National Non-Communicable Diseases Conferences- A Platform to Inform Policies and Practices in Tanzania.

Background: Non-communicable diseases (NCDs) arise from diverse risk factors with differences in the contexts and variabilities in regions and countries. Addressing such a complex challenge requires local evidence. Tanzania has been convening stakeholders every year to disseminate and discuss scientific evidence, policies, and implementation gaps, to inform policy makers in NCDs responses. This paper documents these dissemination efforts and how they have influenced NCDs response and landscape in Tanzania and the region. Methods: Desk review was conducted through available MOH and conference organizers' documents. It had both quantitative and qualitative data. The review included reports of the four NCDs conferences, conference organization, and conduct processes. In addition, themes of the conferences, submitted abstracts, and presentations were reviewed. Narrative synthesis was conducted to address the objectives. Recommendations emanated from the conference and policy uptake were reviewed and discussed to determine the impact of the dissemination. Findings: Since 2019, four theme-specific conferences were organized. This report includes evidence from four conferences. The conferences convened researchers and scientists from research and training institutions, implementers, government agencies, and legislators in Tanzania and other countries within and outside Africa. Four hundred and thirty-five abstracts were presented covering 14 sub-themes on health system improvements, financing, governance, prevention intervention, and the role of innovation and technology. The conferences have had a positive effect on governments' response to NCDs, including health care financing, NCDs research agenda, and universal health coverage. Conclusion: The National NCDs conferences have provided suitable platforms where stakeholders can share, discuss, and recommend vital strategies for addressing the burden of NCDs through informing policies and practices. Ensuring the engagement of the right stakeholders, as well as the uptake and utilization of the recommendations from these platforms, remains crucial for addressing the observed epidemiological transition in Tanzania and other countries with similar contexts.

Non-communicable Diseases Week: Best Practices in Addressing the NCDs Burden from Tanzania.

Background: Five million people die every year from non-communicable diseases (NCDs) globally. In Tanzania, more than two-thirds of deaths are NCD-related. The country is investing in preventive and advocacy activities as well as interventions to reduce the burden. Of particular interest, the Ministry of Health (MoH) commemorates NCDs' week using a multisectoral and multi-stakeholders' approach. This paper highlights activities conducted during NCDs week with the aim of sharing lessons for other countries with similar context and burdens. Methods: A thorough review of official reports and the national strategic plans for NCDs was done including the 2020 and 2021 National NCDs' week reports, the National Strategic Plan for NCDs 2015-2020, and the National NCDs agenda. Findings: NCDs week is commemorated annually throughout the country involving the five key activities. First, community awareness and participation are encouraged through media engagement and community-based preventive and advocacy activities. Second, physical activities and sports festivals are implemented with a focus on developing and renovating infrastructures for sports and recreation. Third, health education is provided in schools to promote healthy behaviors for secondary school adolescents in transition to adulthood. Fourth, health service provision and exhibitions are conducted involving screening for hypertension, diabetes, obesity, alcohol use, and physical activities. The targeted screening of NCDs identified 10% of individuals with at least one NCD in 2020. In 2021, a third of all screened individuals were newly diagnosed with hypertension, and 3% were found to have raised blood glucose levels. Fifth, the national NCDs scientific conferences conducted within the NCDs week provide an avenue for stakeholders to discuss scientific evidence related to NCDs and recommend strategies to mitigate NCDs burden. Conclusion: The initiation of NCDs week has been a cornerstone in advocating for NCDs control and prevention in the country. It has created awareness on NCDs, encourage healthy lifestyles and regular screening for NCDs. The multi-stakeholder and multi-sectoral approaches have made the implementation of the mentioned activities feasible and impactful. This has set an example for the united efforts toward NCD control and prevention at national, regional, and global platforms while considering contextual factors during adoption and implementation.

Mitigating the Rising Burden of Non-Communicable Diseases through Locally Generated Evidence-Lessons from Tanzania.

