Care And Treatment Center Research Articles

Healthcare teams' ethical obligations towards care of adolescents' living with human immunodeficiency virus disease.

To explore healthcare team members' perceptions of their ethical obligations toward HIV-positive adolescents and their enrolment in and adherence to antiretroviral therapy among adolescents attending a Care and Treatment Center (CTC) in Temeke Regional Referral Hospital in Tanzania. This is a descriptive exploratory qualitative study. A total of 16 healthcare team members were purposively selected from the hospital CTC to participate in in-depth qualitative interviews. With the aid of NVivo software, qualitative thematic analysis was used to analyze the information. Five themes on ethical obligations emerged: (1) informing adolescents of their status before enrolment to the HIV CTC, (2) securing adolescents' confidential information, (3) disclosing adolescents' HIV status, (4) informing others about the adolescent's HIV status; and (5) offering reproductive health education for adolescents living with HIV. The healthcare team faces many ethical challenges in the care and support of adolescents who enroll in an HIV CTC in Tanzania. Differing ethical obligations must be balanced with the needs of adolescents and their parents in discerning what is in the best interest of the adolescent and advocating for life-saving treatment.

Upscaling cervical cancer screening and treatment for women living with HIV at a rural referral hospital in Tanzania: protocol of a before-and-after study exploring HPV testing and novel diagnostics

BackgroundCervical cancer (CC) is nearly always caused by persistent human papillomavirus (HPV) infection. It is the most common cancer among women living with HIV (WLWH) and is the leading cause of cancer-related death in women in East Africa, with 10,241 new cases reported in Tanzania in 2020. In 2019, the World Health Organization (WHO) presented a global strategy for the elimination of CC as a public health problem, proposing targets to meet by 2030 for HPV vaccine coverage (90% of all 15-year-old girls), CC screening (70% of all women once at 35 and again at 45 years of age) and treatment delivery, to be scaled at national and subnational levels with a context-sensitive approach. This study aims to evaluate the upscaling of screening and treatment services at a rural referral hospital in Tanzania in order to address the second and third WHO targets.MethodsThis is an implementation study with a before-and-after design performed at St. Francis Referral Hospital (SFRH) in Ifakara (south-central Tanzania). CC screening and treatment services are integrated within the local HIV Care and Treatment Center (CTC). The standard of care, consisting of visualization of the cervix with acetic acid (VIA) and cryotherapy has been up-scaled with self-sampled HPV testing and also involved the introduction of mobile colposcopy, thermal ablation and loop electrosurgical excision procedure (LEEP). Participants are WLWH aged 18 to 65 years. Outcome measures included the percentage of women screened, HPV prevalence and genotype, and adherence to screening, treatment and follow-up plan. Additionally, we will explore the performance of novel diagnostic tests (QG-MPH®, Prevo-Check® and PT Monitor®), which share the features of being manageable and inexpensive, and thus a potential tool for effective triage in HPV high-prevalence cohorts.DiscussionThe study will provide relevant information about HPV prevalence and persistence, as well as reproductive and lifestyle indicators in a CC high-risk cohort of WLWH and about upscaling screening and treatment services at the level of a rural referral hospital in Tanzania. Furthermore, it will provide exploratory data on novel assays.Trial registrationClinicalTrials.gov Identifier: NCT05256862, date of registration 25/02/2022. Retrospectively registered.

Retention and Predictors of Attrition Among HIV-infected Children on Antiretroviral Therapy in Côte d'Ivoire Between 2012 and 2016.

An estimated 21,000 children 0-14 years of age were living with HIV in Côte d'Ivoire in 2020, of whom only 49% have been diagnosed and are receiving antiretroviral therapy (ART). Retention in HIV care and treatment is key to optimize clinical outcomes. We evaluated pediatric retention in select care and treatment centers (CTCs) in Côte d'Ivoire. We retrospectively reviewed medical records using 2-stage cluster sampling for children under 15 years initiated on ART between 2012 and 2016. Kaplan-Meier time-to-event analysis was done to estimate cumulative attrition rates per total person-years of observation. Cox proportional hazard regression was performed to identify factors associated with attrition. A total of 1198 patient records from 33 CTCs were reviewed. Retention at 12, 24, 36, 48 and 60 months after ART initiation was 91%, 84%, 74%, 72% and 70%, respectively. A total of 309 attrition events occurred over 3169 person-years of follow-up [266 children were lost to follow-up (LTFU), 29 transferred to another facility and 14 died]. LTFU determinants included attending a "public-private" CTC [adjusted hazard ratio (aHR) 6.05; 95% confidence interval (CI): 4.23-8.65], receiving care at a CTC without an on-site laboratory (aHR: 4.01; 95% CI: 1.70-9.46) or attending a CTC without an electronic medical record (EMR) system (aHR: 2.22; 95% CI: 1.59-3.12). In Cote d'Ivoire, patients attending a CTC that is public-private, does not have on-site laboratory or EMR system were likely to be LTFU. Decentralization of laboratory services and scaling use of EMR systems could help to improve pediatric retention.

