Urban Tanzania Research Articles

Promoting and managing youth jogging groups in Tanzania: can we bank on social capital?

ABSTRACT Rationale/Purpose The article examined the manner and the extent to which social capital influenced the formation, promotion and management of jogging groups in Tanzania. Design/Methodology/Approach A qualitative approach was used to collect and analyse data, whereby interviews, focus group discussions and observations were used as data collection methods. Social capital theory (SCT) guided this study. Findings Social capital manifested in features such as friendship and neighbourhood ties, work connections and association memberships, norms and values like trust and respect facilitate the formation, promotion, and management of physical activity in urban Tanzania through Youth Jogging Groups (YJG). Practical Implication State and non-state actors like private institutions, parents, and community residents should provide training, moral guidance and financial support to existing youth jogging groups’ initiatives and goals. This support has practical contributions towards addressing multiple health-related challenges facilitated by urban sedentary lifestyles. Research contribution Well-established social capital features among urban youth in the global youth serve a critical role in mobilising, managing, and surviving collective physical activity such as group jogging.

Timing of cesarean section for prolonged labor in urban Tanzania: A criterion-based audit

Timing of cesarean section for prolonged labor in urban Tanzania: A criterion-based audit

Fetal, neonatal, and infant death among offspring of pregnant women with HIV in Tanzania.

Assess the risk of death for offspring of pregnant women with HIV (PWHIV) and the association with sociodemographic, pregnancy, HIV-related, and birth factors. We conducted a prospective cohort study of PWHIV on antiretroviral therapy (ART) and their offspring in urban Tanzania who were enrolled in a vitamin D trial conducted from June 2015 to October 2019. We described rates of fetal, neonatal, and infant death and assessed risk factors for these outcomes with generalized estimating equations. We also estimated population-attributable risk percentages for the contribution of prematurity and small-for-gestational age (SGA) to neonatal and infant mortality. Among 2299 PWHIV, there were a total of 136 fetal deaths (5.6%) and the stillbirth rate was 42.0 per 1000 total births. Among 2167 livebirths, there were 57 neonatal deaths (26.3 per 1000 livebirths) and 114 infant deaths (52.6 per 1000 livebirths). Twin birth was associated with neonatal death, while maternal CD4 + T-cell count <350 cells/μl in pregnancy was associated with infant death ( P -values < 0.05). As compared to term-appropriate-for-gestational age (AGA) births, the relative risks for neonatal mortality for term-SGA, preterm-AGA, and preterm-SGA infants were 2.07 [95% confidence interval (CI): 1.00-4.28], 2.87 (95% CI 1.54-5.35), and 7.15 (95% CI: 2.11-24.30), respectively. We estimated that 42.7% of neonatal and 29.4% of infant deaths were attributable to prematurity and SGA in the cohort. The risk of death is high for offspring of PWHIV in Tanzania and the combination of prematurity and fetal growth restriction may account for nearly half of neonatal deaths.

An Implementation Evaluation of the Smartphone-Enhanced Visual Inspection with Acetic Acid (SEVIA) Program for Cervical Cancer Prevention in Urban and Rural Tanzania.

The World Health Organization (WHO) recommends visual inspection with acetic acid (VIA) for cervical cancer screening (CCS) in lower-resource settings; however, quality varies widely, and it is difficult to maintain a well-trained cadre of providers. The Smartphone-Enhanced Visual Inspection with Acetic acid (SEVIA) program was designed to offer secure sharing of cervical images and real-time supportive supervision to health care workers, in order to improve the quality and accuracy of visual assessment of the cervix for treatment. The purpose of this evaluation was to document early learnings from patients, providers, and higher-level program stakeholders, on barriers and enablers to program implementation. From 9 September to 8 December 2016, observational activities and open-ended interviews were conducted with image reviewers (n = 5), providers (n = 17), community mobilizers (n = 14), patients (n = 21), supervisors (n = 4) and implementation partners (n = 5) involved with SEVIA. Sixty-six interviews were conducted at 14 facilities, in all five of the program regions Results SEVIA was found to be a highly regarded tool for the enhancement of CCS services in Northern Tanzania. Acceptability, adoption, appropriateness, feasibility, and coverage of the intervention were highly recognized. It appeared to be an effective means of improving good clinical practice among providers and fit seamlessly into existing roles and processes. Barriers to implementation included network connectivity issues, and community misconceptions and the adoption of CCS more generally. SEVIA is a practical and feasible mobile health intervention and tool that is easily integrated into the National CCS program to enhance the quality of care.