Background: The burden of Non-Communicable Diseases (NCDs) is rapidly increasing globally, and low- and middle-income countries (LMICs) bear the brunt of it. Tanzania is no exception. Addressing the rising burden of NCDs in this context calls for renewed efforts and commitment by various stakeholders. This paper highlights local initiatives and strategies to combat NCDs in Tanzania and provides lessons for countries with similar contexts. Methods: We reviewed published and grey literature and conducted policy analysis on NCDs in Tanzania to examine the burden of NCDs and the national response addressing it. The documents included National NCD strategic plans, NCD research agenda, and reports from the World Diabetes Foundation and the World Health Organization. Moreover, a scoping review of ongoing NCD activities and programs in other countries was also conducted to supplement the evidence gathered. Results: The rising burden of NCDs as a result of the epidemiological transition in Tanzania called for the launching of a dedicated National NCD Control and Prevention Program. The Ministry of Health collaborates with local, national, and international partners on NCD prevention and curative strategies. This led to the development of important guidelines and policies on NCDs, including strengthening the capacity of health facilities and healthcare workers, increased community engagement and awareness of NCDs, and increased advocacy for more resources in NCD initiatives. Strong governmental commitment has been vital; this is demonstrated by a renewed commitment to the fight through national NCD week and related advocacy activities conducted annually. To ensure multi-stakeholders' engagement and political commitment, all these activities are coordinated at the Prime Minister's office and provide strong lessons for countries with contexts similar to Tanzania. Conclusion: Multi-stakeholders' engagement, innovative approaches, and coordinated governmental efforts to address NCDs have shone a light on addressing the burden of NCDs and may be sustainable if aligned with locally available resources. Such initiatives are recommended for adoption by other nations to address the burdens of NCDs.

Integrated management of HIV, diabetes, and hypertension in sub-Saharan Africa (INTE-AFRICA): a pragmatic cluster-randomised, controlled trial.

BACKGROUND: In sub-Saharan Africa, health-care provision for chronic conditions is fragmented. The aim of this study was to determine whether integrated management of HIV, diabetes, and hypertension led to improved rates of retention in care for people with diabetes or hypertension without adversely affecting rates of HIV viral suppression among people with HIV when compared to standard vertical care in medium and large health facilities in Uganda and Tanzania. METHODS: In INTE-AFRICA, a pragmatic cluster-randomised, controlled trial, we randomly allocated primary health-care facilities in Uganda and Tanzania to provide either integrated care or standard care for HIV, diabetes, and hypertension. Random allocation (1:1) was stratified by location, infrastructure level, and by country, with a permuted block randomisation method. In the integrated care group, participants with HIV, diabetes, or hypertension were managed by the same health-care workers, used the same pharmacy, had similarly designed medical records, shared the same registration and waiting areas, and had an integrated laboratory service. In the standard care group, these services were delivered vertically for each condition. Patients were eligible to join the trial if they were living with confirmed HIV, diabetes, or hypertension, were aged 18 years or older, were living within the catchment population area of the health facility, and were likely to remain in the catchment population for 6 months. The coprimary outcomes, retention in care (attending a clinic within the last 6 months of study follow-up) for participants with either diabetes or hypertension (tested for superiority) and plasma viral load suppression for those with HIV (>1000 copies per mL; tested for non-inferiority, 10% margin), were analysed using generalised estimating equations in the intention-to-treat population. This trial is registered with ISCRTN 43896688. FINDINGS: Between June 30, 2020, and April 1, 2021 we randomly allocated 32 health facilities (17 in Uganda and 15 in Tanzania) with 7028 eligible participants to the integrated care or the standard care groups. Among participants with diabetes, hypertension, or both, 2298 (75·8%) of 3032 were female and 734 (24·2%) of 3032 were male. Of participants with HIV alone, 2365 (70·3%) of 3365 were female and 1000 (29·7%) of 3365 were male. Follow-up lasted for 12 months. Among participants with diabetes, hypertension, or both, the proportion alive and retained in care at study end was 1254 (89·0%) of 1409 in integrated care and 1457 (89·8%) of 1623 in standard care. The risk differences were -0·65% (95% CI -5·76 to 4·46; p=0·80) unadjusted and -0·60% (-5·46 to 4·26; p=0·81) adjusted. Among participants with HIV, the proportion who had a plasma viral load of less than 1000 copies per mL was 1412 (97·0%) of 1456 in integrated care and 1451 (97·3%) of 1491 in standard care. The differences were -0·37% (one-sided 95% CI -1·99 to 1·26; pnon-inferiority<0·0001 unadjusted) and -0·36% (-1·99 to 1·28; pnon-inferiority<0·0001 adjusted). INTERPRETATION: In sub-Saharan Africa, integrated chronic care services could achieve a high standard of care for people with diabetes or hypertension without adversely affecting outcomes for people with HIV. FUNDING: European Union Horizon 2020 and Global Alliance for Chronic Diseases.

