6 research outputs found
Feasibility of SMS to remind pregnant and breastfeeding women living with HIV to take antiretroviral treatment in Kilimanjaro region, Tanzania: a pilot study
Background: Pregnant and breastfeeding Women Living with HIV (WLHIV) often have difficulties in reaching adequate levels of adherence (>95%) to Antiretroviral treatment. âForgettingâ is the most commonly mentioned reason. Sending reminders via SMS is expected to improve adherence. We conducted a pilot study to investigate acceptability, user experience and technical feasibility of sending reminder-SMS to WLHIV.Methods: This was a 6-months observational pilot-study among WLHIV attending antenatal and postnatal care at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. Women received a reminder-SMS 30 minutes before usual time of intake. One hour later, they received an SMS asking whether they took medication to which they could reply with âYesâ or âNoâ. Messages were sent 3 times a week on randomly chosen days to prevent reliance on daily messages. We calculated the percentage of number of SMS delivered, failed to be delivered, and replied to. We analysed feedback from exit-interviews about experience with the SMS-reminders.Results: 25 women were enrolled (age 18-45), 2 were lost to follow up. 5,054 messages were sent of which 53 failed to be delivered (1%). 1,880 SMS were sent with a question if medication was taken; 1,012 (54%) messages were replied to, of which 1,003 (99%) were replied with âYESâ and closely to âYESâ, and a total of 9 (1%) with âNOâ and âclosely to NOâ. 868 messages (46%) were not responded to due to either dropout, change of phone number, loss of phone or network failure. Results from 18 interviews showed that 16 (89%) women were satisfied with SMS reminders. 2 (11%) were concerned about unwanted disclosure because of the content âdonât forget to take medicationâ and one reported other privacy issues (6%). 3 (17%) women experienced stigma.Conclusion: 99%of SMS being delivered indicates that SMS reminders in this resource-limited setting are technically feasible. However, concerns regarding privacy were noted, specifically the risk of unwanted disclosure and the experience of stigma. Participants indicated that being made aware of their adherence, motivated them to adhere better. However, personalised and more neutral content of the SMS might be a way to improving the intervention
Returning of antiretroviral medication dispensed over a period of 8 months suggests non-adherence despite full adherence according to real time medication monitoring
Real-time medication monitoring (RTMM) may potentially enhance adherence to antiretroviral treatment (ART). We describe a participant in an ongoing trial who, shortly after completing trial participation, died of cryptococcal meningitis despite high levels of adherence according to self-report, pill-counts and RTMM (>â99%). However, she evidenced consistently high HIV viral load throughout the 48-week study follow-up. Subsequently, her relatives unsolicitedly returned eight months' dispensed ART medication that she was supposed to have taken. This brief report illustrates the challenges of adherence measurements including RTMM, and reinforces the need to combine adherence assessments with viral load monitoring in HIV care
Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study
Introduction Most sub-Saharan African countries endure a high burden of communicable infections but also face a rise of non-communicable diseases (NCDs). Interventions targeting particular epidemics are often executed within vertical programmes. We establish an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) model with three domains; stepwise training approach, integration of communicable and NCDs and a learning system. The model aims to shift traditional vertical programmes to an adaptive diseases management approach through integrating communicable and NCDs using the tuberculosis (TB) and diabetes mellitus (DM) dual epidemic as a case study. We aim to describe the ADEPT protocol with underpinned implementation and operational research on TB/DM.Methods and analysis The model implement a collaborative TB and DM services protocol as endorsed by WHO in Tanzania. Evaluation of the process and outcomes will follow the logic framework. A mixed research design with both qualitative and quantitative approaches will be used in applied research action. Anticipated implementation research outcomes include at the health facilities level for organising TB/DM services, pathways of patients with TB/DM seeking care in different health facilities, factors in service delivery that need deimplementation and the ADEPT model implementation feasibility, acceptability and fidelity. Expected operational research outcomes include additional identified patients with dual TB/DM, the prevalence of comorbidities like hypertension in patients with TB/DM and final treatment outcomes of TB/DM including treatment-related complications. Findings will inform the future policies and practices for integrating communicable and NCDs services.Ethics and dissemination Ethical approval was granted by The National Research Health Ethical Committee (Ref-No. NIMR/HQ/R.8a/Vol.IX/2988) and the implementation endorsed by the government authorities. Findings will be proactively disseminated through multiple mechanisms including peer-reviewed journals, and engagement with various stakeholdersâ example in conferences and social media
Implementation and effectiveness of evriMED with short messages service (SMS) reminders and tailored feedback compared to standard care on adherence to treatment among tuberculosis patients in Kilimanjaro, Tanzania: Proposal for a cluster randomized controlled trial
Background: Adherence to tuberculosis (TB) treatment is challenging because of many factors. The World Health Organization has recommended the use of digital adherence monitoring technologies in its End TB Strategy. However, evidence on improving adherence is limited. EvriMED is a real-time medication-monitoring device which was found to be feasible and acceptable in a few studies in Asia. In Tanzania, however, there may be challenges in implementing evriMED due to stigmatization, network and power access, accuracy, and cost effectiveness, which may have implications for treatment outcome. We propose a pragmatic cluster randomized trial to investigate the effectiveness of evriMED with reminder cues and tailored feedback on adherence to TB treatment in Kilimanjaro, Tanzania. Methods/design: We will create clusters in Kilimanjaro based on level of health care facility. Clusters will be randomized in an intervention arm, where evriMED will be implemented, or a control arm, where standard practice directly observed treatment will be followed. TB patients in intervention clusters will take their medication from the evriMED pillbox and receive tailored feedback. We will use the 'Stages of Change' model, which assumes that a person has to go through the stages of pre-contemplation, contemplation, preparation, action, and evaluation to change behavior for tailored feedback on adherence reports from the device. Discussion: If the intervention shows a significant effect on adherence and the devices are accepted, accurate, and sustainable, the intervention can be scaled up within the National Tuberculosis Programmes. Trial registration: Pan African Clinical Trials Registry, PACTR201811755733759. Registered on 8 November 2018
Epidemiology of Hidradenitis Suppurativa: Prevalence, Pathogenesis, and Factors Associated with the Development of HS
Abstracts of Tanzania Health Summit 2020
This book contains the abstracts of the papers/posters presented at the Tanzania Health Summit 2020 (THS-2020) Organized by the Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender, and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS) held on 25â26 November 2020. The Tanzania Health Summit is the annual largest healthcare platform in Tanzania that attracts more than 1000 participants, national and international experts, from policymakers, health researchers, public health professionals, health insurers, medical doctors, nurses, pharmacists, private health investors, supply chain experts, and the civil society. During the three-day summit, stakeholders and decision-makers from every field in healthcare work together to find solutions to the countryâs and regional health challenges and set the agenda for a healthier future.
Summit Title: Tanzania Health SummitSummit Acronym: THS-2020Summit Date: 25â26 November 2020Summit Location: St. Gasper Hotel and Conference Centre in Dodoma, TanzaniaSummit Organizers: Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS)