Prevalence and predictors of human immunodeficiency virus and selected sexually transmitted infections among people who inject drugs in Dar es Salaam, Tanzania: A new focus to get to zero

Background: Previous studies in Tanzania indicated that human immunodeficiency virus (HIV) prevalence among people who inject drugs (PWIDs) could be as high as 40%. We aim to provide data on the prevalence of HIV and sexually transmitted infection among PWIDs to inform national plans to get to zero. Materials and Methods: Respondent-driven sampling was used to collect drug use, and sexual practices data among PWIDs aged 15 years and older. Blood samples were examined for HIV, herpes simplex virus type 2, syphilis, and hepatitis B. Results: A total of 620 PWIDs with a median age of 32 (interquartile range, 17–52) participated in the study. Their use of drugs had typically started during adolescence. The prevalence of HIV was found to be 15.5%, whereas that of herpes simplex type 2 was 43.3%. Associated with an increased likelihood of HIV infection was being a female (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.0–3.6), sharing of syringes (aOR, 2.4; 95% CI, 1.1–6.1), used syringes hidden in public places (aOR, 5.1; 95% CI, 1.3–10.2), and having had a genital ulcer during the last 12 months before this survey. On the other hand, being educated, use of noninjectable drugs, access (aOR, 0.5; 95% CI, 0.2–0.8), and use of clean syringes (aOR, 0.3; 95% CI, 0.1–0.6) were associated with decreased likelihood of HIV infection. Conclusions: The prevalence of HIV infection among PWIDs in Dar es Salaam is 3 times higher than that in the general population. Behavioral and biological risk factors contribute to HIV transmission and needs to be addressed to be able to get to zero. The final version of this research has been published in Sexually Transmitted Diseases. © 2017 Lippincott, Williams & Wilkin

HIV and STIs among men who have sex with men in Dodoma municipality, Tanzania: a cross-sectional study

Objectives: To determine the seroprevalence of HIV, STI and related risks among men who have sex with men (MSM) in Dodoma municipality, Tanzania. Methods: A cross-sectional study using respondent-driven sampling was employed to recruit study participants aged 18 years and above. Data on sociodemographics, HIV/STI knowledge and sexual practices were collected. Blood samples were tested for HIV and selected STIs. Results: A total of 409 participants aged from 18 to 60 years took part in this study. The median age at first anal intercourse was 15 years. At last anal intercourse, 37.5% practiced receptive, 47.5% insertive and 15.0% both insertive and receptive anal intercourse. The seroprevalence of HIV, herpes simplex virus 2 (HSV-2), syphilis, hepatitis B virus and hepatitis C virus were 17.4%, 38.5%, 0.2%, 5.4% and 3.4%, respectively. A third of MSM perceived their risk for HIV to be low and this was associated with unprotected sex (adjusted OR (AOR), 4.8, 95% CI 1.8 to 10.2). HIV seropositivity was also associated with HSV-2 (AOR, 5.0, 95% CI 3.01 to 11.21); having lived outside Dodoma (AOR 1.7, 95% CI 1.1 to 6.7); age above 25 years; (AOR 2.1, 95% CI 1.7 to 3.7); sexual relationship with a woman (AOR 5.6, 95% CI 3.9 to 12.8); assuming a receptive (AOR 7.1, 95% CI 4.8 to 17.4) or receptive and insertive (AOR 4.5, 95% CI 1.9 to 11.4) position during last anal intercourse; engaging in group sex (AOR 3.1, 95% CI 1.2 to 6.1) and the use of alcohol (AOR 3.9, 95% CI 1.1 to 9.2). Conclusions: HIV prevalence among MSM is five times higher compared with men in the general population in Dodoma. Perceived risk for HIV infection was generally low and low risk perception was associated with unprotected sex. STI, bisexuality and other behavioural risk factors played an important part in HIV transmission. The findings underscore the need for intensified HIV prevention programming addressing and involving key populations in Tanzania

Hiv Prevalence and Associated Risk Factors Among Men Who Have Sex With Men in Dar Es Salaam, Tanzania