Acceptability of using mobile Health (mHealth) as an intervention tool for people with drug use disorders in Tanga, Tanzania.

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.

Prevalence and factors associated with potential substance use disorders among police officers in urban Tanzania: a cross-sectional study.

BACKGROUND: Substance Use Disorders (SUDs) among Police Officers has been a concern to many professionals in the field of health, research and criminal justice since their work is subjected to higher levels of stress and hence more likely to use alcohol or tobacco as a coping mechanism. However, little is known about SUDs among Police Officers in Tanzania. Therefore, we assessed the prevalence and factors associated with SUDs among Police Officers in urban Tanzania. MATERIALS AND METHODS: A cross-sectional study was conducted between April and October 2019 among Police Officers in Dar es Salaam. Multistage cluster sampling technique was used to recruit study participants. The WHO-Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) version 3.0 was used to measure potential SUDs. Bivariate and multivariate analyses were performed to establish associations between potential SUDs and predictors of interest, and an alpha of 5% was used in sample size calculation. RESULTS: A total of 497 participants were enrolled, of these, 76.6% (376/491) were males, the median age (years) and IQR was 37.0 (30.0, 47.0). The prevalence of past three months use of alcohol and tobacco were 31.3% and 6.3%, respectively. About 13.3% (62/468) and 6.2% (29/468) of Police Officers met criteria for potential Alcohol Use Disorder (AUD) and potential Tobacco Use Disorder (TUD) respectively. In adjusted analysis, participants with depression had about two times increased odds for potential AUD (aOR: 2.27, 95% CI; 1.12 - 4.58, p = 0.023) than those with no depression. Potential AUD and depression were associated with about eight times (aOR: 8.03, 95% CI; 3.52 - 18.28, p < 0.01) and more than twice (aOR: 2.63, 95% CI; 1.12 - 6.15, p = 0.026) higher odds for potential TUD respectively. CONCLUSION: Substance use and potential substance use disorders particularly AUD and TUD are common among Police Officers in urban Tanzania. Depression was found to be an important factor for potential AUD and TUD among Police Officers and, a significant co-occurrence of potential AUD with potential TUD was observed. Findings from this study call for interventions, for example, the need to routinize the brief motivational interview services for alcohol and tobacco use among Police Officers.

Humoral Immune Responses following COVID-19 Vaccinations among Adults in Tanzania.

COVID-19 vaccination remains to be the most important intervention in the fight against the pandemic. The immunity among the vaccinated population and its durability can significantly vary due to various factors. This study investigated the humoral immune responses among individuals who received any of the COVID-19 vaccines approved for use in Tanzania. A total of 1048 randomly selected adults who received COVID-19 vaccines at different time points were enrolled and humoral immune responses (IR) were tested at baseline and three months later (960, 91.6%). The level of SARS-CoV-2 anti-spike/receptor binding domain (RBD) IgG, anti-nucleocapsid IgG, and IgM antibodies were determined using a commercially available chemiluminescent microparticle immunoassay. Descriptive data analysis was performed using STATA version 18 and R. At baseline, serum IgG against anti-spike/RBD was detected in 1010/1048 (96.4%) participants (95%CI: 94.9-97.5) and 98.3% (95%CI: 97.3-99) three months later. The IgG against the SARS-CoV-2 nucleocapsid proteins were detected in 40.8% and 45.3% of participants at baseline and follow-up, respectively. The proportion of seroconverters following vaccination and mean titers of anti-spike/RBD antibodies were significantly more among those who had past SARS-CoV-2 infection than in those with no evidence of past infection, (p < 0.001). Only 0.5% of those who had detectable anti-spike/RBD antibodies at baseline were negative after three months of follow-up and 1.5% had breakthrough infections. The majority of participants (99.5%) had detectable anti-spike/RBD antibodies beyond 6 months post-vaccination. The proportion of Tanzanians who mounted humoral IR following COVID-19 vaccination was very high. Seroconversions, as well as the mean titers and durability of humoral IR, were significantly enhanced by exposure to natural SARS-CoV-2 infection. In view of the limited availability of COVID-19 vaccines as well as challenges to completing subsequent doses, booster doses could only be suggested to high-risk groups.

