Risky sexual behaviours among young adults attending Higher Learning Institutions in Mbeya, Tanzania: implications for STIs and HIV preventive programs.

BACKGROUND: High-risk sexual behaviours (HRSBs) among young adults are a key risk for Sexually Transmitted Infections (STIs), HIV and unplanned pregnancies. The World Health Organization has identified the 15-24 year age-group as high-risk for STIs. Students at Higher Learning Institutions (HLIs) may be at higher risk because they are free of immediate parental supervision, a transient migratory population, and probably at peak years of sexual activity. Here, we describe risky sexual behaviours and preventive practices among young adults attending HLIs in Mbeya, Tanzania. METHODS: ross-sectional study was conducted from March 2019 to January 2020 among students aged 18-24 years enrolled in HLIs within Mbeya. A self-administered questionnaire was used to collect information on sexual health education, activity, behaviour and STI knowledge. RESULTS: 504 students were enrolled; mean age of 21.5 (SD 1.74) years. 377 (74.8%) students were sexually active. Mean age of first sexual encounter was 18.4 years and 11.6% reported their sexual debut was ≤15 years. A higher proportion of male students (59.7%) reported their sexual debut with non-steady partners compared with female students (40.9%). Lack of condom use at sexual debut was reported by 43.3% of sexually active students. Consistent condom use during the past 4-weeks was reported at 23.3% and 16.9% among men and women, respectively. Almost 1 in 10 students reported being forced into having sex by someone they were dating. Sex under the influence of alcohol was reported by 25.5% of the students. Nearly 7 in 10 (77%) students had heard of STIs, but only 15% were aware STIs could be asymptomatic. CONCLUSION: STI prevention programs need to recognize young adults in HLIs as an at-risk population. HLIs must advocate targeted messages to minimize risks to acquiring STIs, offer counselling and support for those experiencing sexual violence, and promote condom use and safer-sex negotiation skills

Linkage into care among newly diagnosed HIV-positive individuals tested through outreach and facility-based HIV testing models in Mbeya, Tanzania: a prospective mixed-method cohort study

Objective: Linkage to care is the bridge between HIV testing and HIV treatment, care and support. In Tanzania, mobile testing aims to address historically low testing rates. Linkage to care was reported at 14% in 2009 and 28% in 2014. The study compares linkage to care of HIV-positive individuals tested at mobile/ outreach versus public health facility-based services within the first 6 months of HIV diagnosis. Setting: Rural communities in four districts of Mbeya Region, Tanzania. Participants: A total of 1012 newly diagnosed HIV-positive adults from 16 testing facilities were enrolled into a two-armed cohort and followed for 6 months between August 2014 and July 2015. 840 (83%) participants completed the study. Main outcome measures: We compared the ratios and time variance in linkage to care using the Kaplan-Meier estimator and Log rank tests. Cox proportional hazards regression models to evaluate factors associated with time variance in linkage. Results: At the end of 6 months, 78% of all respondents had linked into care, with differences across testing models. 84% (CI 81% to 87%, n=512) of individuals tested at facility-based site were linked to care compared to 69% (CI 65% to 74%, n=281) of individuals tested at mobile/outreach. The median time to linkage was 1 day (IQR: 1-7.5) for facility-based site and 6 days (IQR: 3-11) for mobile/outreach sites. Participants tested at facility-based site were 78% more likely to link than those tested at mobile/outreach when other variables were controlled (AHR=1.78;95% CI 1.52 to 2.07). HIV status disclosure to family/relatives was significantly associated with linkage to care (AHR=2.64;95% CI 2.05 to 3.39). Conclusions: Linkage to care after testing HIV positive in rural Tanzania has increased markedly since 2014, across testing models. Individuals tested at facility-based sites linked in significantly higher proportion and modestly sooner than mobile/outreach tested individuals. Mobile/outreach testing models bring HIV testing services closer to people. Strategies to improve linkage from mobile/outreach models are needed

Impact of N-Acetyl Cysteine (NAC) on Tuberculosis (TB) Patients—A Systematic Review

This research article was published by MDPI in 2022Sustained TB infection overproduces reactive oxygen species (ROS) as a host defense mechanism. Research shows ROS is destructive to lung tissue. Glutathione (GSH) neutralizes ROS, although it is consumed. NAC is a precursor of GSH synthesis, and administering an appropriate dose of NAC to patients with respiratory conditions may enhance lung recovery and replenish GSH. The present review searched for articles reporting on the effects of NAC in TB treatment from 1960 to 31 May 2022. The PICO search strategy was used in Google Scholar, PubMed, SciFinder, and Wiley online library databases. The COVIDENCE tool was used to delete inappropriate content. We eventually discovered five clinical trials, one case report, seven reviews, in vitro research, and four experimental animal studies from the twenty-four accepted articles. The use of NAC resulted in increased GSH levels, decreased treatment time, and was safe with minimal adverse events. However, the evidence is currently insufficient to estimate the overall effects of NAC, thus the study warrants more NAC clinical trials to demonstrate its effects in TB treatment

Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low- and middle- income country setting

The study was funded by the European and Developing Countries Clinical Trials Partnership (EDCTP), grant TWENDE-EDCTP-CSA-2014-283.Background : Early access to diagnosis is crucial for effective management of any disease including tuberculosis (TB). We investigated the barriers and opportunities to maximise uptake and utilisation of molecular diagnostics in routine healthcare settings. Methods : Using the implementation of World Health Organisation approved TB diagnostics, Xpert MTB/RIF and Line Probe Assay (LPA) as a benchmark we evaluated the barriers and how they could be unlocked to maximise uptake and utilisation of molecular diagnostics. Results : Health officers representing 190 districts/counties participated in the survey across Kenya, Tanzania and Uganda. The survey findings were corroborated by 145 healthcare facility (HCF) audits and 11 policymaker engagement workshops. Xpert MTB/RIF coverage was 66%, falling behind microscopy and clinical diagnosis by 33% and 1% respectively. Stratified by HCF type, Xpert MTB/RIF implementation was 56%, 96% and 95% at district-, regional- and national referral- hospital levels. LPA coverage was 4%, 3% below culture across the three countries. Out of 111 HCFs with Xpert MTB/RIF, 37 (33%) utilised it to full capacity, performing ≥8 tests per day of which 51% of these were level five (zonal consultant and national referral) HCFs. Likewise, 75% of LPA was available at level five HCFs. Underutilisation of Xpert MTB/RIF and LPA was mainly attributed to inadequate- utilities, 26% and human resource, 22%. Underfinancing was the main reason underlying failure to acquire molecular diagnostics. Second to underfinancing was lack of awareness with 33% healthcare administrators and 49% practitioners were unaware of LPA as TB diagnostic. Creation of a health tax and decentralising its management was proposed by policymakers as a booster of domestic financing needed to increase access to diagnostics. Conclusion : Our findings suggest higher uptake and utilisation of molecular diagnostics at tertiary level HCFs contrary to the WHO recommendation. Country-led solutions are crucial for unlocking barriers to increase access to diagnostics.Publisher PDFPeer reviewe

Processes and dynamics of linkage to care from mobile/outreach and facility‑based HIV testing models in hard‑to‑reach settings in rural Tanzania. Qualitative findings of a mixed methods study

BACKGROUND: Like other countries, Tanzania instituted mobile and outreach testing approaches to address low HIV testing rates at health facilities and enhance linkage to care. Available evidence from hard-to-reach rural settings of Mbeya region, Tanzania suggests that clients testing HIV+ at facility-based sites are more likely to link to care, and to link sooner, than those testing at mobile sites. This paper (1) describes the populations accessing HIV testing at mobile/outreach and facility-based testing sites, and (2) compares processes and dynamics from testing to linkage to care between these two testing models from the same study context. METHODS: An explanatory sequential mixed-method study (a) reviewed records of all clients (n = 11,773) testing at 8 mobile and 8 facility-based testing sites over 6 months; (b), reviewed guidelines; (c) observed HIV testing sites (n = 10) and Care and Treatment Centers (CTCs) (n = 8); (d) applied questionnaires at 0, 3 and 6 months to a cohort of 1012 HIV newly-diagnosed clients from the 16 sites; and (e) conducted focus group discussions (n = 8) and in-depth qualitative interviews with cohort members (n = 10) and health care providers (n = 20). RESULTS: More clients tested at mobile/outreach than facility-based sites (56% vs 44% of 11,733, p < 0.001). Mobile site clients were more likely to be younger and male (p < 0.001). More clients testing at facility sites were HIV positive (21.5% vs. 7.9% of 11,733, p < 0.001). All sites in both testing models adhered to national HIV testing and care guidelines. Staff at mobile sites showed more proactive efforts to support linkage to care, and clients report favouring the confidentiality of mobile sites to avoid stigma. Clients who tested at mobile/outreach sites faced longer delays and waiting times at treatment sites (CTCs). CONCLUSIONS: Rural mobile/outreach HIV testing sites reach more people than facility based sites but they reach a different clientèle which is less likely to be HIV +ve and appears to be less “linkage-ready”. Despite more proactive care and confidentiality at mobile sites, linkage to care is worse than for clients who tested at facility-based sites. Our findings highlight a combination of (a) patient-level factors, including stigma; and (b) well-established procedures and routines for each step between testing and initiation of treatment in facility-based sites. Long waiting times at treatment sites are a further barrier that must be addressed