Welfare Impact of Mobile Financial Services Business Among Youth in Urban and Peri-urban Tanzania

Welfare Impact of Mobile Financial Services Business Among Youth in Urban and Peri-urban Tanzania

Functioning and quality of life among treatment-engaged adults with psychotic disorders in urban Tanzania: Baseline results from the KUPAA clinical trial.

There is a treatment gap for those living with severe mental illnesses in low- and middle-income countries, yet not enough is known about those who are currently accessing clinical services. A better understanding of potentially modifiable factors associated with functioning and quality of life will help inform policies and programming. To describe the functioning and quality of life for a psychiatric treatment-engaged population living with psychotic disorders in two urban areas of Tanzania, and to explore their respective correlates. This study analyzed cross-sectional data from 66 individuals enrolled in the Kuwezeshana Kupata Uzima (KUPAA) pilot clinical trial who had a diagnosis of schizophrenia or schizoaffective disorder, recent relapse, and who were receiving outpatient treatment. Baseline functioning (WHO Disability Assessment Schedule 2.0) and quality of life (WHO Quality of Life BREF scale) were measured. Univariable and multivariable regression analyses were conducted to determine correlates of functioning and quality of life. Adjusted analyses indicated that higher disability was associated with higher food insecurity, more symptomatology, more self-stigma, less instrumental support, less hope, lower self-efficacy, and/or lower levels of family functioning. Higher quality of life was associated with higher levels of self-efficacy, more hopefulness, more instrumental support, less self-stigma, and better family functioning. Identification of factors associated with disability and quality of life can help clinicians and policymakers, as well as consumers of mental health services, to better co-design and target psychosocial interventions to optimize their impact in low-resource settings. Trial registration: ClinicalTrials.gov # NCT04013932, July 10, 2019.

Evaluating compliance with local and International Food Labelling Standards in urban Tanzania: a cross-sectional study of pre-packaged snacks in Dar Es Salaam

BackgroundUrbanization influences food culture, particularly in low- and middle-income countries where there is an increasing consumption of processed and pre-packaged foods. This shift is contributing to a rise in non-communicable diseases. Food labelling standards are crucial for regulating manufacturing practices and helping consumers make healthy food choices. We aimed to assess the compliance of local and imported pre-packaged snacks with Tanzanian and international labelling standards in Dar es Salaam, Tanzania.MethodologyA cross-sectional study was conducted on 180 snack products. A checklist based on Tanzanian and Codex labelling standards was used to evaluate adherence. We also examined factors influencing adherence, such as product origin, price, category, purchase location, and package size.ResultsThe majority of the snacks demonstrated partial adherence to Tanzania (n = 97; 54%) and International (Codex) (n = 120; 67%) labelling standards. Imported products showed significantly better adherence to both Tanzanian (n = 46; 53%) and international (n = 42; 48%) standards. Notably, more than half (n = 110; 66.7%) of the products used English for labelling, and infrequently (n = 74; 41.4%) used the recommended World Health Organization Front-of-Pack Nutrition Labelling. Product category, origin, and package size were significantly associated with higher levels of international standard adherence (p < 0.05).ConclusionThe inadequate adherence to mandatory labelling standards and the scarce use of Swahili and FoPL highlight the need to strengthen labelling practices and potential challenges faced by consumers in understanding nutritional information. Thus, strengthening and emphasizing good labelling practices are urgently needed as we seek to address diet-related noncommunicable diseases.

Unbundling tenure security and demand for property rights: Evidence from urban Tanzania

Rapid urbanisation in sub-Saharan Africa occurs with little land registration, and government-led regularisation schemes often find limited uptake of title deeds by residents. In theory, there could be private and public benefits from land titling in cities. However, little is known about how landholders value the various dimensions of formal property rights in comparison to informal tenure. We address these questions by unbundling property rights into multiple functions of tenure security and by adopting an innovative combination of methods, including an incentivised willingness-to-pay exercise, a survey, and in-depth interviews conducted in Dar es Salaam, Tanzania. Examining how landholders perceive dimensions of tenure advances our understanding of limited land formalisation in urban Africa and provides evidence for alternative policy approaches to address local demand for tenure security more effectively.

