Magnitude and factors associated with pre-diagnosis loss to follow-up among tuberculosis presumptive patients in the Cycle of Health Care, Musoma, Tanzania: Cross-sectional study

Background: Despite National Tuberculosis (TB) Program efforts on tuberculosis control in the country, pre-diagnosis loss to follow-up is still a major problem. The study aims at exploring the magnitude and risk factors of presumptive TB cases who either do not submit a second sputum sample or do not show up for their laboratory results. Methods: The study included presumptive TB registered at the Musoma Regional Referral Hospital between May and November 2014.  Lost to follow up presumptive TB were then traced and interviewed from December 2014 to April 2015. One hundred and thirty-two among those who submitted both samples and showed up for their results were randomly selected as a comparison group.  Results: A total of 620 presumptive TB was registered at the Musoma Regional Referral Hospital (MRRH), of which 521 (84.0%) completed TB testing in accordance with the national TB diagnostic algorithm while 99 (16.0%) did not complete. Out of those who did not complete, 65 (65.7%) submitted only one spot sample and 34 (34.3%) submitted both but all of these did not pick-up their results. The Mean age of participants was 45.3 years (Standard deviation 17.7). The main reasons for loss to follow-up were: 23 (23.2%) opted to go to other health care facilities; 23 (23.2%) lack of transport fare; and 20 (20.2%) long distance to the hospital. Males were 1.6 (95%CI1.02-2.90) more likely to complete TB diagnostic algorithm

Knowledge and utilization of prevention of mother-to-child transmission of HIV services among pregnant women in Tanzania

Background: Human Immunodeficiency Virus (HIV) infection among children is mainly vectored through mother-to-child transmission. Prevention of mother-to-child-transmission strategy is highly effective; however, its accessibility and utilization is affected by the lack of knowledge among other factors. Methods: A cross-sectional study was conducted among antenatal care attendees in two districts in Tanzania to determine their knowledge and utilization of the prevention of MTCT services. Results:  We interviewed 160 antenatal care attendees aged 18-45 years with a mean (SD) age of 30.4 (6.3) years; 74 (46.2 %) were HIV-infected. HIV-infected women demonstrated significantly correct knowledge of HIV (p=0.001) and AIDS (p=0.014) than uninfected individuals. HIV-infected women also significantly demonstrated correct knowledge of mother-to-child transmission during pregnancy than HIV-uninfected women (p=0.016) and during delivery (p=0.005). A significant proportion of HIV-positive women compared to HIV-negative women were aware that correct use of antiretroviral during pregnancy can reduce the risk of mother-to-child-transmission of HIV (p<0.039), but only 6 (3.75%) of all women were aware that correct use of antiretroviral during delivery can significantly reduce the risk of mother-to-child-transmission. HIV-infected women had significant comprehensive knowledge of HIV/AIDS (p=0.001) and prevention of mother-to-child transmission of HIV (p=0.006) than HIV-negative women. Comprehensive knowledge prevention of mother-to-child transmission of HIV was low among the study participants. Male partners’ involvement in maternal antenatal care was significantly higher among HIV-infected women than males from the HIV-infected women group (p<0.006). Conclusion: The study demonstrated inadequate knowledge of PMTCT among women who made ANC visits. HIV uninfected women had poorer knowledge compared to the HIV-infected ones. Routine HIV counseling and testing services were highly accepted among these women

Availability of HIV/AIDS community intervention programmes and quality of services in and around selected mining sites in Tanzania

Background: Mining is one of the major sectors of the country’s economy as it employs and attracts a large number of people from different areas. As a result, mining sites are at great risk of HIV transmission. While a few unsynchronized mine-specific population-based studies provide evidence of a growing HIV problem in this sector, virtually few evidence exists on availability and quality of interventions targeting HIV and AIDS in this population. The study was conducted to assess the availability and quality of HIV/AIDS intervention programmes in and around mining sites in Tanzania.Methods: This cross sectional study was conducted from November 2012 to April 2013. Both quantitative and qualitative methods were used to collect data. Study areas involved both mining sites and its surrounding communities in Kahama, Nzega and Geita Districts. It involved household members from villages in and around the mining sites, mining community relations officers, community health facility workers, district HIV/AIDS focal persons and village leaders.Results: A total of 463 individuals were recruited into the study for household interviews. In-depth interviews with Key Informants involved 15 respondents. HIV/AIDS intervention programmes in the study area were available despite that knowledge of their existence was limited to a segment of the community.  Their availability was only known to about 25% of the study respondents in Geita and Kahama study sites.  The programmes carried out intervention activities which included HIV/AIDS education campaigns, promoting uptake of voluntary counselling and testing services, promoting and supporting condom use, safer sex, and male circumcision. HIV/AIDS services such as screening, distribution of condoms and ARVs for infected people were available and were offered free of charge. Conclusion: Our findings show that HIV/AIDS intervention programmes were available despite that they were unequally distributed. Although their availability has contributed to the decrease of HIV prevalence in the community, knowledge of their availability was limited to some people in the community

Community-based HIV services during Differentiated Service Delivery Models: a cross-sectional survey from nine regions in Tanzania

Introduction: To combat the HIV epidemic and reach the 90-90-90 goals, community-based HIV/AIDS services (CHBS) plays a great role. However, how well CHBS works in the era of adopting differentiated service delivery models for care and treatment has not been adequately evaluated. We hence assessed CBHS programs implemented by various partners with a focus on the coverage; program needs; linkage and referral process; consistent use of guidelines and training curricula and challenges faced by providers and clients. Methods: It was a cross-sectional study conducted in July 2020 in 9 regions using both quantitative and qualitative methods. Quantitative data were analyzed using STATA version 12 and qualitative data were managed using Thematic Content Analysis. Results: 26 implementing partners were offering CBHS in biomedical, behavioral, and structural areas. Their focus was on PLHIV, orphans, and key and vulnerable populations. The majority of PLHIV had a positive perception of different CBHS. Key factors in the perceived effectiveness of community HIV services were the consistent use and availability of guidelines and training curricula, standard operating procedures, and readiness of essential commodities and supplies. Out of 1391 PLHIV who were involved, 67.4% and 25.0% were tested at the health facility and communities respectively. About 69.8% were referred after confirming their seropositivity and forms were not given to about 57.5% when referred from health facilities to communities for CBHS. There was a deficit of 45% in health workers across different cadres, a deficit in all categories of supplies and equipment example the HIV test kit by 53.8%. Challenges for CBHS included financial hindrances, HIV-related stigma, and discrimination, distance to health facilities, and poor incentives for community health workers. Conclusion: it is important to address HIV-related stigma hence accelerating efforts to limit the spread of the HIV epidemic in the respective communities

Genetic profile of Mycobacterium tuberculosis and treatment outcomes in human pulmonary tuberculosis in Tanzania

Information on the different spoligotype families of Mycobacterium tuberculosis in Tanzania is limited, and where available is restricted to small geographical areas.  This article describes the genetic profile of M. tuberculosis across Tanzania and suggests how spoligotype families might affect drug resistance and treatment outcomes for smear positive pulmonary tuberculosis patients in Tanzania. In this study conducted from 2006 to 2008, the M. tuberculosis isolates were obtained from samples collected under the routine drug resistance surveillance system. The isolates were from specimens collected from 2001 to 2007, and stored at the Central and Reference Tuberculosis Laboratory in Dar es Salaam. A total of 487 isolates from 23 regions in Tanzania were spoligotyped. However, clinical information for 446 isolates was available. Out of the 487 isolates spoligotyped, 195 (40.0%) belonged to the Central Asian (CAS) family, 84 (17.5%) to the Latin American Mediterranean (LAM) family, 49 (10.1%) to the East-African Indian (EAI) family, and 33 (6.8%) to the Beijing family. Other isolates included 1 (0.2%) for H37Rv, 10 (2.1%) for Haarlem, 4 (0.8%) for S family, 58 (11.9%) for T family and 52 (10.7%) for unclassified.  No spoligotype patterns were consistent with M. bovis. As regards to treatment outcomes, the cure rate was 80% with no significant variation between the spoligotype families.  The overall level of MDR-TB was 2.5% (3/121), with no significant difference between the spoligotype families. All Beijing strains (11.8%, 30/254) originated from the Eastern and Southern zones of the country, of which 80% were from Dar es Salaam.  Isolates from the CAS and T families were reported disproportionately from the Eastern-Southern zone, and EAI and LAM families from the Northern-Lake zones but the difference was not statistically significant. Five isolates were identified as Non-tuberculous Mycobacteria. In conclusion, M. tuberculosis isolates from pulmonary tuberculosis cases in Tanzania were classified mostly within the CAS, LAM, and EAI and T families.  Consistently good treatment outcomes were recorded across the spoligotype families.  The proportion of drug resistance strains was low. The findings also suggest variation of spoligotype families with varying geographical localities within the country. 

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 evidence-based multiple focus integrated intensified TB screening to end TB (EXIT-TB) package in East Africa : a qualitative study

Funding: This study was part of the EXIT-TB project funded by the European & Developing Countries Clinical Trials Partnership 2 (EDCTP2) program supported by the European Union (Grant number CSA2016S-1608).Introduction Tuberculosis (TB) remains a major cause of morbidity and mortality, especially in sub-Saharan Africa. We qualitatively evaluated the implementation of an Evidence-Based Multiple Focus Integrated Intensified TB Screening package (EXIT-TB) in the East African region, aimed at increasing TB case detection and number of patients receiving care. Objective We present the accounts of participants from Tanzania, Kenya, Uganda, and Ethiopia regarding the implementation of EXIT-TB, and suggestions for scaling up. Methods A qualitative descriptive design was used to gather insights from purposefully selected healthcare workers, community health workers, and other stakeholders. A total of 27, 13, 14, and 19 in-depth interviews were conducted in Tanzania, Kenya, Uganda, and Ethiopia respectively. Data were transcribed and translated simultaneously and then thematically analysed. Results The EXIT-TB project was described to contribute to increased TB case detection, improved detection of Multidrug-resistant TB patients, reduced delays and waiting time for diagnosis, raised the index of TB suspicion, and improved decision-making among HCWs. The attributes of TB case detection were: (i) free X-ray screening services; (ii) integrating TB case-finding activities in other clinics such as Reproductive and Child Health clinics (RCH), and diabetic clinics; (iii), engagement of CHWs, policymakers, and ministry level program managers; (iv) enhanced community awareness and linkage of clients; (v) cooperation between HCWs and CHWs, (vi) improved screening infrastructure, (vii) the adoption of the new simplified screening criteria and (viii) training of implementers. The supply-side challenges encountered ranged from disorganized care, limited space, the COVID-19 pandemic, inadequate human resources, inadequate knowledge and expertise, stock out of supplies, delayed maintenance of equipment, to absence of X-ray and GeneXpert machines in some facilities. The demand side challenges ranged from delayed care seeking, inadequate awareness, negative beliefs, fears towards screening, to financial challenges. Suggestions for scaling up ranged from improving service delivery, access to diagnostic equipment and supplies, and infrastructure, to addressing client fears and stigma. Conclusion The EXIT-TB package appears to have contributed towards increasing TB case detection and reducing delays in TB treatment in the study settings. Addressing the challenges identified is needed to maximize the impact of the EXIT-TB intervention.Publisher PDFPeer reviewe

Cryptococcal Meningitis Screening and Community-based Early Adherence Support in People With Advanced Human Immunodeficiency Virus Infection Starting Antiretroviral Therapy in Tanzania and Zambia: A Cost-effectiveness Analysis.

BACKGROUND: A randomized trial demonstrated that among people living with late-stage human immunodeficiency virus (HIV) infection initiating antiretroviral therapy, screening serum for cryptococcal antigen (CrAg) combined with adherence support reduced all-cause mortality by 28%, compared with standard clinic-based care. Here, we present the cost-effectiveness. METHODS: HIV-infected adults with CD4 count <200 cells/μL were randomized to either CrAg screening plus 4 weekly home visits to provide adherence support or to standard clinic-based care in Dar es Salaam and Lusaka. The primary economic outcome was health service care cost per life-year saved as the incremental cost-effectiveness ratio (ICER), based on 2017 US dollars. We used nonparametric bootstrapping to assess uncertainties and univariate deterministic sensitivity analysis to examine the impact of individual parameters on the ICER. RESULTS: Among the intervention and standard arms, 1001 and 998 participants, respectively, were enrolled. The annual mean cost per participant in the intervention arm was US$339 (95$331-$347), resulting in an incremental cost of the intervention of US$77 (95% CI, $66-$88). The incremental cost was similar when analysis was restricted to persons with CD4 count <100 cells/μL. The ICER for the intervention vs standard care, per life-year saved, was US$70 (95$43-$211) for all participants with CD4 count up to 200 cells/μL and US$91 (95% CI, $49-$443) among those with CD4 counts <100 cells /μL. Cost-effectveness was most sensitive to mortality estimates. CONCLUSIONS: Screening for cryptococcal antigen combined with a short period of adherence support, is cost-effective in resource-limited settings

Challenges of Loss to Follow-up in Tuberculosis Research.

In studies evaluating methods for diagnosing tuberculosis (TB), follow-up to verify the presence or absence of active TB is crucial and high dropout rates may significantly affect the validity of the results. In a study assessing the diagnostic performance of the QuantiFERON®-TB Gold In-Tube test in TB suspect children in Tanzania, factors influencing patient adherence to attend follow-up examinations and reasons for not attending were examined. In 160 children who attended and 102 children who did not attend scheduled 2-month follow-up baseline health characteristics, demographic data and risk factors for not attending follow-up were determined. Qualitative interviews were used to understand patient and caretakers reasons for not returning for scheduled follow-up. Being treated for active tb in the dots program (OR: 4.14; 95% CI:1.99-8.62;p-value<0.001) and receiving money for the bus fare (OR:129; 95% CI 16->100;P-value<0.001) were positive predictors for attending follow-up at 2 months, and 21/85(25%) of children not attending scheduled follow-up had died. Interviews revealed that limited financial resources, i.e. lack of money for transportation and poor communication, were related to non-adherence. Patients lost to follow-up is a potential problem for TB research. Receiving money for transportation to the hospital and communication is crucial for adherence to follow-up conducted at a study facility. Strategies to ensure follow-up should be part of any study protocol

QuantiFERON®-TB gold in-tube performance for diagnosing active tuberculosis in children and adults in a high burden setting.

To determine whether QuantiFERON®-TB Gold In-Tube (QFT) can contribute to the diagnosis of active tuberculosis (TB) in children in a high-burden setting and to assess the performance of QFT and tuberculin skin test (TST) in a prospective cohort of TB suspect children compared to adults with confirmed TB in Tanzania. Sensitivity and specificity of QFT and TST for diagnosing active TB as well as indeterminate QFT rates and IFN-γ levels were assessed in 211 TB suspect children in a Tanzanian district hospital and contrasted in 90 adults with confirmed pulmonary TB. Sensitivity of QFT and TST in children with confirmed TB was 19% (5/27) and 6% (2/31) respectively. In adults sensitivity of QFT and TST was 84% (73/87) and 85% (63/74). The QFT indeterminate rate in children and adults was 27% and 3%. Median levels of IFN-γ were lower in children than adults, particularly children <2 years and HIV infected. An indeterminate result was associated with age <2 years but not malnutrition or HIV status. Overall childhood mortality was 19% and associated with an indeterminate QFT result at baseline. QFT and TST showed poor performance and a surprisingly low sensitivity in children. In contrast the performance in Tanzanian adults was good and comparable to performance in high-income countries. Indeterminate results in children were associated with young age and increased mortality. Neither test can be recommended for diagnosing active TB in children with immature or impaired immunity in a high-burden setting