Analytical treatment interruption (ATI) is an important tool to evaluate interventions designed to achieve HIV eradication or long-term control without antiretroviral therapy. We convened a stakeholder workshop to update the published recommendations for the conduct of ATI studies. Important changes to the recommendations include more lenient entry criteria on CD4 count, CD4 nadir, and past medical history, and allowance for greater variation based on regional standards. As the mechanism of potential HIV remission might rely on immune control, the criteria for antiretroviral therapy resumption now allow for longer periods of viraemia at higher levels to stimulate a more robust immune response. Greater emphasis is placed on the importance of psychosocial monitoring and support, the prevention of HIV transmission to partners during ATI, and the integration of sociobehavioural research into ATI studies. Recommendations for the conduct of paediatric and adolescent ATI trials, absent from previous guidelines, are now included. These recommendations, based on current available data, expert opinion, and community consultation, aim to help steer the safe and ethical implementation of the next generation of ATI trials as we continue the search for an HIV cure.
Background While pharmacy education has expanded in Tanzania, students’ motivations for choosing the profession and their career expectations remain underexplored. Understanding these drivers is crucial for aligning training with healthcare needs, enhancing professional satisfaction, and ensuring graduates contribute effectively to national health priorities. Methods A descriptive cross-sectional study was conducted between March and July 2025 among 324 undergraduate pharmacy students from three tertiary institutions in Tanzania. Data were collected using a structured questionnaire and analyzed using STATA version 17. Descriptive statistics, chi-square tests, and multivariate logistic regression were employed to identify associations between factors influencing program choice and career attitudes, with statistical significance set at p < 0.05. Results Pharmacy was the first-choice program for 76.2% of participants, and 53.7% demonstrated positive career attitudes. Significant associations with selecting pharmacy as first choice were found for institution attended (χ²=13.587, p = 0.001), program level (χ²=13.862, p < 0.001), confidence in choice (χ²=7.438, p = 0.006), program reputation (χ²=14.75, p < 0.001), source of influence (χ²=14.742, p = 0.002), advice from pharmacists/healthcare workers (χ²=4.105, p = 0.043), and attitudinal disposition (χ²=7.342, p = 0.007). After adjustment, significant predictors of choosing pharmacy first included institution (KIUT: AOR = 9.06, p = 0.007), degree program (AOR = 0.13, p = 0.002), low confidence (AOR = 0.33, p = 0.046), program reputation (AOR = 0.39, p = 0.017), negative attitude (AOR = 0.54, p = 0.047), and community pharmacy career goals (AOR = 3.82, p = 0.045). Conclusion Pharmacy program choice among Tanzanian students is influenced by institutional factors, professional reputation, mentorship from healthcare professionals, and attitudinal disposition rather than financial incentives. Structured mentorship programs and enhanced career guidance are recommended to align student expectations with workforce needs.
BACKGROUND:Index case testing (ICT) is an effective strategy for HIV case finding, but implementation in low- and middle-income countries (LMICs) is often limited by cost and logistical challenges. Traditional ICT training-centralized and in-person-is costly, disrupts service delivery, and varies in quality. OBJECTIVE:This study evaluates the cost-effectiveness of a blended learning (BL) implementation package designed to build health care worker capacity for ICT, combining tablet-guided teaching and practice sessions, phone-based feedback, and tablet-guided continuous quality improvement, compared with standard of care (SOC) training. METHODS:The Package of Resources for Assisted Contact Tracing: Implementation, Costs, and Effectiveness (PRACTICE) cluster-randomized controlled trial included 33 clusters in southern Malawi from May 2022 to September 2023, randomized 2:1 to SOC (n=22) or SOC + BL implementation package (n=11). Our cost-effectiveness analysis, from the health system perspective, used microcosting, time-and-motion assessments, and observed trial outcomes. The decision tree model estimated total program costs, contact testing outcomes, and incremental cost-effectiveness ratios (ICERs) per contact tested and per person diagnosed with HIV across 1 year of implementation. Sensitivity analyses assessed parameter uncertainty, and a scenario analysis modeled a nationwide scale-up under a decentralized, Ministry of Health-led approach. RESULTS:Our model simulated 100,000 index clients eligible for contact elicitation over 1 year across 2 districts (50,000 per arm). The BL implementation package arm yielded 891 additional contacts tested and 54 more HIV diagnoses. The ICERs were US $125 per contact tested and US $2045 per person diagnosed with HIV; excluding training development costs reduced these to US $69 and US $1136, respectively. Nationwide scale-up under a Ministry of Health-led model further reduced ICERs to US $43 per contact tested and US $698 per person diagnosed with HIV. Probabilistic sensitivity analyses showed the BL implementation package was cost-effective in most simulations. CONCLUSIONS:The BL implementation package improved ICT delivery and HIV case finding. Scenario analyses suggested that a decentralized, government-led scale-up could substantially reduce costs and may represent an efficient case-finding strategy, particularly in Malawi's mature epidemic. BL implementation packages provide a scalable, system-integrated, cost-effective approach that could strengthen health care worker capacity across other service delivery areas in low-resource settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.1136/bmjopen-2023-077706.
