Reduction of HIV transmission rates from mother to child in the era of antiretroviral therapy in the Lake Victoria zone, Tanzania

Background: Since the introduction of prevention of mother to child transmission (PMTCT) in Tanzania, HIV infection rates have been reduced in different regions across the country. However, there is limited published data from the Lake Victoria zone of Tanzania regarding the effectiveness of various regimens used for PMTCT. This study was done to assess the effectiveness of antiretroviral therapy in preventing mother to child transmission of HIVMethods: Infants aged ≤18 months born to HIV positive mothers undertaking PMTCT programme and those with no intervention program from Mara, Kagera, Mwanza and Shinyanga were tested for HIV-1 DNA polymerase chain reaction (PCR). Data were analysed using STATA version 10.0 to assess factors associated with outcome.Results: A total of 1,005 study subjects were enrolled in the study. Of these 55% (554/1005) were females. Majority (82.6%; 830/1005) of the infants studied were aged 1-6 months. The median age of the infant studied was 3 months (IQR 2-4). Out of 1005 non-repetitive samples; 61(6.1%) were HIV-1 DNA PCR positive. Positive dried blood spots (DBS) rates by region were 6.4%, 5.9%, 5.6% and 5.1% in Mwanza, Mara, Kagera and Shinyanga, respectively. During pregnancy interventions, the positive rate for women with no therapy was 12.6% and for zidovudine alone was 5.4% while for triple antiretroviral therapy was 0.5%. Women who were in highly active antiretroviral therapy (HAART) during pregnancy had significantly lower positive rate than those without HAART treatment (p=0.001). Of 755 infants who received nevirapine, 3.9% were DBS positive compared to 12.8% of those who didn’t receive nevirapine (p=0.001).Conclusion: The use of antiretroviral therapy in the PMTCT programme is effective in reducing HIV transmission from mother to child

What do District Health Planners in Tanzania think about improving priority setting using 'Accountability for Reasonableness'?

<p>Abstract</p> <p>Background</p> <p>Priority setting in every health system is complex and difficult. In less wealthy countries the dominant approach to priority setting has been Burden of Disease (BOD) and cost-effectiveness analysis (CEA), which is helpful, but insufficient because it focuses on a narrow range of values – need and efficiency – and not the full range of relevant values, including legitimacy and fairness. 'Accountability for reasonableness' is a conceptual framework for legitimate and fair priority setting and is empirically based and ethically justified. It connects priority setting to broader, more fundamental, democratic deliberative processes that have an impact on social justice and equity. Can 'accountability for reasonableness' be helpful for improving priority setting in less wealthy countries?</p> <p>Methods</p> <p>In 2005, Tanzanian scholars from the Primary Health Care Institute (PHCI) conducted 6 capacity building workshops with senior health staff, district planners and managers, and representatives of the Tanzanian Ministry of Health to discussion improving priority setting in Tanzania using 'accountability for reasonableness'. The purpose of this paper is to describe this initiative and the participants' views about the approach.</p> <p>Results</p> <p>The approach to improving priority setting using 'accountability for reasonableness' was viewed by district decision makers with enthusiastic favour because it was the first framework that directly addressed their priority setting concerns. High level Ministry of Health participants were also very supportive of the approach.</p> <p>Conclusion</p> <p>Both Tanzanian district and governmental health planners viewed the 'accountability for reasonableness' approach with enthusiastic favour because it was the first framework that directly addressed their concerns.</p

The association between alcohol consumption and intimate partner violence in young male perpetrators in Mwanza, Tanzania: a cross-sectional study