‘Please do not leave us’ Qualitative excerpts of HIV-infected participants’ perspectives towards a clinical trial endpoint in Tanzania

Introduction: The field of bioethics lacks empirical evidence to support the debates surrounding human involvement in clinical investigations. We focused on HIV clinical trials to explore participants’ perceptions and experiences towards clinical trial endpoints. Methods: This qualitative multiple case study used in-depth interviews (IDIs), and case narratives to collect data. IDIs were conducted with HIV study participants at the Care and Treatment Centers (CTC) and the Child Centred Family Care Clinic (CCFCC) until data saturation was achieved. The interviews covered motivations for participation, perceived risks and benefits, and trial endpoint expectations. Additionally, participants were also encouraged to provide relevant recommendations. Results: A total of 18 in-depth interviews were conducted with individuals visiting CTC and CCFCC for various reasons including routine medication, voluntary counselling and testing, for visits as mandated by clinical trials, or as caretakers/guardians accompanying their children to HIV clinic for prevention of mother to child (PMTCT) programs. Participants reported different reasons for their motivation to participate in clinical trials. They perceived no risks involved in participating in clinical trials and highlighted financial benefits and high-quality healthcare received from health workers during the clinical trial at the period of participation. However, at the exit of the study, all participants expressed uncertainties about their fate and their children after the trials. Participants wished to continue accessing post-trial medical services similar to the one provided during the clinical trials even after being linked to other health facilities for standard care. They appreciated friendly service, regular professional advice, and follow-up of their health during the clinical trials. Conclusion: Our findings show that although at the end of the trial, patients are linked to standard care, continuation of supportive measures after the trial is also essential. Our findings highlight the importance of providing post-trial benefits for participants in HIV studies as a basic ethical practice such as intervention treatment, professional advice, and devices found beneficial to participants. Further research should focus on participants’ transition to standard care and their post-trial coping strategies.

Oral Impacts on Daily Performances among People Living with Human Immunodeficiency Virus on HAART Era Attending Care and Treatment Clinics in Dar es Salaam, Tanzania

Oral disease/conditions are reported to have negative effects on the quality of life of People Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (PLWHIV/AIDS). This study aimed to assess the prevalence and causes of oral impacts on daily performances (OIDP) and its associated factors among PLWHIV/AIDS. A cross-sectional study was conducted among 218 PLWHIV/AIDS attending two HIV Care and Treatment Centres (CTCs) in Dar es Salaam. The study utilized a structured interview schedule containing questions on socio-demography and a single item of global oral health measure on the perception of current oral health status (OHS). A Swahili version of an OIDP inventory was used to assess the impacts of oral conditions on participants’ daily performances. Frequency distribution, chi-square, and logistic regression analyses were conducted (p < 0.05). Participants’ age ranged from 20 to 70 years, mean of 41.15 SD 10.7. About 70% (n = 154) of the participants perceived their oral health status (OHS) as good. The prevalence of OIDP (³ 1) was 26.1% (n = 57). The most affected performances reported were eating and chewing food followed by maintaining the usual emotional state without being irritable. Toothache was the main cause of impacts on all daily performances except ‘speaking and pronouncing clearly’ which was caused by oral ulcer. Age (p = 0.025) and perceived oral health status (p = 0.000) were significantly associated with OIDP. More studies on biological and behavioural factors are recommended to support inclusion of oral health in CTCs.
 Keywords: Care and Treatment Centres; HAART; HIV; Oral health; Quality of life

Prevalence and factors associated with substance use among HIV positive youth attending HIV care and treatment centers in Dodoma, Tanzania

