Decline in the prevalence HIV among pregnant women attending antenatal clinics in Tanzania, 2001-2011

Background: The Tanzania National AIDS Control Programme has established HIV sentinel surveillance among antenatal clinic (ANC) attendees as one of the methods for collecting data on HIV prevalence. This article provides trends on HIV prevalence for 92 sentinel sites that have constantly been part of the surveillance system since 2001 and have participated in at least three consecutive rounds.Method: The surveillance population included all pregnant women aged 15–49 years who were attending a selected sentinel ANC site for the first time for any pregnancy between 2001 and 2011. Serial testing for HIV infection was done anonymously by detecting for the presence of IgG antibodies to HIV on dried blood spot (DBS) specimens. HIV trends were calculated taking into account random effects from sites on the following variables:  region, sites and socio-demographic characteristics defined as age, marital status, parity, education level and duration of stay at present residence.Results: Overall, there was a significant decline in HIV prevalence from 9.6% in 2001 to 5.6% in 2011 (p<0.01). Specifically, the HIV prevalence among 15-24 years’ pregnant women significantly declined from 7.8% in 2001/2002 to 4% in 2011 (p<0.01). The decline in HIV prevalence occurred irrespective of residence, marital status, education level or previous pregnancies.Conclusion: There has been a significant decline in HIV infections among young pregnant women attending ANC clinics in Tanzania since 2001. This study also indicates that ANC surveillance among pregnant women over time can provide useful estimates of HIV situation between the population surveys

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

Relationship dynamics and anticipated stigma: Key considerations for PrEP use among Tanzanian adolescent girls and young women and male partners

Objectives: We examined key gender, interpersonal and community dynamics influencing PrEP acceptability among adolescent girls and young women (AGYW) and their male partners. Methods: We administered 12 in-depth interviews (IDI) to partnered, or married AGYW aged 15-24 years living without HIV, and 16 IDIs to male partners living without HIV aged 18 or older, partnered or married to an AGYW in Tanzania. Card sorting, a participatory qualitative method for facilitating systematic discussion, was used to identify attitudes, values, and desires that would influence PrEP acceptability. Results: Relationship distrust, partner communication about HIV risk, and need to control HIV risk were highly influential considerations for PrEP use. AGYW and male partners both wanted to discuss PrEP use amidst relationship distrust, while most male partners encouraged AGYW PrEP use for shared protective benefit. Anticipated stigma of being perceived as a person living with HIV, as a result of PrEP use, was a deterrent for both AGYW and male partners while AGYW also feared additional stigma of being considered sexually promiscuous. Conclusions: Couples counseling for PrEP uptake and adherence might be a well-placed strategy for couples who are living without HIV to educate one another about the relationship benefits of using PrEP, thereby increasing its acceptance and adherence, addressing unequal power dynamics, and reducing associated relationship distrust. Community awareness and education about PrEP can help curb persistent PrEP stigma, including intersectional stigma

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

Replication Data for: Provider perspectives on PrEP for adolescent girls and young women in Tanzania: The role of provider biases and quality of care

Oral pre-exposure prophylaxis (PrEP) has the potential to reduce HIV acquisition among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, health care providers’ (HCPs) perspectives and interactions with potential clients can substantially influence effective provision of quality health services. Findings show that qualitatively, HCPs acknowledged that biases, rooted in cultural norms, often result in stigmatizing and discriminatory care toward AGYW, a potential barrier for PrEP provision. Better training to provide HIV services was associated with greater willingness to prescribe PrEP. However, HCPs feared the potential negative impact of PrEP on the provision of existing HIV services (e.g., overburdened staff), and suggested the integration of PrEP into non-HIV services and the use of paramedical professionals to facilitate PrEP provision. The data presented here indicate that preparing for PrEP introduction a two-pronged strategy: addressing HCPs’ biases regarding sexual health services to AGYW; and preparing the health system infrastructure for the introduction of PrEP

Replication Data for: Provider perspectives on PrEP for adolescent girls and young women in Tanzania: The role of provider biases and quality of care