BACKGROUND: Although alcohol consumption is a well-known risk factor for intimate partner violence (IPV) perpetration, few studies have been conducted among young males in low- and middle-income countries. Alcohol consumption and IPV are both complex phenomena, whose association requires more in-depth exploration regarding drinking patterns and the alcohol-related manifestation of five different forms of IPV. OBJECTIVE: In this study, we sought to explore the relationship between alcohol use and IPV in young Tanzanian men and to identify differences in the magnitude of past-year IPV perpetration among alcohol drinkers and abstainers. Furthermore, we aimed to assess the association between various drinking patterns with the perpetration of different forms of IPV. METHODS: A cross-sectional survey of 1002 young males residing in Mwanza, Tanzania, was conducted in 2021-2022. Data on alcohol consumption were collected using the alcohol use disorder identification test. IPV perpetration was assessed using an index total of 19 items on acts of physical, sexual, economic, emotional abuse, and controlling behaviour. Logistic regression models were conducted to estimate the relationship between alcohol use and the perpetration of each form of IPV. RESULTS: Among partnered respondents currently consuming alcohol (n = 189, 18.8%), the most and the least prevalent IPV forms in the past 12 months were controlling behaviour (84.1%) and physical IPV (25.4%), respectively. Those reporting recent alcohol consumption reported higher rates of all forms of past-year IPV perpetration compared to abstainers. While no form of IPV was associated with low-risk consumption versus abstention, all forms of IPV were associated with hazardous drinking. CONCLUSION: Young men who drink alcohol, especially those drinking hazardously, are also more likely to report perpetrating IPV. An understanding of the different drinking patterns and manifestations of forms of IPV can contribute to better-tailored alcohol-related interventions and has the potential to improve young adults' health and reduce IPV perpetration

A Cross-Sectional Analysis of Young Men's Gambling and Intimate Partner Violence Perpetration in Mwanza, Tanzania

Objectives: The prevalence of intimate partner violence (IPV) in Tanzania is one of the highest in sub-Saharan Africa. There are very few studies on the co-occurrence of gambling and IPV and none from LMICs, despite gambling being a behaviour associated with gender norms exalting masculinity underlying IPV perpetration. Methods: Cross-sectional survey data of 755 currently partnered men aged 18-24 from Mwanza, Tanzania were analysed to investigate whether gambling was associated with past-year physical, sexual, emotional and economic IPV. We conducted bivariate and multivariate logistic regressions to control for potential confounders, based on their significant association bivariately with the main outcome variables. Results: Of the men who gambled, 18 percent perpetrated physical IPV, 39 percent sexual IPV, 60 percent emotional IPV and 39 percent economic IPV. Gambling was significantly associated with sexual (aOR: 2.59; 95% CI: 1.70-3.97), emotional (aOR: 1.55; 95% CI: 1.12-2.14) and economic IPV (aOR: 1.38; 95% CI: 1.02-1.88) after controlling for confounders. Conclusion: The analysis shows that gambling is associated with IPV perpetration. More research is needed to understand how current IPV prevention efforts can be expanded to include problem gambling treatment

SUPPORT Tools for Evidence-informed Policymaking in health 6: Using research evidence to address how an option will be implemented

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd

Role of Trust in Self-Organizing Pharmaceutical Supply Chain Model with Variable Good Quality and Imperfect Information

We present an Agent-Based Model (hereafter ABM) for a pharmaceutical supply chain operating under conditions of weak regulation and imperfect information, exploring the possibility of poor quality medicines and their detection. Our interest is to demonstrate how buyers can learn about the quality of sellers (and their medicines) based on previous successful and unsuccessful transactions, thereby establishing trust over time. Furthermore, this network of trust allows the system itself to evolve to positive outcomes (under some but not all circumstances) by eliminating sellers with low quality products. The ABM we develop assumes that rational and non-corrupt agents (wholesalers, retailers and consumers) learn from experience and adjust their behaviour accordingly. The system itself evolves over time: under some — but not all — circumstances, sellers with low-quality products are progressively eliminated. Three distinct states of the supply chain are observed depending on the importance of trust built up from past experience. The “dynamic” state is characterised by a low level of trust leading to a continually changing system with new drugs introduced and rejected with little regard to quality. The “frozen” state arises from high levels of reliance on past experience and locks the supply chain into a suboptimal state. The “optimising” state has moderate reliance on past experience and leads to the persistence of suppliers with good quality; however, the system is still “invadable” by better quality drugs. Simulation results show that the state reached by the system depends strongly on the precise way that trust is established: Excessive levels of trust make it impossible for new, improved treatments to be adopted. This highlights the critical need to understand better how personal experience influences consumer behaviour, especially where regulation is weak and for products like medicines whose quality is not readily observable

Antimicrobial Susceptibility Testing Patterns of <i>Neisseria gonorrhoeae</i> from Patients Attending Sexually Transmitted Infections Clinics in Six Regions in Tanzania