Drug use and associated factors in a North Eastern region of Tanzania: a cross-sectional study.

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.

Depression, suicidality and associated risk factors among police officers in urban Tanzania: a cross-sectional study.

BACKGROUND: The WHO has classified depression as a disease of public concern. Police officers are a particular subpopulation group that is at an increased risk for mental health problems. This study examined the prevalence of depression, suicidality and associated risk factors among police officers in urban Tanzania. AIMS: The aim of this study was to examine the prevalence of depression, suicidality and associated risk factors among police officers in Tanzania. METHODS: A cross-sectional study was conducted between April 2019 and October 2020 among 550 participants in Dar es Salaam recruited using a multistage cluster sampling technique. The Patient Health Questionnaire-9 was used to screen for depression and suicidality. The Interpersonal Support Evaluation List-12 tool was used to measure perceived social support. Descriptive statistics were summarised using frequencies and percentages. Bivariate and multivariate analyses were used to establish associations between predictors of interest, depression and suicidality. RESULTS: There were 497 participants in the study. Of these, 76.6% (376 of 491) were men, and the median (IQR) age was 37.0 (17) years. Around 19.8% (96 of 486) of the police officers screened positive for depression and 15.4% (75 of 413) for suicidality. A significant proportion was either moderately (29 of 96, 30.2%) or severely depressed (8 of 75, 10.7 %). Of those who experienced suicidal thoughts, 10.7% (8 of 75) reported having daily suicidal thoughts. Perceiving low social support was associated with an increased risk of reporting depression (adjusted OR (aOR): 28.04, 95% CI: 8.42 to 93.37, p<0.001) and suicidality (aOR: 10.85, 95% CI: 3.56 to 33.08, p<0.001) as compared with those with high perceived social support. CONCLUSION: The magnitude of depression and suicidality among police officers in urban Tanzania is alarmingly high. The study findings indicate the need for routine screening for depression and suicidality among police officers and design appropriate mental health responsive services in this population.

Creating Evidence-Based Youth Mental Health Policy in Sub-Saharan Africa: A Description of the Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania.

Addressing depression in young people is a health-care policy need in sub-Saharan Africa. There exists poor mental health literacy, high levels of stigma, and weak capacity at the community level to address this health-care need. These challenges are significant barriers to accessing mental health care for depression, soon to be the largest single contributor to the global burden of disease. We here describe an innovative approach that addresses these issues simultaneously while concurrently strengthening key mental health components in existing education and health-care systems as successfully applied in Malawi and replicated in Tanzania. Improving the pathway to care for young people with depression requires the following: improving mental health literacy (MHL) of communities, youth, and teachers; enhancing case identification and linking schools to community health clinics; improving the capacity of community health-care providers to identify, diagnose, and effectively treat depression in youth. Funded by Grand Challenges Canada, we developed and applied a program called "An Integrated Approach to Addressing the Challenge of Depression Among the Youth in Malawi and Tanzania" (IACD). This was an example of, a horizontally integrated pathway to care model designed to be applied in low-resource settings. The model is designed to 1) improve awareness/knowledge of mental health and mental disorders (especially depression) in communities; 2) enhance mental health literacy among youth and teachers within schools; 3) enhance capacity for teachers to identify students with possible depression; 4) create linkages between schools and community health clinics for improved access to mental health care for youth identified with possible depression; and 5) enhance the capacity of community-based health-care providers to identify, diagnose, and effectively treat youth with depression. With the use of interactive, youth-informed weekly radio programs, mental health curriculum training for teachers and peer educators in secondary schools, and a clinical competency training program for community-based health workers, the innovation created a "hub and spoke" model for improving mental health care for young people. Positive results obtained in Malawi and replicated in Tanzania suggest that this approach may provide an effective and potentially sustainable framework for enhancing youth mental health care, thus providing a policy ready framework that can be considered for application in sub-Saharan Africa.