BackgroundSubstance use among people living with HIV is associated with poor health, social, and psychological outcomes. This study assessed the prevalence of substance use and associated factors among youth attending HIV care and treatment centers (CTCs) in Dodoma, Tanzania.MethodsThis cross-sectional study was carried out in Dodoma, Tanzania, from February to April 2020 among youth aged 15–24 attending HIV CTCs. Data was collected using sociodemographic, WHO ASSIST Version 3.0, BDI II, and SERAD questionnaires. Data analysis was done using Stata 17. Descriptive statistics were used to summarize continuous and categorical variables. Univariable and multivariable logistic regression analyses were conducted to determine factors independently associated with substance use.ResultsThe prevalence of substance use was relatively low (6.6%). Older youth (20 to 24 years) were 2% less likely to use substances compared to the younger ones (15 to 19 years) (AOR: 0.07; 95% CI 0.01, 0.83). There were statistically significant decreasing odds of substance use with every year increase in age at HIV diagnosis (OR: 1.66; 95% CI 1.14, 2.41). Being unemployed was statistically significantly associated with decreased odds of substance use among this population (OR: 0.03; 95% CI 0.02, 0.33). Youth who had detectable viral loads were significantly more likely to use substances compared to those with undetectable viral loads (AOR: 12.9; 95% CI 1.07, 156.05).ConclusionsDespite the low prevalence of substance use found in this study, it is important to note that late age of HIV diagnosis, employment, and detectable viral load negatively impacted HIV positive youth with regards to substance use. It is recommended that CTCs emphasize routine screening for substance use among youth who have detectable viral loads.

Factors associated with cervical cancer screening among women living with HIV in the Kilimanjaro region, northern Tanzania: A cross-sectional study

Despite cervical cancer being a highly preventable disease, it is the fourth most common cancer among women in both incidence and mortality. Cervical cancer screening is crucial in preventing the disease. Women living with HIV (WLHIV) are at higher risk of cervical cancer because of their immune-compromised state. We aimed to determine factors associated with cervical cancer screening among WLHIV in the Kilimanjaro region, northern Tanzania.A cross-sectional study was conducted in the Kilimanjaro region among 297 WLHIV attending care and treatment centers (CTC) in northern Tanzania between August 21 and September 3, 2020; and interviewed using a questionnaire. Logistic regression model determined factors associated with cervical cancer screening at 5% significance level.Half (50.2 %) of the 297 WLHIV had ever screened for cervical cancer. WLHIV with positive attitudes towards cervical cancer screening (AOR = 3.48, 95 % CI 1.86, 6.51) and those who received information on cervical cancer from Health Care Providers (HCP) (AOR = 17.31, 95 % CI 6.00, 50.22) had higher odds of ever being screened for cervical cancer. Lower odds of screening (AOR = 0.50, 95 % CI 0.27, 0.96) were among women diagnosed with HIV within the past three years.WLHIV having a positive attitude towards screening and received cervical cancer screening information from HCP, were likely to have ever screened. Women newly diagnosed with HIV are less likely to have ever screened. HCPs at CTC are an important source of information about screening and for promoting cervical cancer screening among WLHIV. Special attention should be given to women newly diagnosed with HIV.

Prevalence and determinants of non-communicable diseases including depression among HIV patients on antiretroviral therapy in Dar es Salaam, Tanzania.

People living with HIV/AIDS (PLHA) are experiencing growing co-morbidities due to an increase in life expectancy and the use of long-term antiretroviral therapy (ART). The lack of integrated non-communicable diseases (NCDs) screening and management at the HIV care and treatment centres (CTCs) make it difficult to determine the trends of NCD co-morbidity among patients with HIV. This study aimed to assess the burden and determinants of common NCDs, including depression among patients with HIV. Analytical cross-sectional study of 1318 HIV patients enrolled using systematic random sampling conducted from April to November 2020. Five large CTCs in district referral hospitals were selected representing the five districts of Dar es Salaam including Mwananyamala, Temeke, and Amana regional referral hospitals and Sinza and Vijibweni hospitals. The study population consisted of adult PLHA aged 18 years and above. The primary outcome measure was the prevalence of NCDs among HIV patients. Observation of actual NCD medications or their purchase receipts or booked NCD clinic appointments that PLHA had during the study period was used to verify the reported presence of NCDs. The secondary outcome measure was the prevalence of probable depression among PLHA. The locally validated Swahili Patient Health Questionnaire (PHQ-9) was used to screen for depressive symptom severity. A logistic regression model was used to identify factors associated with common NCDs and those associated with probable depression. Potential risk factors that were statistically significant at a P-value of 0.2 or less in univariable analysis were included as potential confounders in multivariable models. The median age of participants was 42 (IQR 35-49) years, with 32.7% in the 36-45 years age group. The majority of patients were women (69%). Most (80.5%) had achieved HIV viral (VL) suppression (a serum HIV VL of <1000 copies/ml). Overall, 14.3% of self-reported an NCD with evidence of their current medication for the NCD from receipts for medication purchased and appointments from NCD clinics they attended. In the multivariable analyses, higher odds of NCDs were in older patients (>45 years) and those with a weight above 75 kg (P < 0.05). Male patients had 51% reduced odds of NCDs (aOR 0.49; 95% CI: 0.32-0.74) than females (P < 0.001). Probable depression prevalence was 11.8%, and depressed patients had more than twice the odds of having NCDs than those without depression (aOR 2.26; 95% CI: 1.45-3.51; P < 0.001). This study determined co-existing previously diagnosed NCDs among PLHA accessing care and high levels of depressive symptom severity. We recommend additional research on the feasibility, acceptability, and cost implications of screening and treating NCDs on HIV care platforms to provide evidence for Tanzania's integrated HIV/NCD care model.