Antimicrobial resistance (AMR) is global health threat that is on the increase, and it has been adversely affecting the proper management of sexually transmitted infections (STI). Data on antimicrobial susceptibility testing patterns of N. gonorrhoeae are limited in local settings. We determined in vitro antimicrobial susceptibility and phenotypic profiles of N. gonorrhoeae isolated from STI/Outpatient Department (OPD) clinics. Minimum Inhibitory Concentrations (MIC) (µg/mL) were determined using E-Test and agar dilution methods for previously and currently recommended antimicrobial agents. A total of 164 N. gonorrhoeae isolates from urethral discharge and endocervical swabs were tested. The prevalence of resistant N. gonorrhoeae to tetracycline, norfloxacin, penicillin and ciprofloxacin were 98.6%, 82.2%, 84.3% and 75.6%, respectively. None of the isolates was resistant to kanamycin. Penicillinase producing N. gonorrhoeae (PPNG) was found to be 73.7%, with 56.7% and 43.3% observed among isolates from women and men, respectively. Tetracycline resistant-N. gonorrhoeae (TRNG) was found to be 34.0%, and QRNG with HLR to ciprofloxacin was 79.9%. The overall MDR-NG was 79.9%, and XDR-NG was 3.6%. MIC50 and MIC90 were 4.0 and 8.0 and 2.0 and 4.0 µg/mL for ciprofloxacin and norfloxacin, respectively. Dendrograms showed that 44 phenotypic groups are associated with a high rate of AMR among high MDR-NG and moderate XDR-NG isolates. The predominant groups of quinolone-resistant N. gonorrhoeae (QRNG)+PPNG (34.7%) and QRNG+PPNG+TRNG (32.9%) were observed among the isolates having HLR to ciprofloxacin. We reported a high prevalence of AMR (>90%) to previously recommended antimicrobials used for the treatment of gonorrhoea. Multidrug resistant N. gonorrhoeae (MDR-NG) was highly reported, and extensively drug resistant (XDR-NG) has gradually increased to the currently recommended cephalosporins including ceftriaxone and cefixime. Heterogeneous groups of QRNG+PPNG+ and QRNG+PPNG+TRNG were highly resistant to penicillin, tetracycline, ciprofloxacin and norfloxacin. A surveillance program is imperative in the country to curb the spread of AMR

High Prevalence of Sexually Transmitted and Reproductive Tract Infections (STI/RTIs) among Patients Attending STI/Outpatient Department Clinics in Tanzania

We determined the prevalence and reported risk factors associated with sexually transmitted and reproductive tract infections (STI/RTIs) among patients who presented with genital symptoms in STI/outpatient department (OPD) clinics in two regional referral hospitals and six health centres in six regions in Tanzania. Methods: The patients were consecutively recruited, and the data collection was conducted in eight health care facilities from 2014 to 2016. Genital swabs were collected for the detection of the aetiological pathogens of STI/RTIs. Results: A total of 1243 participants were recruited in the study; the majority (1073, 86%) were women. The overall median age was 27.8. The prevalence of Neisseria gonorrhoeae was 25.7% (319/1243), with proportions of 50.9 and 21.5% for men and women, respectively, of Chlamydia trachomatis 12.9% (160/1241) and Mycoplasma genitalium 4.7% (53/1134). Unmarried men were more often likely to be infected with gonococcal infections as compared to their women counterparts (57.9 vs. 24.1%) p p = 0.01), but those reported to the regional referral hospitals were more likely to be infected with N. gonorrhoeae (OR = 2.5) and C. trachomatis (OR = 2.1) than those from the health centres (p p = 0.03), though VC was strongly inversely associated with an N. gonorrhoeae infection (p N. gonorrhoeae (51.1%) and C. trachomatis (23.3%) were found in the Dodoma and Dar es Salaam regions, respectively. M. genitalium (7.6%) was found to be the highest in Mwanza. Conclusion: We reported a high prevalence of STI/RTIs. The findings suggest that these infections are common and prevalent in STI/OPD clinics in six regions of Tanzania. We recommend surveillance to be conducted regularly to elucidate the true burden of emerging and classical STI/RTIs by employing modern and advanced laboratory techniques for the detection and monitoring of STI/RTIs in low- and high-risk populations, including the community settings