1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Githendu P, Morrison L, Silaa R, Pothapregada S, Asiimwe S, Idris R, Peterson T, Davidson E, Lesego A, Mwale N, Mwakalobo SM, Bwanakunu LR, Achoki T. Transformation of the Tanzania medical store department through global fund support: an impact assessment study. BMJ Open 2020; 10:e040276. [PMID: 33158832 PMCID: PMC7651727 DOI: 10.1136/bmjopen-2020-040276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The Tanzania government sought support from The Global Fund to Fight AIDs, Tuberculosis and Malaria to reform its Medical Stores Department, with the aim of improving performance. The study sought to assess the impact of the reforms and document the lessons learnt. METHODS Quantitative and qualitative research methods were applied to assess the impact of the reforms. The quantitative part entailed a review of operational and financial data covering the period before and after the implementation of the reforms. Interrupted time series analysis was used to determine the change in average availability of essential health commodities at health zones. Qualitative data were collected through 41 key informant interviews. Participants were identified through stakeholder mapping, purposive and snowballing sampling techniques and responses were analysed through thematic content analysis. RESULTS Availability of essential health commodities increased significantly by 12.6% (95% CI 9.6% to 15.6%) after the reforms and continued to increase on a monthly basis by 0.2% (95%CI 0.0% to 0.3%) relative to the preintervention trend. Sales increased by 56.6% while the cost of goods sold increased by 88.6% between 2014/2015 and 2017/2018. Surplus income increased by 56.4% between 2014/2015 and 2017/2018 with reductions in rent and fuel expenditure. There was consensus among study participants that the reforms were instrumental in improving performance of the Medical Stores Department. CONCLUSION Positive results were realised through the reforms. However, despite the progress, there were risks such as the increasing government receivable that could jeopardise the sustainability of the gains. Therefore, multistakeholder efforts are necessary to make progress and expand public health.
Collapse
Affiliation(s)
- Patrick Githendu
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Linden Morrison
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Rosemary Silaa
- Independent Consultants, Dar es Salaam, Tanzania, United Republic of
| | - Sai Pothapregada
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Sarah Asiimwe
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Rafiu Idris
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Tatjana Peterson
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Emma Davidson
- Independent Consultants, Dar es Salaam, Tanzania, United Republic of
| | - Abaleng Lesego
- Africa Institute for Health Policy Foundation, Nairobi, Kenya
| | - Neema Mwale
- Tanzania Medical Stores Department, Dar es Salaam, Tanzania, United Republic of
| | | | | | - Tom Achoki
- Africa Institute for Health Policy Foundation, Nairobi, Kenya
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
4
|
Wandwalo E, Kamara V, Yassin MA, Morrison L, Nwaneri NB, Asiimwe S, Matiku S, Mutayoba B. Enhancing tuberculosis case finding in Tanzania: implementation of a quality improvement initiative. Public Health Action 2020; 10:57-59. [PMID: 32640006 DOI: 10.5588/pha.19.0065] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
Tuberculosis (TB) is one of the major causes of morbidity and mortality in Tanzania. A quality improvement (QI) initiative was implemented by the National Tuberculosis Programme with support from The Global Fund to enhance TB case finding. The initiative involved identifying gaps in the quality of services, introducing tools, building capacity of health workers, and strengthening laboratory and referral services. The initiative was piloted at sub-national level and subsequently scaled-up nationally. Overall, 1280 health workers were trained, leading to an 81% cumulative increase in notified TB cases in the pilot region and 4000 additional TB cases notified nationally. The QI initiative could serve as a model for the improvement of TB case notification in other settings.
Collapse
Affiliation(s)
- E Wandwalo
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - V Kamara
- National TB and Leprosy Programme, Dodoma, United Republic of Tanzania
| | - M A Yassin
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - L Morrison
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - N B Nwaneri
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - S Asiimwe
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - S Matiku
- New Dimension Consulting, Dar es Salaam, United Republic of Tanzania
| | - B Mutayoba
- National TB and Leprosy Programme, Dodoma, United Republic of Tanzania
| |
Collapse
|
5
|
Lubinga SJ, Kintu A, Atuhaire J, Asiimwe S. Concomitant herbal medicine and Antiretroviral Therapy (ART) use among HIV patients in Western Uganda: a cross-sectional analysis of magnitude and patterns of use, associated factors and impact on ART adherence. AIDS Care 2012; 24:1375-83. [PMID: 22292937 DOI: 10.1080/09540121.2011.648600] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Use of herbal medicines among patients receiving Anti-retroviral Therapy (ART) remains by far an uncharacterised phenomenon in Africa and Uganda specifically. We evaluated the use of herbal medicines among patients on ART at the HIV clinic of Mbarara Regional Referral Hospital (MRRH), examined factors associated with their concomitant use and their impact on ART adherence. This was a cross-sectional study among 334 systematically sampled patients receiving ART at the HIV clinic of MRRH from February to April 2010. We collected data on patient demographics, clinical characteristics, perceptions of quality of care received, self-perceived health status, information on ART received, herbal medicines use and ART adherence. Study outcomes were concomitant herbal medicine and ART use, and ART adherence. Descriptive analysis and logistic regression were conducted using Stata10.0. Close to half, 155 (46.4%) reported concomitant herbal medicines and ART use, with 133 (39.8%) using herbal medicines at least once daily. Most (71.6%) used herbal medicines to treat HIV-related symptoms. A majority (92.3%) reported that the doctors were unaware of their use of herbal medicines, 68.5% citing its minimal importance to the attending physician. Most frequently used herbs were Aloe vera (25%) and Vernonia amygdalina (21%). Time since start of ART (OR 1.14 95% CI: 1.01-1.28, for each one year increase), number of ART side effects reported (≥3 vs.≤1, OR 2.20 95% CI 1.13-4.26) and self-perceived health status (Good vs. Poor, OR 0.31 95% CI 0.12-0.79) were independently associated with concomitant herbal medicine and ART use. Concomitant herbal medicine and ART use was not associated with poor ART adherence (OR 0.85 95% CI 0.47-1.53). There is widespread concomitant herbal medicines and ART use among our patients, with no association to poor ART adherence. Patients appear to use these therapies to complement as opposed to substituting ART.
Collapse
Affiliation(s)
- S J Lubinga
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.
| | | | | | | |
Collapse
|