Religion, healthcare, and social media use in urban Tanzania: an ethnographic study of faith-based organizations

ABSTRACT The relationship between religion and social media has been critically discussed on potential benefits and opportunities the work of faith-based organizations (FBOs) enjoys in relation to the growing social media technology. Using ethnographic approaches, this study focuses on the use of social media by the new generation of FBOs in their healthcare interventions in urban Tanzania. In particular, the study examines the types of social media used and the messages they carry and explores why FBOs prioritize the use of social media in their healthcare interventions. The findings show that FBOs use Instagram, Facebook, WhatsApp, local social media platforms and YouTube to broadcast and share recorded videos, testimonies, and messages of their healthcare interventions. FBOs select social media platforms for their healthcare interventions based on the targeted audience and desired outcomes, while simultaneously addressing both religious and non-religious needs and obligations. This in turn may have an impact on the public recognition of their work and strengthening their influence in society in terms of attracting more beneficiaries to their religious ideologies, inspiring, and motivating followers in meeting their religious and social obligations and attracting government support and recognition.

Menstrual health and hygiene knowledge among post menarche adolescent school girls in urban and rural Tanzania.

Adolescent girls' capacity to lead healthy lives and perform well in school has been hampered by their lack of awareness about menstruation and the requirements for its hygienic management. Lack of enabling infrastructure, improper menstrual supplies, and limited socioeconomic support for good menstrual health and cleanliness are characteristics of schools in Africa South of the Sahara. We evaluated school-age girls' knowledge of menstrual hygiene and identified bottlenecks that could affect policy and programming for menstrual health and hygiene. A school-based cross-sectional study involved 8,012 adolescent school girls in the age group of 11-18 years (mean age = 14.9 years). The study evaluated students' knowledge of menstrual health and hygiene (MHH) from the viewpoints of schools and communities using a combination of qualitative and quantitative approaches. Data was collected using self-administered surveys, focus group discussions, in-depth interviews, and site observations. Girls' older age (AOR = 1.62, P 0.001), having a female guardian (AOR = 1.39: P = 001), and having a parent in a formal job (AOR = 1.03: P 0.023) were positively associated with Menstrual health and Hygiene Knowledge. MHH knowledge levels varied significantly between girls attending government (53.3) and non-government schools (50.5%, P = 0.0001), although they were comparable for girls attending rural and urban schools. Only 21% of the study's schools had at least one instructor who had received training in MHH instruction for students. We have established that the majority of adolescent girls in schools have inadequate knowledge on menstrual health and hygiene, and that school teachers lack the skills to prepare and support young adolescents as they transition into puberty. Concerted actions aimed at building supportive policy are paramount, for school-aged teenagers to learn about and reap the long-term advantages of good menstrual health practices.

Dynamics of proselytization and conversion in the Pentecostals’ healthcare interventions in Urban Tanzania

Dynamics of proselytization and conversion in the Pentecostals’ healthcare interventions in Urban Tanzania

Temporal dynamics of gut microbiomes in non-industrialized urban Amazonia.

Increasing levels of industrialization have been associated with changes in gut microbiome structure and loss of features thought to be crucial for maintaining gut ecological balance. The stability of gut microbial communities over time within individuals seems to be largely affected by these changes but has been overlooked among transitioning populations from low- to middle-income countries. Here, we used metagenomic sequencing to characterize the temporal dynamics in gut microbiomes of 24 individuals living an urban non-industrialized lifestyle in the Brazilian Amazon. We further contextualized our data with 165 matching longitudinal samples from an urban industrialized and a rural non-industrialized population. We show that gut microbiome composition and diversity have greater variability over time among non-industrialized individuals when compared to industrialized counterparts and that taxa may present diverse temporal dynamics across human populations. Enterotype classifications show that community types are generally stable over time despite shifts in microbiome structure. Furthermore, by tracking genomes over time, we show that levels of bacterial population replacements are more frequent among Amazonian individuals and that non-synonymous variants accumulate in genes associated with degradation of host dietary polysaccharides. Taken together, our results suggest that the stability of gut microbiomes is influenced by levels of industrialization and that tracking microbial population dynamics is important to understand how the microbiome will adapt to these transitions.IMPORTANCEThe transition from a rural or non-industrialized lifestyle to urbanization and industrialization has been linked to changes in the structure and function of the human gut microbiome. Understanding how the gut microbiomes changes over time is crucial to define healthy states and to grasp how the gut microbiome interacts with the host environment. Here, we investigate the temporal dynamics of gut microbiomes from an urban and non-industrialized population in the Amazon, as well as metagenomic data sets from urban United States and rural Tanzania. We showed that healthy non-industrialized microbiomes experience greater compositional shifts over time compared to industrialized individuals. Furthermore, bacterial strain populations are more frequently replaced in non-industrialized microbiomes, and most non-synonymous mutations accumulate in genes associated with the degradation of host dietary components. This indicates that microbiome stability is affected by transitions to industrialization, and that strain tracking can elucidate the ecological dynamics behind such transitions.