Improving feeding and growth of HIV-positive children through nutrition training of frontline health workers in Tanga, Tanzania.

BACKGROUND: Nutrition training can boost competence of health workers to improve children's feeding practices. In this way, child undernutrition can be ameliorated in general populations. However, evidence is lacking on efficacy of such interventions among Human Immunodeficiency Virus (HIV)-positive children. We aimed to examine the efficacy of a nutrition training intervention to improve midlevel providers' (MLPs) nutrition knowledge and feeding practices and the nutrition statuses of HIV-positive children in Tanga, Tanzania. METHODS: This cluster-randomized controlled trial was conducted in 16 out of 32 care and treatment centers (CTCs) in Tanga. Eight CTCs were assigned to the intervention arm and a total of 16 MLPs received nutrition training and provided nutrition counseling and care to caregivers of HIV-positive children. A total of 776 pairs of HIV-positive children and their caregivers were recruited, of whom 397 were in the intervention arm. Data were analyzed using instrumental variable random effects regression with panel data to examine the efficacy of the intervention on nutrition status through feeding practices. RESULTS: Mean nutrition knowledge scores were higher post-training compared to pre-training among MLPs (37.1 vs. 23.5, p < 0.001). A mean increment weight gain of 300 g was also observed at follow-up compared to baseline among children of the intervention arm. Feeding frequency and dietary diversity improved following the intervention and a 6 months follow-up (p < 0.001). An increase in each unit of feeding frequency and dietary diversity were associated with a 0.15-unit and a 0.16-unit respectively decrease in the child underweight (p < 0.001). CONCLUSIONS: Nutrition training improved nutrition knowledge among MLPs caring for HIV-positive children attending CTCs in Tanga, Tanzania. Caregivers' feeding practices also improved, which in turn led to a modest weight gain among HIV-positive children. To sustain weight gain, efforts should be made to also improve households' food security and caregivers' education in addition to inservice nutrition trainings. The protocol was registered on 15/02/2013, before the recruitment at ISRCTN trial registry with the trial registration number: ISRCTN65346364.

Addressing Adolescent Depression in Tanzania: Positive Primary Care Workforce Outcomes Using a Training Cascade Model.

BACKGROUND: This is a report on the outcomes of a training program for community clinic healthcare providers in identification, diagnosis, and treatment of adolescent Depression in Tanzania using a training cascade model. METHODS: Lead trainers adapted a Canadian certified adolescent Depression program for use in Tanzania to train clinic healthcare providers in the identification, diagnosis, and treatment of Depression in young people. As part of this training program, the knowledge, attitudes, and a number of other outcomes pertaining to healthcare providers and healthcare practice were assessed. RESULTS: The program significantly, substantially, and sustainably improved provider knowledge and confidence. Further, healthcare providers' personal help-seeking efficacy also significantly increased as well as the clinicians' reported number of adolescent patients identified, diagnosed, and treated for Depression. CONCLUSION: To our knowledge, this is the first study reporting positive outcomes of a training program addressing adolescent Depression in Tanzanian community clinics. These results suggest that the application of this training cascade approach may be a feasible model for developing the capacity of healthcare providers to address youth Depression in a low-income, low-resource setting.

A school mental health literacy curriculum resource training approach: effects on Tanzanian teachers' mental health knowledge, stigma and help-seeking efficacy.