Adherence to Antiretroviral Therapy and Associated Factors Among People Living With HIV Following the Introduction of Dolutegravir Based Regimens in Dar es Salaam, Tanzania.

Background: Adherence to antiretroviral therapy (ART) is the key determinant of virological suppression in people living with HIV (PLHIV). This study reports factors associated with non-adherence among PLHIV one year after introducing dolutegravir (DTG) based regimens in Tanzania. Methods: A hospital-based cross-sectional study was conducted in two health facilities in Dar es Salaam, Tanzania, in 2020. Results: A total of 406 PLHIV were recruited, where the majority (73.4%) were females, with 94.6% of patients being on DTG based regimens. Factors such as refill interval and sharing of antiretrovirals had significant effects on adherence. Multivariate analysis found that patients attending care and treatment center (CTC) at Temeke Regional Referral Hospital (RRH) were 4.3 times more likely to have non-adherence compared to those attending Amana RRH (aOR [adjusted odds ratio] 4.3, 95% CI [confidence interval]: 2.38 – 7.91, p-value < 0.0001). Conclusions: Sustainable adherence counseling is warranted to overcome non-adherence to ART.

Pubertal Development among HIV-Infected Children aged 8-18 Years in Dar es Salaam, Tanzania: A Cross Sectional Study

Background Pubertal development can be impaired among children living with HIV. This can lead to a psychosocial burden and subsequent negative self-image, social withdrawal and declining academic performance. Objective To assess timing of pubertal development of HIV infected children aged 8-18 years in Dar es Salaam, Tanzania. Methods This was a hospital-based cross-section study conducted at Amana and Mwananyamala, Care and Treatment Centres (CTC) in Dar es Salaam, Tanzania. A structured questionnaire was used to collect information on demographic and clinical characteristics. Participants were regarded to have entered puberty if they were at Tanner stage 2 or more for either breast (female) or genital (male) development and Tanner stage 2 or more for pubic hair development in both sexes. Data was analysed using STATA version 10 statistical packages. Puberty development of study participants was compared to their peers in a database of health children and adolescents attending schools in Dar es Salaam, Tanzania. Descriptive statistics were summarised as median (interquartile range), mean (standard deviation) for continuous variable and proportions for categorical variables. Differences in various groups was tested using Student t- test (means), Mann-Whitney U test (median) and chi square test (Proportions) and p value of < 0.05 was considered significant. Results A total of 330 HIV infected children were recruited, out of these 183 (55.4 %) were females. The median age of the study populations was 12.0 years (IQR 11-15). Median duration on ART at the time of the study was 48 months (IQR 30-62). Majority were in WHO stage III and had CD4 cell count above 500cells/µl. The median age at menarche for HIV infected adolescents was 15 years (IQR 14-16). HIV infected females and males had no significant age difference at baseline but attained puberty one or two years later than their HIV negative peers. Conclusion HIV infected children have delayed sexual maturation compared to their HIV negative peers. We recommend that as part of physical examination of an adolescent, sexual maturation to be emphasized and those identified to have delayed onset to be followed up and offered appropriate counselling.

The impact of out-of-pocket expenditures on missed appointments at HIV care and treatment centers in Northern Tanzania

BackgroundMissed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV (PLHIV). PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care. The objective of this study was to examine the relationship between out-of-pocket (OOP) health expenditures and the likelihood of missing appointments. MethodTotally 618 PLHIV older than 18 years attending two HIV care and treatment centres (CTC) in Northern Tanzania were enrolled in the study. Clinic attendance and clinical characteristics were abstracted from medical records. Information on OOP health expenditures, demographics, and socio-economic factors were self-reported by the participants. We used a hurdle model. The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings (TZS) increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period. ResultsAmong these 618 participants, 242 (39%) had at least one missed clinic appointment in the past year. OOP expenditure was not significantly associated with the number of missed clinic appointments. The median amount of OOP paid was 5 100 TZS per visit, about 7% of the median monthly income. Participants who were separated from their partners (adjusted odds ratio [AOR] = 1.83, 95% confidence interval [CI]:1.11‒8.03) and those aged above 50 years (AOR = 2.85, 95% CI: 1.01‒8.03) were significantly associated with missing an appointment. For those who had at least one missed appointment over the study period, the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC (P = 0.49, 95% CI: 0.88‒0.09) and aged between > 25‒35 years (P = 0.90, 95% CI: 0.11‒1.69). ConclusionInterventions focused on improving compliance to clinic appointments should target public CTCs, PLHIV aged between > 25‒35 years, above 50 years of age and those who are separated from their partners.