Risky sexual behaviours among young adults attending Higher Learning Institutions in Mbeya-Tanzania

Data was collected from a cross-sectional designed study, conducted from March 2019 to January 2020 in Mbeya region, Tanzania among students attending Higher Learning Institutions (HLIs) in the region registered by the Tanzania Commission for Universities (TCU). Eligible participants included Tanzanian students enrolled in HLIs within Mbeya region in any year of study, aged 18-24 years of age and agreed to provide written informed consent prior to all study-related procedures. Participants were ineligible to take part if they were students attending short-term courses (< 6 months) or elective students. Each HLI in Mbeya region was invited to participate. A complete electronic list of all students registered, aged 18-24 years of age was obtained from the Academic Registrars' offices. Based on the varying number of students from each HLI, and the study desired sample size, probability proportional to size was used to determine the total number of students by gender from each HLI. Students were not selected based on the department or course they are registered for. Each selected student was notified via phone that he/she has been randomly selected to take part in the study and if he/she was willing to take part, he/she was then requested to report to the data collection point within their respective campuses. An individual self-administered questionnaire was used in the study. The questionnaire was administered using a tablet or smart phone through a web-based software (ODK) or hard copy, which ever method the participant preferred. Data was entered in a database, and thereafter cleaned and analysed using statistical software Stata version 14 for Windows. Ethical approval was granted by the Mbeya Medical Research and Ethics Review Committee (MMREC) Reference Number SZEC-2439/R.A/V.1/07, Kilimanjaro Christian Medical College Research Ethics and Review Committee (CRERC) Reference Number 2405, and National Health Research Ethics Committee (NatHREC) Reference Number NIMR/HQ/R.8a/Vol.IX/3092. All eligible participants who agree to participate in this study received study information and were consented prior to any study related activity. Only participant’s study identification number was used in the questionnaire

Quantitative data on Linkage to HIV care in Mbeya Tanzania

Data collected from newly diagnosed HIV individuals with regards to Linkage to HIV care with in the first six months of HIV testing either at the facility-based or mobile/outreach HIV testing site in the rural settings of Mbeya region in Tanzania.The interviews were administered during enrollment (round one), then at three months(round two) and last interview at six months( round three)since diagnosis

Indicators of optimal diabetes care and burden of diabetes complications in Africa: a systematic review and meta-analysis.

OBJECTIVE: Contemporary data on the attainment of optimal diabetes treatment goals and the burden of diabetes complications in adult populations with type 2 diabetes in Africa are lacking. We aimed to document the current status of attainment of three key indicators of optimal diabetes care and the prevalence of five diabetes complications in adult African populations with type 2 diabetes. METHODS: We systematically searched Embase, PubMed and the Cochrane library for published studies from January 2000 to December 2020. Included studies reported any information on the proportion of attainment of optimal glycated haemoglobin (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDLC) goals and/or prevalence of five diabetes complications (diabetic peripheral neuropathy, retinopathy, nephropathy, foot ulcers and peripheral arterial disease). Random effect model meta-analysis was performed to determine the pooled proportion of attainment of the three treatment goals and the prevalence of five diabetes complications. RESULTS: In total, 109 studies with a total of 63 890 participants (53.3% being females) were included in the meta-analysis. Most of the studies were conducted in Eastern African countries (n=44, 40.4%). The pooled proportion of attainment of an optimal HbA1c, BP and LDLC goal was 27% (95% CI 24 to 30, I2=94.7%), 38% (95% CI 30 to 46, I2=98.7%) and 42% (95% CI 32 to 52, I2=97.4%), respectively. The pooled prevalence of diabetic peripheral neuropathy, retinopathy, diabetic nephropathy, peripheral arterial disease and foot ulcers was 38% (95% CI 31 to 45, I2=98.2%), 32% (95% CI 28 to 36, I2=98%), 31% (95% CI 22 to 41, I2=99.3%), 19% (95% CI 12 to 25, I2=98.1%) and 11% (95% CI 9 to 14, I2=97.4%), respectively. CONCLUSION: Attainment of optimal diabetes treatment goals, especially HbA1c, in adult patients with type 2 diabetes in Africa remains a challenge. Diabetes complications, especially diabetic peripheral neuropathy and retinopathy, are highly prevalent in adult populations with type 2 diabetes in Africa