Background Oral pre-exposure prophylaxis (PrEP) has the potential to reduce HIV acquisition among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, health care providers’ (HCPs) perspectives and interactions with potential clients can substantially influence effective provision of quality health services. We examine if HCPs’ knowledge, attitude, and skills, as well as their perceptions of facility readiness to provide PrEP are associated with their willingness to provide PrEP to AGYW at high risk of HIV in Tanzania. Methods A self-administered questionnaire was given to 316 HCPs from 74 clinics in two districts and 24 HCPs participated in follow-up in-depth interviews (IDIs). We conducted bivariate and multivariable Poisson regression to assess factors associated with willingness to provide PrEP to AGYW. Thematic content analysis was used to analyze the IDIs, which expanded upon the quantitative results. Results Few HCPs (3.5%) had prior PrEP knowledge, but once informed, 61.1% were willing to prescribe PrEP to AGYW. Higher negative attitudes toward adolescent sexuality and greater concerns about behavioral disinhibition due to PrEP use were associated with lower willingness to prescribe PrEP. Qualitatively, HCPs acknowledged that biases, rooted in cultural norms, often result in stigmatizing and discriminatory care toward AGYW, a potential barrier for PrEP provision. However, better training to provide HIV services was associated with greater willingness to prescribe PrEP. Conversely, HCPs feared the potential negative impact of PrEP on the provision of existing HIV services (e.g., overburdened staff), and suggested the integration of PrEP into non-HIV services and the use of paramedical professionals to facilitate PrEP provision. Conclusions Preparing for PrEP introduction requires more than solely training HCPs on the clinical aspects of providing PrEP. It requires a two-pronged strategy: addressing HCPs’ biases regarding sexual health services to AGYW; and preparing the health system infrastructure for the introduction of PrEP.</p

Community-based antiretroviral therapy (ART) delivery for female sex workers in Tanzania: 6-month ART initiation and adherence

We conducted an implementation science study of a community-based ART distribution program for HIV-positive female sex workers (FSW) whereby clients received ART services through community-based mobile and home-based platforms. We compared 6-month treatment-related outcomes in the community-based ART arm (N = 256) to the standard facility-based ART delivery arm (N = 253). Those in the intervention arm were more likely to have initiated ART (100.0% vs. 71.5%; p = 0.04), be currently taking ART at the 6-month visit (100.0% vs. 95.0%; p \u3c 0.01), and less likely to have stopped taking ART for more than 30 days continuously (0.9% vs. 5.7%; p = 0.008) or feel high levels of internalized stigma (26.6% vs. 39.9%; p = 0.001). In the adjusted regression model, internalized stigma (adjusted OR [aOR]: 0.5; 95% CI 0.28–0.83) and receiving community-based ART (aOR: 208.6; 95% CI 12.5–3479.0) were significantly associated with ART initiation. Community-based ART distribution model can improve linkage to and adherence to ART over standard facility-based ART programs for FSWs

Community-based HIV treatment service delivery model for female sex workers in Tanzania: Evaluation findings

Project SOAR in collaboration with the National AIDS Control Program of the Government of Tanzania, National Institute of Medical Research, and Jhpiego’s Sauti Program, conducted an implementation science study to investigate the delivery of community-based antiretroviral treatment (ART) services to female sex workers (FSWs) in Tanzania. Studies from sub-Saharan Africa have shown improved HIV treatment outcomes, such as uptake of HIV services, retention in care, and increased dignity and quality of life, by using community-based delivery of HIV services. As detailed in this Project SOAR final report, the study assessed the effectiveness of the community-based ART delivery intervention in improving HIV treatment outcomes among FSWs in Tanzania

Community-based antiretroviral therapy (ART) delivery for female sex workers in Tanzania: Intervention model and baseline findings

To increase linkage to and retention in antiretroviral therapy (ART) care, we piloted a community-based, ART service delivery intervention for female sex workers (FSWs). At baseline, we recruited and collected data from 617 FSWs (intervention: 309; comparison: 308) who were HIV positive and not on ART. This paper presents (1) the description of the intervention model, and (2) key descriptive and bivariate-level findings of the baseline FSW cohort. The data showed more than half of FSWs had a non-paying sex partner, and less than one-third used a condom at last sex with paying and non-paying clients, which suggest potentially high levels of HIV transmission. In addition, there is a gap in HIV testing and treatment because one-third learned about their HIV-positive status only at study enrollment, and among FSWs who had known their status for more than a month, half had not registered in care. This substantiates the importance of timely HIV diagnosis and treatment. A community-based ART program may serve as an important strategy in closing the HIV care and treatment gap for FSWs

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)