Knowledge, attitude, and practice of cervical cancer screening among women living with HIV in the Kilimanjaro region, northern Tanzania.

BackgroundCervical cancer is the fourth most common cancer globally among women in incidence and mortality. Women living with HIV (WLHIV) are disproportionately at a higher risk of developing the disease.AimTo determine the knowledge, attitude, and practice of cervical cancer screening among WLHIV in the Kilimanjaro region, northern Tanzania, following the integration of these services in routine HIV care in the country.Methods and resultsA cross‐sectional study was conducted in the Kilimanjaro region among 297 WLHIV attending care and treatment centers (CTC) in Hai district and Mawenzi regional hospitals in northern Tanzania between 21 August and 3 September 2020. A questionnaire was used for data collection using face‐to‐face interviews. Data were analyzed using SPSS version 20.0. Frequencies and percentages summarized categorical variables and numerical variables summarized using median and interquartile range (IQR). About half (50.2%) of 297 WLHIV in this study had ever screened for cervical cancer, and 64% screened within the past 12 months preceding the survey. Although 90% ever heard of cervical cancer screening, only 20.5% knew when WLHIV should start screening. Over half (52.5%) had adequate knowledge of prevention, 38.4% on risk factors, and 27.9% of cervical cancer signs and symptoms. Two‐thirds (66.7%) had positive attitudes toward cervical cancer screening. A major source of cervical cancer screening information was the health care providers (80.1%) and the mass media (66%), particularly radio.ConclusionsThe WLHIV in this study had inadequate knowledge but favorable attitudes toward cervical cancer screening, while half had screened for cervical cancer. Efforts should be directed to capacity building of health care providers at CTC and scaling up the mass media campaigns as relevant interventions to promote the uptake of cervical cancer screening programs among WLHIV in Tanzania.

Retention and predictors of attrition among children living with HIV on antiretroviral therapy (ART) in Côte d’Ivoire between 2012 and 2016

Background: In Côte d’Ivoire a retrospective national-level cohort study conducted in 2009 indicated that 77%, 72% and 75% of children living with HIV (CLHIV) remained in care at 12, 36, and 48 months after starting ART, respectively. The CDC-sponsored Improving HIV Surveillance and Program Evaluation in Côte d’Ivoire project assessed retention progress since that study. Methods and materials: A retrospective review of medical records was conducted using 2-stage cluster sampling. HIV care and treatment centers (CTC) were sampled based on patient caseload, then records of patients under 15 years of age who initiated ART between 2012–2016 were randomly selected. Time-to-event analysis was performed to estimate the cumulative attrition rates per total number of person-years (PYs) of observation. Cox proportional hazard regressions were conducted to identify factors associated with attrition. Results: 1198 patient records from 33 CTC were reviewed. At time of ART initiation, CLHIVs’ mean age was 5.8 years, 609 (51%) were male, median CD4 count was 529 cells/μL (interquartile range: 270-910), and 210 (21%) were severely undernourished. Retention was 91%, 84%, 74%, 72%, and 70% at 12, 24, 36, 48 and 60 months after ART initiation, respectively. 309 attrition events occurred over 3,169 PYs of follow-up, with 266 lost to follow-up (LTFU), 29 transfers and 14 deaths. Multivariate analyses showed determinants for LTFU included attending a CTC with a mixed (public-private) status [adjusted hazard ratio (aHR) 6.05, 95% confidence interval (CI): 4.23–8.65], a CTC with no on-site laboratory (aHR 4.01, 95% CI: 1.70–9.46), and a CTC without an electronic medical record system (aHR 2.22, 95% CI: 1.59–3.12). Age, clinical and immunological status at ART initiation, and parent's HIV status were not related to attrition. Conclusion: Attrition rates were high, with no substantial improvement since 2009 for time periods longer than 12 months since ART initiation. Retention improvements in Cote d’Ivoire would require a focus on scaling up innovative service delivery models such as decentralization of services to the community, coordination with local or regional labs for facilities without an on-site laboratory, and rigorous tracking systems for patients in care.