BACKGROUND: Mental health literacy (MHL) is foundational for mental health promotion, prevention, stigma reduction, and care; School supported information pertaining to MHL in sub-Saharan Africa is extremely limited, including in Tanzania. Successful application of a school MHL curriculum resource may be an effective way to increase teacher MHL and therefore help to improve mental health outcomes for students. METHODS: Secondary school teachers in Tanzania were trained on the African Guide (AG) a school MHL curriculum resource culturally adapted from a Canadian MHL resource (The Guide) for use in Africa. Teacher training workshops on the classroom application of the AG were used to evaluate its impact on mental health literacy in a sample of Tanzanian Secondary school teachers. Pre-post training assessment of participant knowledge and attitudes was conducted. Help-seeking efficacy for teachers themselves and their interventions for students, friends, family members and peers were determined. RESULTS: Paired t test (n = 37) results demonstrate highly significant improvements in teacher's overall knowledge (p < 0.001; d = 1.14), including mental health knowledge, (p < 0.001; d = 1.14) and curriculum specific knowledge (p < 0.01; d = 0.63). Teachers' stigma against mental illness decreased significantly following the training (p < 0.001; d = 0.61). Independent t tests comparing the paired sample against unpaired sample also demonstrated significant differences between the groups for teacher's overall knowledge (p < 0.001). Teachers also reported high rates (greater than ¾ of the sample) of positive help-seeking efficacy for themselves as well as for their students, friends, family members and peers. As a result of the training, the number of students teachers identified for potential mental health care totaled over 200. CONCLUSIONS: These positive results, when taken together with other research, suggest that the use of a classroom-based resource (the AG) that integrates MHL into existing school curriculum through training teachers may be an effective and sustainable way to increase the MHL (improved knowledge, decreased stigma and positive help-seeking efficacy) of teachers in Tanzania. As this study replicated the results of a previous intervention in Malawi, consideration could be given to scaling up this intervention in both countries and applying this resource and approach in other countries in East Africa.

Association of opioid agonist therapy with the initiation of antiretroviral therapy - a systematic review.

OBJECTIVES: People who inject drugs are at high risk of HIV infection but often face barriers in accessing medical care including access to antiretroviral therapy (ART). Evidence is available about the effectiveness of opioid agonist therapy on drug dependency and risk behaviors. However, it remains scattered regarding access to ART among HIV-positive people who inject drugs. We conducted a systematic review to examine the association of opioid agonist therapy with ART initiation among HIV-positive people who inject drugs. METHODS: We searched the literature for evidence from seven databases. We conducted a narrative synthesis and meta-analysis to examine the association of opioid agonist therapy with ART initiation. RESULTS: Five out of 2,901 identified studies met the inclusion criteria. Three out of five studies reported that, HIV-positive people receiving opioid agonist therapy initiated ART more than those not receiving opioid agonist therapy. In meta-analysis, opioid agonist therapy was associated with ART initiation among HIV positive people who inject drugs (pooled odds ratio: 1.68; 95% confidence interval: 1.03-2.73). CONCLUSIONS: Opioid agonist therapy is positively associated with ART initiation among HIV-positive people who inject drugs. It is important to scale up opioid agonist therapy among people who inject drugs to improve their ART initiation.

Improvements in health-related quality of life among methadone maintenance clients in Dar es Salaam, Tanzania.

BACKGROUND: Injection of heroin has become widespread in Dar es Salaam, Tanzania and is spreading throughout the country. To prevent potential bridging of HIV epidemics, the Tanzanian government established a methadone maintenance treatment (MMT) clinic in February 2011. We assess the effect of MMT on health-related quality of life (HRQOL) and examine factors, particularly HIV infection and methadone dose, associated with changes in HRQOL. METHODS: This study utilized routine data on clients enrolling in methadone from February 2011 to April 2012 at Muhimbili National Hospital. Change in physical (PCS) and mental health (MCS) composite scores, as measured by the SF-12 tool, were the primary outcomes. Backward stepwise linear regression, with a criterion of p<0.2 was used to identify baseline exposure variables for inclusion in multivariable models, while adjusting for baseline scores. RESULTS: A total of 288 MMT clients received baseline and follow-up assessments. Mean methadone dose administered was 45mg (SD±25) and 76 (27%) were confirmed HIV-positive. Significant improvements were observed in PCS and MCS, with mean increases of 15.7 and 3.3, respectively. In multivariable models, clients who had previous poly-substance use with cocaine [p=0.040] had a significantly higher mean change in PCS. Clients who were living with HIV [p=0.002]; satisfied with current marital situation [p=0.045]; had a history of suicidal thoughts [p=0.021]; and previously experienced cognitive difficulties [p=0.012] had significantly lower mean change in PCS. Clients with shorter history of heroin use [p=0.012] and who received higher methadone doses [p=0.028] had significantly higher mean change in MCS, compared to their counterparts. CONCLUSION: Aspects of mental and physical health, risk behaviors and quality of life among drug users are intertwined and complex. Our research revealed positive short-term effects of MMT on HRQOL and highlights the importance of sustained retention for optimal benefits. Comprehensive supportive services in addition to provision of methadone are needed to address the complex health needs of people who inject drugs.