“I only seek treatment when I am ill”: experiences of hypertension and diabetes care among adults living with HIV in urban Tanzania

BackgroundFor adults living with HIV (ALHIV) and comorbidities, access to comprehensive healthcare services is crucial to achieving optimal health outcomes. This study aims to describe lived experiences, challenges, and coping strategies for accessing care for hypertension and/or diabetes (HTN/DM) in HIV care and treatment clinics (CTCs) and other healthcare settings.MethodologyWe conducted a qualitative study that employed a phenomenological approach between January and April 2022 using a semi-structured interview guide in six HIV CTCs in Dar es Salaam, Tanzania. We purposively recruited 33 ALHIV with HTN (n = 16), DM (n = 10), and both (n = 7). Thematic content analysis was guided by the 5As framework of access to care.FindingsThe majority of the participants were females, between the ages of 54–73, and were recruited from regional referral hospitals. HIV CTCs at regional referral hospitals had more consistent provision of HTN screening services compared to those from district hospitals and health centers. Participants sought HTN/DM care at non-CTC health facilities due to the limited availability of such services at HIV CTCs. However, healthcare delivery for these conditions was perceived as unaccommodating and poorly coordinated. The need to attend multiple clinic appointments for the management of HTN/DM in addition to HIV care was perceived as frustrating, time-consuming, and financially burdensome. High costs of care and transportation, limited understanding of comorbidities, and the perceived complexity of HTN/DM care contributed to HTN/DM treatment discontinuity. As a means of coping, participants frequently monitored their own HTN/DM symptoms at home and utilized community pharmacies and dispensaries near their residences to check blood pressure and sugar levels and obtain medications. Participants expressed a preference for non-pharmaceutical approaches to comorbidity management such as lifestyle modification (preferred by young participants) and herbal therapies (preferred by older participants) because of concerns about side effects and perceived ineffectiveness of HTN/DM medications. Participants also preferred integrated care and focused patient education on multimorbidity management at HIV CTCs.ConclusionOur findings highlight significant barriers to accessing HTN/DM care among ALHIV, mostly related to affordability, availability, and accessibility. Integration of NCD care into HIV CTCs, could greatly improve ALHIV health access and outcomes and align with patient preference.

Sociodemographic and Clinical Predictors of Weight Gain During the First Year of Antiretroviral Therapy among Adults Living With HIV in Urban Tanzania.

Antiretroviral therapy (ART) has improved the survival of people living with HIV (PLHIV) but this success has been accompanied by an increase in noncommunicable diseases. We conducted a prospective cohort study of 4000 adult PLHIV who were initiating ART in Dar es Salaam, Tanzania, to assess weight gain during the first year of treatment and associated sociodemographic and clinical factors. Anthropometric data were collected at ART initiation and monthly follow-up visits. The mean weight gain during the first year of treatment was 2.6 ± 0.3 kg, and the prevalence of overweight or obesity increased from 26.3% at baseline to 40.7%. Female sex, greater household wealth, lower CD4-T-cell counts, higher WHO HIV disease stage, and pulmonary tuberculosis were associated with a greater increase in body mass index (P < .05). Weight gain following ART initiation was common but was greater among females and PLHIV with advanced HIV or comorbidities.