Retention in HIV/AIDS Management Services: is it Really Poor? The Case of Yaounde Central Hospital in Cameroon.

Background:After consecutively defaulting on their appointments for three months, many HIV positive patients are often reported to have defaulted on their treatment, become lost to follow-up (LTFU), or no longer in care. We sought to determine if retention in HIV/AIDS care and treatment is really poor.Methods:Outcomes of patients with missed clinic appointments and reasons for missing appointments were studied. We sampled adult HIV positive patients on antiretroviral therapy (ART) who by clinic had missed their clinic appointments by more than four weeks between 1997 and 2019 at the HIV Care and Treatment Center (CTC) (Day Hospital) of the Yaoundé Central Hospital. We assumed that patients who missed their clinic appointment also missed some doses of their ART medications. Patients considered LTFU and those who had defaulted for two months were traced by telephone calls and home visits. Reasons for ART discontinuation were recorded for those who stopped or interrupted ART.Results:Of the 1139 patients who were either LTFU or who had defaulted for two months, 247/1139 (22 %) could not be traced. Out of the successfully traced patients, 50 (4%) had died and 798/1139 (70%) were alive and 310/1139 (27%) were on ART of which 35/1139 (3%) had developed informal ways of obtaining ART through clinic personnel. A good number were brought back to and reinitiated on ART after tracking (540/1139 or 47%). Of those known not to be on treatment(ART), 27/1139 (2%) had deliberately stopped ART and 63/1139 (6%) promised to return and took an appointment with CTC pyscho-social workers. Major reasons shared for missing clinic appointments were travel out of city (39%), distance from health facility, and financial cost for getting to health facility.Conclusion and Global Health Implications:Despite clinic data showing many patients had missed monthly appointments or were LTFU, we saw that a sizeable amount of such patients were actually in care and on ART. The above findings lead to the suggestion that clinic data used in program performance evaluation may not always reflect the true picture retention in care for persons in HIV/AIDS programs at hospital and national levels.

A 0.85% saline as alternative detection buffer for SD-bioline HIV rapid test in resource limited setting

Accuracy in the diagnosis is a key step to identify HIV infected individuals for appropriate management. Insufficient supply of manufacturer´s buffers in relation to the number of strips per kit has negative impact on patient´s results hence improper patient´s management. In resource limited settings, some laboratory staff use different substitute buffers which has never been validated on their reliability. This study aimed at comparing the performance of 0.85% saline and SD-Bioline manufacturer´s buffer in detection of HIV antibodies. A total of 220 whole blood specimens: 110 HIV positive specimens from patients attending care and treatment center (CTC) and 110 HIV negative specimens from blood donors were re-tested for HIV status using SD-Bioline HIV rapid test using manufacturer´s buffer and 0.85% saline separately. Data and laboratory results were recorded in Microsoft excel sheet followed by analysis using STATA version 13. For all tested samples, the level of agreement between 0.85% saline and manufacturer´s buffer was 98.64% (kappa=0.9727). The value of kappa indicates very good agreement between 0.85% saline and manufacturer´s buffer. In incidents where manufacturer´s buffer is not sufficient, 0.85% saline can give reliable results. Further studies to evaluate the suitable buffer for other rapid tests for HIV and other diseases are recommended especially in resource limited settings.

Adherence to combination antiretroviral therapy among orphaned children in Dar es Salaam, Tanzania.

BackgroundAdherence to combination antiretroviral therapy (cART) among HIV-infected children is often complicated by various factors including medication formulation, dosing frequency, drug toxicities, age and developmental stage, psychosocial and behavioural characteristics of both children and caregivers and can additionally be complicated by being an orphan.ObjectivesThis study was aimed at determining the factors and the extent of their influence on cART adherence among HIV-infected orphaned children attending Care and Treatment Centres (CTCs) in Dar es Salaam, Tanzania.MethodsA cross-sectional study was performed, which assessed adherence in HIV-positive orphaned children aged 2–14 years receiving nevirapine (NVP) based cART for at least 6 months. Data was collected using questionnaires administered to primary caregivers of HIV-infected orphaned children, the review of medical files, and the laboratory measurement of NVP plasma concentrations and CD4 counts. Adherence to cART was determined based on caregivers’ self-report, consistency of clinic attendance and NVP plasma concentrations.ResultsAmong the 216 enrolled orphaned children, adherence to cART was found to be 79.6%, 82.9% and 72.2% respectively based on caregivers’ self-report, clinic attendance and NVP plasma levels. Significant reductions in NVP concentrations (< 3 µg/mL) were seen among children with poor immunological outcomes, poor clinic attendance (p < 0.05) and were suggested by caregivers’ self-reported adherence (p = 0.06). Adherence challenges identified by caregivers included financial constraints (87.5%), lengthy waiting times at clinics (75.5% spent > 2 h at the clinic) and low HIV knowledge among caregivers.ConclusionSignificant numbers of HIV-infected orphans have poor adherence to cART ranging between 17% and 28% based on different assessment methods. Inadequate caregiver knowledge of HIV/AIDS, long clinic waiting times and forgetfulness were identified as barriers to cART adherence in these orphans.