A Mismatch between High-Risk Behaviors and Screening of Infectious Diseases among People Who Inject Drugs in Dar es Salaam, Tanzania.

BACKGROUND: People who inject drugs are at risk of various infectious diseases. Despite such a risk, evidence is limited which studied the utilization of screening services for common infectious diseases among people who inject drugs in Tanzania. We aimed to examine their high-risk behaviors; utilization of screening services for HIV infection, hepatitis B/C, any other sexually transmitted infection, and tuberculosis; and their associated factors in Dar es Salaam, Tanzania. METHODS: We conducted a baseline cross-sectional study as part of a prospective cohort study of people who inject drugs. We included 578 participants comprising of new enrollees of the integrated methadone-assisted treatment program and those who were selected from the communities but not enrolled in the program. We interviewed new enrollees preceding their enrollment and receipt of services from the program. We measured participants' high-risk behaviors and their utilization of screening services. We analyzed the data descriptively and used multiple logistic regressions to identify the factors associated with ever being screened for infectious diseases. RESULTS: Of 578 participants, 14.2% shared injection needles. Of 547 sexually active participants, 37.5% had multiple sexual partners and only 17.4% used a condom. Of all participants, however, only 36.0% had ever been screened for HIV infection, 18.5% for tuberculosis, 11.8% for any other sexually transmitted infection, and 11.6% for hepatitis B/C. They were more likely to have ever been screened for HIV infection if they had education levels above primary education (adjusted odds ratio [AOR]: 2.54, 95% CI: 1.54-4.20), had a history of transactional sex (OR: 2.63, 95% CI: 1.01-6.84), and were new enrollees of the program (AOR: 7.41, 95% CI: 4.41-12.86). CONCLUSIONS: People who inject drugs practice high-risk behaviors but their utilization of screening services for infectious diseases is poor in Dar es Salaam, Tanzania. It is crucial to increase the coverage of screening services for them and strengthen the counseling of safer sexual practices.

Correlates of health care seeking behaviour among people who inject drugs in Dar es Salaam, Tanzania.

BACKGROUND: People who inject drugs (PWID) suffer from a high burden of infectious disease. At the same time, they often have poor access to health care. As in other East African countries, the population of PWID is growing in Tanzania, but little is known about their contact with health care services. In this paper we examine patterns of health care use among PWID in Dar es Salaam and identify what factors are associated with regular contact with clinicians during illness. METHODS: We conducted a baseline cross-sectional study as part of a prospective cohort study involving PWID. We recruited 578 PWID, of whom 273 were newly enrolled on an integrated methadone-assisted treatment (MAT) program and 305 were community-recruited. At baseline, we interviewed the MAT program enrollees before they received services at the program clinics. We used bivariate and multiple logistic regression analyses to identify the factors associated with seeking medical care when ill. RESULTS: Only 25.4% of 578 participants reported seeing clinicians regularly when they needed medical care. Participants were more likely to see clinicians regularly if they were employed, (OR: 2.25, 95% CI: 1.28-3.98), had higher income levels (OR: 1.10, 95% CI: 1.00-1.22), were parents (OR: 1.71, 95% CI: 1.09-2.68), or knew where to seek affordable care (OR: 3.42, 95% CI: 2.12-5.52). CONCLUSION: PWID in Dar es Salaam generally did not seek health care when needed. To improve their health care seeking behaviour, it is important to advise PWID about where to seek affordable health care and to increase their income-generating skills.

Implementation and Operational Research: Linkage to Care Among Methadone Clients Living With HIV in Dar es Salaam, Tanzania.

BACKGROUND: The first methadone maintenance treatment clinic in Tanzania was launched in February 2011 to address an emerging HIV epidemic among people who inject drugs. We conducted a retrospective cohort study to understand factors associated with linkage to HIV care and explore how a methadone maintenance treatment clinic can serve as a platform for integrated HIV care and treatment. METHODS: This study used routine programmatic and clinical data on clients enrolled in methadone at Muhimbili National Hospital from February 2011 to January 2013. Multivariable proportional hazards regression model was used to examine time to initial CD4 count. RESULTS: Final analyses included 148 HIV-positive clients, contributing 31.7 person-years. At 30, 60, and 90 days, the probability of CD4 screening was 40% [95% confidence interval (CI): 32% to 48%], 55% (95% CI: 47% to 63%), and 63% (95% CI: 55% to 71%), respectively. Clients receiving high methadone doses (≥ 85 mg/d) [adjusted hazard ratio (aHR): 1.68, 95% CI: 1.03 to 2.74] had higher likelihood of CD4 screening than those receiving low doses (<85 mg/d). Clients with primary education or lower (aHR: 1.62, 95% CI: 1.05 to 2.51) and self-reported poor health (aHR: 1.96, 95% CI: 1.09 to 3.51) were also more likely to obtain CD4 counts. Clients with criminal arrest history (aHR: 0.56, 95% CI: 0.37 to 0.85]) were less likely to be linked to care. Among 17 antiretroviral therapy eligible clients (CD4 ≤ 200), 12 (71%) initiated treatment, of which 7 (41%) initiated within 90 days. CONCLUSIONS: Levels of CD4 screening and antiretroviral therapy initiation were similar to Sub-Saharan programs caring primarily for people who do not inject drugs. Adequate methadone dosing is important in retaining clients to maximize HIV treatment benefits and allow for successful linkage to services.

A call for parental monitoring to improve condom use among secondary school students in Dar es Salaam, Tanzania.

BACKGROUND: The number of people newly infected with human immunodeficiency virus (HIV) has been decreasing in sub-Saharan Africa, but prevalence of the infection remains unacceptably high among young people. Despite the alarming pervasiveness of the virus, young people in this region continue to engage in risky sexual behaviors including unprotected sexual intercourse. In developed countries, parents can play important roles in protecting young people from such behaviors, but evidence regarding the impact of parental involvement is still limited in sub-Saharan Africa. Therefore, we conducted this study to examine the magnitude of risky sexual behaviors and the association of parental monitoring and parental communication with condom use at last sexual intercourse among secondary school students in Dar es Salaam, Tanzania. METHODS: We conducted this cross-sectional study among 2,217 male and female students aged 15 to 24 years from 12 secondary schools in Dar es Salaam. From October to November 2011, we collected data using a self-administered questionnaire. Multiple logistic regression analyses were conducted to examine the association of parental monitoring and parental communication with condom use at last sexual intercourse, adjusting for potential confounders. RESULTS: A total of 665 (30.3%) secondary school students reported being sexually active within the year prior to data collection. Among them, 41.7% had multiple sexual partners, 10.5% had concurrent sexual partners, and 41.1% did not use a condom at last sexual intercourse. A higher level of parental monitoring was associated with increased likelihood of condom use at last sexual intercourse among male students (AOR: 1.56, 95% CI: 1.05-2.32; p = 0.03) but not among female students (AOR: 1.54, 95% CI: 0.71-3.37; p = 0.28). The association between parental communication and condom use at last sexual intercourse among both male and female students was not statistically significant. CONCLUSIONS: A high level of parental monitoring is associated with more consistent condom use among male students in Dar es Salaam, Tanzania -- many of whom have engaged in high-risk sexual behaviors such as multiple sexual partnerships, concurrent sexual partnerships, and unprotected sexual intercourse in the past one year. Interventions should thus be strengthened to reduce multiple sexual partnerships, concurrent sexual partnerships, and to improve parental monitoring among such students toward increasing condom use.