HIV treatment outcomes and their associated factors among adolescents and youth living with HIV in Tanzania

Introduction:  Despite improvements in access to Ante-Retroviral therapy in Tanzania, low ART initiation rate, low retention rate, lower viral load suppression, high loss to follow up and death rate among adolescents and youth living with HIV remain a challenge.  This study was conducted to identify factors affecting HIV treatment outcomes among adolescents and youths. Methods: A cross-sectional study was done in seven regions in Tanzania. A total of 1124 in and out of school ALYHIV were interviewed using a semi-structured questionnaire. Results: A total of 1120(99.6%) participants were on ART. Of those who were on ART, 606 (53.9%) participants had advanced HIV disease, 423(37.6 %) had switched to the second line of ART and 1761(7.7%) had a virological failure. After adjusting for confounders, death of both parents (APR= 1.3, 95%CI: 1.01-1.8); regions with high HIV prevalence (APR= 1.7, 95%CI: 1.2-2.3) and taking ARVs for three years and less (APR= 2.2, 95%CI: 1.4-3.6) were associated to have advanced HIV. Additionally, HIV regional prevalence level, level of perception, adherence status, ARV storage and supervision of ART use were independently associated with Virological failure.    Conclusion: This study has shown that despite an almost universal utilization of ART among adolescents and youth living with HIV unfavourable clinical ART outcomes such as advanced HIV disease, virological failure and ART switch to the second line remain a challenge, particularly among males and adolescents. Various factors at individual, community and health facility levels contribute to unfavorable ART clinical outcomes among AYLHIV. Therefore, an all-inclusive multidimensional and multi- stakeholders’ approach is needed to ensure the availability of sustainable, effective and quality care and treatment services prioritizing AYLHIV.&nbsp

Implementation of distance learning IMCI training in rural districts of Tanzania

BACKGROUND: The standard face-to-face IMCI training continues to be surrounded by concerns of low coverage of trainees, absenteeism of trainees from health facility for prolonged time and high cost of training. Consequently, distance learning IMCI training model is increasingly promoted to partly address some of these challenges in resource limited settings. This paper examines participants’ accounts of implementation of the paper based IMCI distance learning training programme in the three district councils in Mbeya region METHODS: A cross-sectional qualitative design was employed as part of an endline evaluation study of PSBI implementation in Busokelo, Kyela and Mbarali District Councils in Mbeya Region of Tanzania. KII were conducted with purposefully selected policymakers, partners, programme managers and healthcare workers including beneciaries and training facilitators. RESULTS: About 60 KIIs were conducted of which, 53% of participants were healthcare workers composed of nurses, clinicians, and pharmacists and; 22% were healthcare administrators including DMOs, RCH coordinators and programme ocers. The ndings indicate that DIMCI was designed to address concerns of standard IMCI by enhancing eciency, increasing outputs and reducing training costs. DIMCI included a mix of brief face-to-face orientation sessions, several weeks of self-directed learning, group discussions and brief face-to-face review sessions with facilitators. DIMCI course covered topics related to management of sick newborns, referral decisions and reporting with nurses and clinicians as the main beneciaries of the training. The problems with DIMCI included technological challenges related to limited access to proper learning technology such as computers and unfriendly learning materials, personal challenges including work-study-family demands, and design and coordination challenges including low nancial incentives contributing to defaulters and limited mentorship and follow-ups due to limited funding and transport. CONCLUSION: DMICI appears to have been implemented successfully in rural Tanzania, it facilitated training of many HCWs at a low cost and resulted into improved knowledge, competence and condence among HCWs in management of sick newborns. However, technological, personal, and design and coordination challenges continue to face learners in rural areas that need to be addressed to maximize the success of DIMCI

Implementation of distance learning IMCI training in rural districts of Tanzania

Abstract Background The standard face-to-face training for the integrated management of childhood illness (IMCI) continues to be plagued by concerns of low coverage of trainees, the prolonged absence of trainees from the health facility to attend training and the high cost of training. Consequently, the distance learning IMCI training model is increasingly being promoted to address some of these challenges in resource-limited settings. This paper examines participants’ accounts of the paper-based IMCI distance learning training programme in three district councils in Mbeya region, Tanzania. Methods A cross-sectional qualitative descriptive design was employed as part of an endline evaluation study of the management of possible serious bacterial infection in Busokelo, Kyela and Mbarali district councils of Mbeya Region in Tanzania. Key informant interviews were conducted with purposefully selected policymakers, partners, programme managers and healthcare workers, including beneficiaries and training facilitators. Results About 60 key informant interviews were conducted, of which 53% of participants were healthcare workers, including nurses, clinicians and pharmacists, and 22% were healthcare administrators, including district medical officers, reproductive and child health coordinators and programme officers. The findings indicate that the distance learning IMCI training model (DIMCI) was designed to address concerns about the standard IMCI model by enhancing efficiency, increasing outputs and reducing training costs. DIMCI included a mix of brief face-to-face orientation sessions, several weeks of self-directed learning, group discussions and brief face-to-face review sessions with facilitators. The DIMCI course covered topics related to management of sick newborns, referral decisions and reporting with nurses and clinicians as the main beneficiaries of the training. The problems with DIMCI included technological challenges related to limited access to proper learning technology (e.g., computers) and unfriendly learning materials. Personal challenges included work-study-family demands, and design and coordination challenges, including low financial incentives, which contributed to participants defaulting, and limited mentorship and follow-up due to limited funding and transport. Conclusion DIMCI was implemented successfully in rural Tanzania. It facilitated the training of many healthcare workers at low cost and resulted in improved knowledge, competence and confidence among healthcare workers in managing sick newborns. However, technological, personal, and design and coordination challenges continue to face learners in rural areas; these will need to be addressed to maximize the success of DIMCI