Processes and dynamics of linkage to care from mobile/outreach and facility-based HIV testing models in hard-to-reach settings in rural Tanzania. Qualitative findings of a mixed methods study

BackgroundLike other countries, Tanzania instituted mobile and outreach testing approaches to address low HIV testing rates at health facilities and enhance linkage to care. Available evidence from hard-to-reach rural settings of Mbeya region, Tanzania suggests that clients testing HIV+ at facility-based sites are more likely to link to care, and to link sooner, than those testing at mobile sites. This paper (1) describes the populations accessing HIV testing at mobile/outreach and facility-based testing sites, and (2) compares processes and dynamics from testing to linkage to care between these two testing models from the same study context.MethodsAn explanatory sequential mixed-method study (a) reviewed records of all clients (n = 11,773) testing at 8 mobile and 8 facility-based testing sites over 6 months; (b), reviewed guidelines; (c) observed HIV testing sites (n = 10) and Care and Treatment Centers (CTCs) (n = 8); (d) applied questionnaires at 0, 3 and 6 months to a cohort of 1012 HIV newly-diagnosed clients from the 16 sites; and (e) conducted focus group discussions (n = 8) and in-depth qualitative interviews with cohort members (n = 10) and health care providers (n = 20).ResultsMore clients tested at mobile/outreach than facility-based sites (56% vs 44% of 11,733, p < 0.001). Mobile site clients were more likely to be younger and male (p < 0.001). More clients testing at facility sites were HIV positive (21.5% vs. 7.9% of 11,733, p < 0.001). All sites in both testing models adhered to national HIV testing and care guidelines. Staff at mobile sites showed more proactive efforts to support linkage to care, and clients report favouring the confidentiality of mobile sites to avoid stigma. Clients who tested at mobile/outreach sites faced longer delays and waiting times at treatment sites (CTCs).ConclusionsRural mobile/outreach HIV testing sites reach more people than facility based sites but they reach a different clientèle which is less likely to be HIV +ve and appears to be less “linkage-ready”. Despite more proactive care and confidentiality at mobile sites, linkage to care is worse than for clients who tested at facility-based sites. Our findings highlight a combination of (a) patient-level factors, including stigma; and (b) well-established procedures and routines for each step between testing and initiation of treatment in facility-based sites. Long waiting times at treatment sites are a further barrier that must be addressed.

Effective linkage from point of HIV testing to care and treatment in Tanga region, Tanzania.

BackgroundLinkage to care and treatment is an important part of efforts to accelerate HIV prevention, treatment, care, and support. It offers an opportunity for PLHIV to receive information and services in a timely manner. Clients who present late for HIV care and treatment may miss out on timely initiation of prophylaxis and ART, which may accelerate disease progression and lead to an increased rate of HIV transmission within the community. The objective of this study was to determine the factors influencing effective linkages of newly diagnosed PLHIV from the point of testing to entry in care and treatment centres (CTCs) in Tanga Region, Tanzania.MethodsThis cross-sectional study examined five clinics with a high volume of clients in each of the three districts in Tanga Region. All adults ages 18 years and above at the time of CTC enrolment, between 2010 and 2014, were eligible to participate in the study.The study engaged both secondary and primary data. To complement the secondary data, mixed methods were applied in primary data collection. Using a structured questionnaire, interviews with the sampled CTC clients while focus group discussions with healthcare providers and in-depth interviews with CTC clients.The qualitative data were analysed using a thematic analysis framework. The outcome of interest was whether a client enrolled in a CTC within three months of his or her first positive HIV test. A logistic regression model was used to determine factors associated with effective linkage of newly diagnosed HIV clients to CTC.ResultsA total of 16,041 adults from the three study districts were enrolled at a CTC from 2010 to 2014. A total of 1,096 clients from the sampled CTCs were recruited into the study for interview. The characteristics of these clients were representative of the larger group (16,041). The majority (72.4%) were female. More than half (52.1%) were married, and almost a quarter (21.2%) were single. The majority (59.6%) of participants completed primary education and almost half (45.1%) were subsistence farmers. The median CD4 count at enrolment was 218 (87–397) cells/mL with more than half (56.3%) having CD4 counts of less than 350 cells per millilitre (mL). Nearly all (91%) of the clients presented at a CTC within three months of receiving a positive HIV test. In a multivariate analysis, factors that remained significantly associated with early entry in CTC were level of education, CD4 count, and point of diagnosis. Participants’ responses were consistent with many of the factors explained by participants to be barriers to effective linkages and referrals repeated in the FGDs and IDIs across the study sites. For instance, FGD respondent expressed that clients were worried about stigma from their relatives, which creates a delay in seeking treatment.ConclusionAlthough the rate of early entry in care and treatment services is high, surprisingly was a marked increase in those who waited more than three months to seek treatment. To meet the target, issues such as disclosure and stigma need to be addressed.