Introduction: Limited studies and differential risk behaviours among men who have sex with men (MSM) in Africa calls for population specific studies. We present results from the largest integrated bio-behavioural survey among MSM in Africa to inform programming. Methods: This was a cross-sectional study utilizing respondent driven sampling to recruit MSM aged 18 and above. Data on socio-demographic characteristics and HIV-related risks were collected and all participants were tested for HIV, Herpes Simplex Virus Type-2 (HSV2), Hepatitis-B Virus (HBV) and Syphilis. Results: A total of 753 MSM with a mean age of 26.5 years participated in the study and 646 (85.7%) gave blood for biological testing. The prevalence of HIV was 22.3%, HSV-2 40.9%, syphilis 1.1 %, and HBV 3.25%. Significant risk factors for HIV were age above 25, having no children (aOR), 2.4, 95% CI: 1.4-4.2), low HIV-risk perception (aOR, 2.6, 95% CI: 1.2- 5.3), receptive position (aOR, 8.7; 95% CI 1.2-5.3), and not using water-based lubricants (aOR, 2.6, 95% CI: 1.0-4.5) during last anal sex. Also associated with HIV infection was, having sexual relationships with women (aOR, 8.0, 95% CI: 4.1-15.6), engaging in group sex (aOR, 3.8, 95% CI: 1.6-8.4), HSV-2 seropositivity (aOR, 4.1, 95% CI: 2.6- 6.5) and history of genital ulcers (aOR, 4.1, 95% CI: 1.1-7.2). Conclusions: HIV infection and HSV-2 were highly prevalent among MSM. Low perceived HIV risk, practice of risk behaviours and infection with HSV-2 were significant predictors of HIV infection. Behavioural interventions, HSV-2 suppressive therapies and Pre-exposure Prophylaxis are highly needed. The final version of this research has been published in Journal of Acquired Immune Deficiency Syndromes. © 2018 Lippincott, Williams & Wilkin

Health services we can trust: how same-sex attracted men in Dar Es Salaam, Tanzania would like their HIV healthcare to be organised

Drawing on qualitative research in Dar es Salaam, Tanzania, this article explores how men who engage in sex with other men perceive their interactions with healthcare providers, and how they would prefer healthcare services to be organised and delivered. The paper describes the strengths and weaknesses men associate with private and public healthcare; the advantages and disadvantages they associate with dedicated clinics for sexual minority persons; what they conceive of as good healthcare services; and how they would characterise a good healthcare worker. The paper also presents recommendations made by study participants. These include the view that health services for same-sex attracted men should be developed and delivered in collaboration with such men themselves; that health workers should receive training on the medical needs as well as the overall circumstances of same-sex attracted men; and that there should be mechanisms that make healthcare available to poorer community members. We analyse men’s views and recommendations in the light of theoretical work on trust and discuss the ways in which same sex attracted men look for signs that healthcare workers and healthcare services are trustworthy

AIDS Knowledge and Risk Perception in Urban and Rural Communities in Arusha Region, Tanzania

The purpose of this study was to investigate demographic, cognitive and behavioral factors associated with levels of AIDS knowledge and perceived susceptibility to HIV. Cross-sectional, population-based surveys were conducted in two urban communities, two townships and two rural villages in Arusha region, Tanzania. Eligible participants were 15 to 54 years old living in randomly selected household clusters. A total of 3068 of the eligible men and women participated (62%). The large majority of participants from all six communities had heard of AIDS (96%) and perceived AIDS to be a serious threat to their community (97%). Both men and women had high levels of AIDS knowledge (67% answered at least 17 out of 18 questions correctly). Men reported to discuss AIDS more frequently than did women, and they perceived themselves as being at high risk for HIV infection more often than did women. For both men and women, having higher education and reporting having frequently discussed AIDS were significantly associated with a high score on the AIDS knowledge scale. Living in an urban community, frequently discussing AIDS and previous sexu al behavior were significantly associated with perceived susceptibility for HIV infection among both men and women. It is recommended that future educational efforts focus on creating opportunities for people to discuss HIV/AIDS in safe and supporting environments

Effectiveness of health care workers and peer engagement in promoting access to health services among population at higher risk for HIV in Tanzania (KPHEALTH): study protocol for a quasi experimental trial

Background While there are indications of declining HIV infection rates in the general population globally, Tanzania included, men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID), now called Key Populations (KP) for HIV epidemic have 2–20 times higher infections rates and contributes up to 30% of new HIV infection. Tanzania have developed a Comprehensive Guideline for HIV prevention among key population (CHIP) to address the epidemic among KPs. However, these populations are stigmatized and discriminated calling for innovative approaches to improve access to CHIP. This project seeks to test the effectiveness of healthcare workers and peer-to-peer engagement in promoting access to CHIP among HIV at risk populations in Tanzania. Methods A quasi-experimental design involving Dar es Salaam City as an intervention region and Tanga as a control region will be done. Using respondent driven sampling, 1800 at risk population (900 from Intervention site and 900 from control site) will be recruited at baseline to identify pull and push factors for health services access. Stakeholder’s consultation will be done to improve training contents for CHIP among health care workers and peers. Effectiveness of healthcare workers training and peer engagement will be tested using a quasi-experimental design. Discussion The results are expected to co-create service provision and improve access to services among KPs as a human right, reverse HIV infection rates among KPs and the general population, and improve social and economic wellbeing of Tanzanian. Trial registration Retrospectively registered on 28th August, 2019 with International Standard Randomized Clinical Trial Number (ISRCTN11126469)

HIV/HCV co-infection and associated risk factors among injecting drug users in Dar es Salaam, Tanzania: potential for HCV elimination

Background Chronic HCV infection causes substantial morbidity and mortality and, in co-infection with HIV, may result in immunological and virological failure following antiretroviral treatment. Estimates of HCV infection, co-infection with HIV and associated risk practices among PWID are scarce in Africa. This study therefore aimed at estimating the prevalence of HCV and associated risk factors among PWID in the largest metropolitan city in Tanzania to inform WHO elimination recommendations. Methods An integrated bio-behavioral survey using respondent-driven sampling was used to recruit PWID residing in Dar es Salaam, Tanzania. Following face-to-face interviews, blood samples were collected for HIV and HCV testing. Weighted modified Poisson regression modeling with robust standard errors was used in the analysis. Results A total of 611 PWID with a median age of 34 years (IQR, 29–38) were recruited through 4 to 8 waves. The majority of participants (94.3%) were males, and the median age at first injection was 24 years (IQR, 19–30). Only 6.55% (40/611) of participants reported to have been enrolled in opioid treatment programs. The weighted HCV antibody prevalence was 16.2% (95%CI, 13.0–20.1). The corresponding prevalence of HIV infection was 8.7% (95%CI, 6.4–11.8). Of the 51 PWID who were infected with HIV, 22 (43.1%) were HCV seropositive. Lack of access to clean needles (adjusted prevalence ratio (APR), 1.76; 95%CI, 1.44; 12.74), sharing a needle the past month (APR, 1.72; 95%CI, 1.02; 3.00), not cleaning the needle the last time shared (APR, 2.29; 95%CI, 1.00; 6.37), and having unprotected not using a transactional sex (APR, 1.87; 95%CI, 1.00; 3.61) were associated with increased risk of HCV infection. On the other hand, not being on opioid substitution therapy was associated with 60% lower likelihood of infection. Conclusions The HCV antibody prevalence among PWID is lower than global estimates indicating potential for elimination. Improving access to safe injecting paraphernalia, promoting safer injecting practices is the focus of prevention programing. Screening for HIV/HCV co-infection should be intensified in HIV care, opioid substitution programs, and other point of care for PWID. Use of direct-acting antiretroviral treatment would accelerate the achievement of hepatitis infection elimination goal by 2030

Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach

BackgroundThere is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. ObjectiveWe present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. MethodsA participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. ResultsThe relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. ConclusionsThe participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial RegistrationInternational Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR20200382322657

Prevalence and risk factors associated with HIV-1 infection among people who inject drugs in Dar es Salaam, Tanzania: a sign of successful intervention?

Background Prevalence of HIV infection among people who inject drugs (PWID) has been reported to be higher than that of the general population. The present study aimed to estimate the prevalence of HIV infection and associated risk factors among PWID in Dar es Salaam, Tanzania, following the introduction of a comprehensive HIV intervention package (CHIP) for PWID in the country in 2014. Methods We conducted an integrated bio-behavioral survey (IBBS) among PWID using respondent-driven sampling (RDS) in Dar es Salaam, Tanzania, between October and December 2017. Data on socio-demographic characteristics and risky behaviors were collected through face-to-face interviews. Blood samples were collected and tested for HIV infection. We accounted for weighting in the analyses, and logistic regression was performed to assess risk factors for HIV infection. Results A total of 611 PWID (94.4% males and 5.6% females) with a median age of 34 years (IQR 29–38) were recruited. The overall prevalence of HIV infection was 8.7% (95% CI 6.5–10.9). The prevalence of HIV infections for males and females were 6.8% (95% CI 4.7–8.9%) and 41.2% (95% CI 23.7–58.6%) respectively. Adjusted weighted logistic regression analysis (WLRA) showed that being a female (aOR 19.1; 95% CI 5.9–61.8), injecting drugs for more than 10 years (aOR = 7.32; 95% CI 2.1–25.5) compared to 1 year or less and being 45 years or older (aOR = 34.22; 95% CI 2.4–489.5) compared to being 25 years or younger were associated with increased odds of HIV infection. Use of a sterile needle at last injection decreased odds of HIV infection (aOR = 0.3; 95% CI 0.1–0.8). Conclusions The present study observed a decline in prevalence of HIV infections among PWID in Dar es Salaam (8.7%) compared to a previous estimate of 15.5% from an IBBS conducted in 2013. Despite the decrease, HIV prevalence remains high among PWID compared to the general population, and women are disproportionally affected. The decline may be possibly attributed to the on-going implementation of CHIP for PWID, highlighting the need for strengthening the existing harm reduction interventions by incorporating access to sterile needle/syringe and addressing the layered risks for women