Dynamics of Religious Organisations in Responding to COVID-19: A Case of Islamic and Christians Organisations in Urban Tanzania

Despite the dynamics of public health policies during COVID-19 pandemic in Tanzania, religious organisations (ROs) enhanced healthcare services and support while adapting safe measures. The study assessed the health care and support activities conducted by ROs during COVID-19. Furthermore, the study explored how Islamic and Christians teachings, practices, and meanings were crucial to the design and execution of ROs’ COVID-19 healthcare activities. The study employed the concepts of religion as a model for, and model of lived reality; and development as holistic process. The study used ethnographic approaches such as participant observation, interviews and focus group discussion. Findings showed that ROs conducted both medical and non-medical activities, formal and informal healthcare services and provided support to their members and the general public access to COVID-19 related healthcare services and support particularly for those coming from poor socioeconomic backgrounds. Religious teachings, practices and meanings informed and motivated ROs healthcare workers, followers and the management in responding to COVID-19. The study concludes that ROs’ COVID-19 healthcare interventions are dynamic, adaptive and practical for they influence and are being influenced by religious teachings, practices, experiences and meanings as well as existing socio-economic and political realities.

Is mechanism of injury associated with outcome in spinal trauma? An observational cohort study from Tanzania.

Traumatic spinal injury (TSI) is a disease of significant global health burden, particularly in low and middle-income countries where road traffic-related trauma is increasing. This study compared the demographics, injury patterns, and outcomes of TSI caused by road traffic accidents (RTAs) to non-traffic related TSI. A retrospective analysis was conducted using a neurotrauma registry from the Muhimbili Orthopaedic Institute (MOI) in Tanzania, a national referral center for spinal injuries. Patient sociodemographic characteristics, injury level, and severity were compared across mechanisms of injury. Neurological improvement, neurological deterioration, and mortality were compared between those sustaining TSI through an RTA versus non-RTA, using univariable and multivariable analyses. A total of 626 patients were included, of which 302 (48%) were RTA-related. The median age was 34 years, and 532 (85%) were male. RTAs had a lower male preponderance compared to non-RTA causes (238/302, 79% vs. 294/324, 91%, p<0.001) and a higher proportion of cervical injuries (144/302, 48% vs. 122/324, 38%, p<0.001). No significant differences between RTA and non-RTA mechanisms were found in injury severity, time to admission, length of hospital stay, surgical intervention, neurological outcomes, or in-hospital mortality. Improved neurological outcomes were associated with incomplete injuries (AIS B-D), while higher mortality rates were linked to cervical injuries and complete (AIS A) injuries. Our study in urban Tanzania finds no significant differences in outcomes between spinal injuries from road traffic accidents (RTAs) and non-RTA causes, suggesting the need for equitable resource allocation in spine trauma programs. Highlighting the critical link between cervical injuries and increased mortality, our findings call for targeted interventions across all causes of traumatic spinal injuries (TSI). We advocate for a comprehensive trauma care system that merges efficient pre-hospital care, specialized treatment, and prevention measures, aiming to enhance outcomes and ensure equity in trauma care in low- and middle-income countries.

Information Needs and Sources Used by Urban Vegetable Farmers. A Case of Vegetable Farmers in Morogoro Municipality

While the role of information in improving vegetable farming in urban areas is widely acknowledged in the literature, its potential cannot be realized unless the information needs that enlighten the stakeholders about appropriate information sources are known. This is because vegetable farming is an information-intensive endeavor full of uncertainties. The study investigated the perceived implication of extension services, information needs, and sources used by vegetable farmers in Morogoro urban Tanzania. A quantitative method research design was used to collect data from 60 respondents. A questionnaire was used in the data collection process. Descriptive analysis was used for analyzing quantitative data. The findings show farmers needed information on pest and disease control, amount and type of fertilizer to apply, produce market, and storage. Fellow farmers (friends and colleagues) ranked as an important source of information followed by public extension officers, researchers, NGOs, input suppliers, Nanenane exhibitions, individual farmers, social networks, books and fliers, and hired extension officers.Recommendations have been provided that, equip vegetable farmers with the up-to-date knowledge and skills to shape farmers’ knowledge through various extension trainings in their localities, by doing this, farmers will increase awareness of multiple challenges about vegetable production. Employing more skilled extension officers with expertise in horticultural crops and use of modern ICT facilities to improve vegetable farmers’ access to information.

Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry.