High magnitude of under nutrition among HIV infected adults who have not started ART in Tanzania--a call to include nutrition care and treatment in the test and treat model

BackgroundUndernutrition among people living with HIV (PLWHIV) can be ameliorated if nutrition specific and sensitive interventions are integrated into their HIV care and treatment centers (CTC). Integrated care is lacking despite expansion of antiretroviral therapy (ART) coverage, representing a substantial missed opportunity. This research aims to examine nutritional status and associated risk factors among HIV-positive adults prior to ART initiation in Tanzania in order to characterize existing gaps and inform early integration of nutrition care into CTC.MethodsWe analyzed data from 3993 pre-ART adults living with HIV enrolled in CTCs within the Trial of Vitamin (TOV3) and progression of HIV/AIDS study in Dar es salaam, Tanzania. The primary outcome for this analysis was undernutrition, measured as body mass index (BMI) below 18.5 kg/m2. We conducted descriptive analyses of baseline characteristics and utilized multiple logistic regression to determine independent factors associated with pre-ART undernutrition.ResultsUndernutrition was prevalent in about 27.7% of pre-ART adults, with a significantly higher magnitude among males compared to females (30% vs. 26.6%, p < 0.025). Severe undernutrition (BMI < 16.0 kg/m2) was prevalent in one in four persons, with a trend toward higher magnitudes among females (26.2% vs. 21.1% p = 0.123). Undernutrition was also more prevalent among younger adults (p < 0.001), those with lower wealth quintiles (p = 0.003), and those with advanced HIV clinical stage (p < 0.001). Pre-ART adults presented with poor feeding practices, hallmarked by low dietary diversity scores and infrequent consumption of proteins, vegetables, and fruits. After adjusting for confounders and important co-variates, pre-ART undernutrition was associated with younger age, low wealth indices, advanced clinical stage, and low dietary diversity.ConclusionsOne in every four pre-ART PLWHIV presented with undernutrition in Dar es salaam, Tanzania. Risk factors for undernourishment included younger age, lower household income, advanced HIV clinical stage, and lower dietary diversity score. Knowledge of the prevalence and prevailing risk factors for undernutrition among pre-ART PLWHIV should guide targeted, early integration of nutrition interventions into routine HIV care and treatment in high-prevalence, low-income settings such as Tanzania.

Prevalence and risk factors of poor immune recovery among adult HIV patients attending care and treatment centre in northwestern Tanzania following the use of highly active antiretroviral therapy: a retrospective study

BackgroundHighly Active Antiretroviral therapy (HAART) reverses the effect of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) by durably suppressing viral replication. This allows CD4 gain to levels that are adequate enough to restore the body’s capability to fight against opportunistic infections (OIs). Patients with poor immune recovery have been shown to have higher risk of developing both AIDS and non AIDS related clinical events. This study aimed at assessing the proportions and risk factors of poor immune recovery in adult HIV-infected patients on 48 months of HAART attending care and treatment center (CTC) in northwestern Tanzania.MethodsA retrospective analysis of adult HIV patients’ data attending CTC at Sekou Toure hospital and who initiated HAART between February 2004 and January 2008 was done. Poor immune recovery was defined as a CD4 count less than 350 cells/µl on follow up as used in other studies.ResultsA total of 734 patients were included in the study. In this study 50.25% of patients attending CTC at Sekou Toure hospital were found to have poor immune recovery. The risk of developing inadequate immune recovery was independently associated with male gender, age older than 50 years, low baseline CD4 counts, and advanced World Health Organization (WHO) clinical stage.ConclusionsPoor immune recovery is prevalent among adult HIV patients attending CTC at Sekou Toure hospital in Northwestern part of Tanzania and opportunistic infections are common in this sub group of patients. Clinicians in resource limited countries need to identify these patients timely and plan them for targeted viral assessment and close clinical follow up to improve their long term clinical outcome.