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Masoud S, Kamori D, Barabona G, Mahiti M, Sunguya B, Lyamuya E, Ueno T. Circulating HIV-1 Integrase Genotypes in Tanzania: Implication on the Introduction of Integrase Inhibitors-Based Antiretroviral Therapy Regimen. AIDS Res Hum Retroviruses 2020; 36:539-543. [PMID: 32126792 DOI: 10.1089/aid.2020.0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/25/2022] Open
Abstract
Tanzania has recently adapted World Health Organization antiretroviral guidelines that include integrase strand transfer inhibitors (INSTIs) in the first-line regimen. However, there is lack of evidence on integrase (IN) gene polymorphisms in viral strains circulating in Tanzania. In this study, we characterize IN gene polymorphisms in viral strains circulating in Dar es Salaam, Tanzania, before introduction of INSTIs. Plasma viral RNAs were prepared from 158 HIV-1-infected subjects, including 111 treated, but viremic (INSTI-naïve), subjects. A part of the pol gene encompassing the IN-coding region was amplified and directly sequenced by the Sanger sequencing method. Subtype analysis revealed that subtypes A1, C, and D and intersubtype recombinants were 42%, 38%, 11%, and 9%, respectively. Although multiple subtypes cocirculate, the IN gene exhibited a relatively conserved amino acid sequence pattern with an average Shannon entropy score of 0.16. No major INSTI resistance mutations were found; however, accessory resistance mutations at positions T97A, E157Q, G163E/K, and 128A/T were detected in 5% of subjects.
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Affiliation(s)
- Salim Masoud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Doreen Kamori
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Godfrey Barabona
- Division of Infection and Immunity, Joint Sciences Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Macdonald Mahiti
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eligius Lyamuya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Takamasa Ueno
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Division of Infection and Immunity, Joint Sciences Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
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Tada K, Shimpuku Y, Sunguya B, Horiuchi S. Evaluation of breastfeeding care and education given to mothers with low-birthweight babies by healthcare workers at a hospital in urban Tanzania: a qualitative study. Int Breastfeed J 2020; 15:36. [PMID: 32375834 PMCID: PMC7201530 DOI: 10.1186/s13006-020-00280-1] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/22/2020] [Indexed: 11/27/2022] Open
Abstract
Background The total neonatal mortality in Tanzania remains high reaching as much as 44,900 deaths per year, particularly among low birthweight (LBW) babies. This makes Tanzania the fourth African country with the highest number of annual neonatal deaths. Studies have shown the advantages of breast milk for LBW babies and the effectiveness of interventions from healthcare workers (HCWs) to encourage mothers to achieve exclusive breastfeeding (EBF). Although these interventions can substantially reduce mortality in this vulnerable group, they remain insufficient in practice particularly in resource-limited countries. Therefore, there is an urgent need to establish the most appropriate interventions for mothers with LBW babies, particularly in these countries. To help address this need, we evaluated the breastfeeding care and education given to mothers with LBW babies by HCWs during hospitalization in Tanzania. Methods A qualitative study using semi-structured interviews with mothers of LBW babies at an urban hospital in Tanzania was conducted. We assessed their understanding of breastfeeding at discharge. All the interviews were conducted in local Swahili and then translated to English. Data were analyzed using content analysis. Results Among the 19 mothers interviewed, only four breastfed their baby within an hour after birth. Nine mothers received no support from HCWs when they breastfeed their baby for the first time. Ten mothers received no education on EBF, and there were mothers who misunderstood the EBF definition. Eight answered that they had difficulty breastfeeding their baby at discharge. Four mothers were dissatisfied with the care and education given by HCWs, and six mothers provided suggestions for improvements. Although six mothers had a high reliance on HCWs, they had difficulty asking HCWs questions because of their authoritative attitude and behavior. Conclusions Mothers with LBW babies need special support to increase their ability to breastfeed and ensure EBF continuance. To address the gaps between the currently provided breastfeeding interventions and the ideal breastfeeding interventions, improvements in the quality and quantity of breastfeeding care and education are required. Training HCWs to systematize standard interventions, confirming mothers’ understanding, and ensuring a comfortable environment for mothers are absolutely needed.