Stroke is a second leading cause of death globally, with an estimated one in four adults suffering a stroke in their lifetime. We aimed to describe the clinical characteristics, quality of care, and outcomes in adults with stroke in urban Northwestern Tanzania. We analyzed de-identified data from a prospective stroke registry from Bugando Medical Centre in Mwanza, the second largest city in Tanzania, between March 2020 and October 2022. This registry included all adults ⩾18 years admitted to our hospital who met the World Health Organization clinical definition of stroke. Information collected included demographics, risk factors, stroke severity using the National Institutes of Health Stroke Scale, brain imaging, indicators for quality of care, discharge modified Rankin Scale, and in-hospital mortality. We examined independent factors associated with mortality using logistic regression. The cohort included 566 adults, of which 52% (294) were female with a mean age of 65 ± 15 years. The majority had a first-ever stroke 88% (498). Premorbid hypertension was present in 86% (488) but only 41% (200) were taking antihypertensive medications before hospital admission; 6% (32) had HIV infection. Ischemic strokes accounted for 66% (371) but only 6% (22) arriving within 4.5 h of symptom onset. In-hospital mortality was 29% (127). Independent factors associated with mortality were severe stroke (adjusted odds ratio (aOR) = 1.81, 95% confidence interval (CI) = 1.47-2.24, p < 0.001), moderate to severe stroke (aOR = 1.49, 95% CI = 1.22-1.84, p < 0.001), moderate stroke (aOR = 1.80, 95% CI = 1.52-2.14, p < 0.001), leukocytosis (aOR = 1.19, 95% CI = 1.03-1.38, p = 0.022), lack of health insurance coverage (aOR = 1.15, 95% CI = 1.02-1.29, p = 0.025), and not receiving any form of venous thromboembolism prophylaxis (aOR = 1.18, 95% CI = 1.02-1.37, p = 0.027). We report a stroke cohort with poor in-hospital outcomes in urban Northwestern Tanzania. Early diagnosis and treatment of hypertension could prevent stroke in this region. More work is needed to raise awareness about stroke symptoms and to ensure that people with stroke receive guidelines-directed therapy.

Gender differences in formal wage employment in urban Tanzania

ABSTRACT We use the Tanzania Integrated Labour Force Survey data and a censored bivariate probit model to analyse gender differences in labour force participation and gender bias in formal wage employment in urban Tanzania. We find that, compared to men, women are less likely to participate in the labour market and less likely to obtain formal wage employment, suggesting the existence of gender bias in the labour market in urban areas of Tanzania. However, after accounting for selection into labour force participation, the existing gender bias is narrowed for women with high school or university education. The regression results suggest that the existing gender differences in formal wage employment probabilities cannot entirely be explained by observable characteristics. The finding of a positive unexplained formal wage employment probability differential suggests that the possibility of gender discrimination against women in urban Tanzania cannot be completely ruled out.

Renal outcomes in adults with HBV, HIV and HBV/HIV coinfection after 3 years of antiviral therapy in urban Tanzania.

An enhanced understanding of renal outcomes in persons with chronic HBV, HIV, and HBV/HIV coinfection is needed to mitigate chronic kidney disease in regions where HBV and HIV are endemic. To investigate changes in estimated glomerular filtration rate (eGFR) in adults with HBV, HIV or HBV/HIV enrolled in a 3 year prospective cohort study of liver outcomes in Dar es Salaam, Tanzania and initiated on antiviral therapy. We compared eGFR between and within groups over time using mixed-effects models. Four hundred and ninety-nine participants were included in the analysis (HBV: 164; HIV: 271; HBV/HIV: 64). Mean baseline eGFRs were 106.88, 106.03 and 107.18 mL/min/1.73 m2, respectively. From baseline to Year 3, mean eGFR declined by 4.3 mL/min/1.73 m2 (95% CI -9.3 to 0.7) and 3.7 (-7.8 to 0.5) in participants with HBV and HIV, respectively, and increased by 5.1 (-4.7 to 14.9) in those with HBV/HIV. In multivariable models, participants with HBV had lower eGFRs compared with those with HIV or HBV/HIV and, after adjusting for HBV DNA level and hepatitis B e antigen (HBeAg) status, significantly lower eGFRs than those with HBV/HIV at all follow-up visits. In this Tanzanian cohort, coinfection with HBV/HIV did not appear to exacerbate renal dysfunction compared with those with either infection alone. Although overall changes in eGFR were small, persons with HBV experienced lower eGFRs throughout follow-up despite their younger age and similar baseline values. Longer-term studies are needed to evaluate continuing changes in eGFR and contributions from infection duration and other comorbidities.