Background: Antimicrobial resistance (AMR) represents an escalating public health crisis, disproportionately affecting low- and middle-income countries where empirical prescribing and limited diagnostic capacity drive inappropriate therapy. No published longitudinal antibiogram data exist for Dodoma Regional Referral Hospital, leaving clinicians reliant on uninformed empirical prescribing. This study characterized AMR patterns and antibiogram trends among bacterial isolates at Dodoma Regional Referral Hospital (DRRH), Tanzania. Methods: A hospital-based retrospective study was conducted using Laboratory records covering 363 culture-positive bacterial isolates from January 2018 to May 2023 were extracted using a structured checklist and analyzed following Clinical and Laboratory Standards Institute guidelines (CLSI) guidelines. Antimicrobial Susceptibility Testing (AST) followed CLSI data were analyzed using SPSS version 25, with chi-square to identify significant resistance associations at 0.05 significance level. Results: Among 363 bacterial isolates generating 591 resistance events, Staphylococcus aureus (41.6%) and Escherichia coli (32.8%) predominated. Resistance burden peaked in 2022 (26.2%) and 2020 (20.6%). Among Gram-negative isolates, ceftazidime resistance was disproportionately elevated in blood p = 0.01), while ciprofloxacin resistance predominated in urine (p = 0.02). Enterobacter spp. showed significantly higher ceftriaxone resistance than expected (p =0.02), whereas E. coli contributed 52 resistant isolates each for gentamicin and ciprofloxacin. Meropenem retained near-complete activity (99.5%). Among Gram-positive isolates, clindamycin resistance was most strongly specimen-associated (χ² = 13.71; p < 0.01), with gentamicin (χ² = 8.06; p = 0.02) and cefoxitin (χ² = 5.66; p = 0.03) resistance also significantly specimen-dependent. Ciprofloxacin resistance remained persistently elevated across all years, peaking at 29.5% in 2020. Conclusion: Significant, specimen- and organism-dependent AMR was demonstrated across common pathogens at DRRH. Ciprofloxacin and gentamicin resistance warrant prioritization in facility stewardship protocols, while carbapenem preservation should be actively monitored. Additionally, these findings underscore the urgent need for continuous surveillance and facility-specific antibiograms to guide empirical therapy and reinforce stewardship programs in Tanzania.
BACKGROUND:People diagnosed with advanced HIV disease (AHD) are at high risk for mortality even after starting antiretroviral therapy (ART). We determined characteristics, clinical outcomes, and risks of mortality among children and adolescents diagnosed with AHD in western Uganda. METHODS:We conducted a retrospective cohort analysis of routinely collected program data of children and adolescents living with HIV (CALHIV) aged 0-19 years, from outpatient HIV clinic electronic medical records in 48 high-volume health facilities in two regions of western Uganda (Fort Portal and Hoima). Data for clients who initiated ART during January 2016-July 2023 were analysed. AHD was defined as a CD4 cell count <200 cells/μL, or WHO stage 3 or 4, or any child younger than 5 years of age living with HIV who had been on ART for more than 12 months and virally non-suppressed (≥1,000 copies). We used descriptive statistics (i.e., frequencies and percentages) to summarise characteristics and treatment outcomes. Kaplan-Meier curves were used to estimate survival overall and by clients' characteristics; log-rank tests were used to compare survival functions. A gamma-shared frailty model was used to determine factors associated with the rate of mortality. Effect measures were summarized using adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (95%CI). RESULTS:A total of 5,143 CALHIV, including 3,067 (59.6%) females, with a median (interquartile range [IQR]) age of 10 (9) years were assessed. Overall, AHD was high (18.1%) and varied by age-0-4 years (68.4%), 5-9 years (12.6%), 10-14 years (13.2%), and lowest among adolescents, 15-19 years (7.7%). Just over half of the CALHIV with AHD were active in care (51.5% [480/932]), about a quarter (26.4% [264/932]) had transferred out, 13.8% (129/932) were lost to follow-up, and 8.3% (77/932) had died. Survival was significantly higher in CALHIV who were not malnourished compared to those with malnutrition (p = 0.001). Overall mortality rate per 100 person-years among CALHIV with AHD was 4.1 (95%CI:3.2-5.2) and was significantly higher among those who had been on ART for 3 months or less (27.3; 95%CI: 20.6-36.2) compared to 6 months or more (1.0; 95%CI: 0.6-1.7). CONCLUSION:Advanced HIV Disease among CALHIV in western Uganda was consistent with what has been published elsewhere. Risk of death differed by nutrition status and was high among those on ART three months or less. Early screening and management of malnutrition, as well as early ART initiation and adherence initiatives, might improve outcomes and reduce AHD-related mortality among CALHIV.