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Affiliation(s)
- Kyoko Tada
- St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Yoko Shimpuku
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Bruno Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nation Road, Upanga, Ilala Municipality, Dar es Salaam, Tanzania
| | - Shigeko Horiuchi
- St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
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Darling AM, Sunguya B, Ismail A, Manu A, Canavan C, Assefa N, Sie A, Fawzi W, Sudfeld C, Guwattude D. Gender differences in nutritional status, diet and physical activity among adolescents in eight countries in sub-Saharan Africa. Trop Med Int Health 2019; 25:33-43. [PMID: 31693777 DOI: 10.1111/tmi.13330] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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
OBJECTIVE The objective of this study was to evaluate gender differences in nutritional status, dietary intake, physical activity and hand hygiene among adolescents from diverse geographical settings in sub-Saharan Africa. METHODS This study utilised cross-sectional data from six countries (Burkina Faso, Ethiopia, Ghana, Nigeria, Tanzania and Uganda) within the ARISE Adolescent Health Survey (n = 7625). Body mass index (BMI) was calculated using measured heights and weights, and z-scores were calculated based on the 2007 WHO growth standards for age and sex. Information on demographics, diet and health behaviours was collected through face-to-face interviews using a standardised questionnaire. Site-specific and pooled prevalence ratios were determined. RESULTS The prevalence of underweight, overweight and stunting pooled across sites was 14.3%, 6.8% and 18.1%, respectively. Female sex was associated with a lower risk of being underweight (pooled prevalence ratio 0.66, 95% 0.57, 0.77) and stunted (pooled PR 0.63, 95% CI 0.55, 0.71), but a higher risk of being overweight (pooled PR 1.60, 95% CI 1.26, 2.06). Females were also less likely to exercise for 1 h or more per day (pooled PR 0.77, 95% CI 0.67, 0.88), and more likely to wash hands after using toilets or latrines and to wash hands with soap (pooled PRs 1.13, 95% CI 1.05, 1.21 and 1.35, 95% CI 1.23, 1.45, respectively). CONCLUSION Our results emphasise that sex is a key predictor of nutritional status among sub-Saharan African adolescents and suggest that gender-specific interventions may be required to reduce the double burden of under- and overnutrition.
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Affiliation(s)
- Anne Marie Darling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bruno Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Abbas Ismail
- Department of Statistics, University of Dodoma, Dodoma, Tanzania
| | - Abubakar Manu
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Chelsey Canavan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nega Assefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chris Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David Guwattude
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
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Siril H, Kaale A, Minja A, Kilewo J, Mugusi F, Sunguya B, Todd J, Kaaya S, Smith Fawzi MC. Improving communication about HIV prevention among people living with HIV and their at-risk social network members in Dar es Salaam, Tanzania. Cogent Med 2019; 6. [PMID: 31355302 PMCID: PMC6660010 DOI: 10.1080/2331205x.2019.1600230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Although a number of HIV prevention programs have been implemented, such as mass media campaigns, high rates of unprotected and concurrent sexual partnerships, as well as low uptake HIV testing and limited HIV knowledge, persist in Tanzania. We examined the effect and predicting factors of HIV prevention communication among people living with HIV (PLH) exposed to NAMWEZA intervention, and their at-risk social network members (NMs) Quantitative data were collected from 326 participants at baseline and 24 months of follow-up. In-depth interviews with 20 PLH were conducted at follow-up. Results indicated specific communication about condom use and HIV testing increased; (mean increase of 0.28 (SD = 0.14) scores, P = 0.012 and 0.42 (SD = 0.11) scores, p < 0.001 respectively while general discussion about protecting other people from HIV did not change significantly; mean increase was 0.01 scores (SD = 0.005), p = 0.890. Positive predictors of communication included being single; OR = 1.10, p = 0.01, female; OR = 1.15, p = 0.03, aged 30 years or older; OR = 1.23, p < 0.01, HIV knowledge, dose of NAMWEZA participation; OR = 1.01, p < 0.001, and high self-efficacy for condom use; OR = 1.4, p < 0.001. Stigma demonstrated a significant but negative association with communication for condom use; OR = 1.01, p < 0.01.Qualitative data reflected perceived possession of more individual skills and ability to address some personal/cultural obstacles to communicating about HIV prevention including those observed in the quantitative data. NAMWEZA improved communication about HIV prevention among PLH with their at-risk-NMs. The approach is a promising complement to media campaigns in similar populations. Future research and program evaluation efforts should explore how communities perceive and communicate about protecting others from HIV.
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Affiliation(s)
- Hellen Siril
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Public Health Evaluations and Quality Improvement, Management and Development for Health, Dar es Salaam, Tanzania
| | - Anna Kaale
- Department of Healthy Options, Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | - Anna Minja
- Department of Healthy Options, Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | - Japheth Kilewo
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jim Todd
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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