BACKGROUND:Global health researchers are celebrating notable success in their efforts to develop preventive vaccines to curb the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) pandemic. HIV vaccine trial participants play a vital role, devoting their time, effort, and bodies to HIV prevention success. However, the conclusion of vaccine trials often shifts the spotlight from trial participants to the broader implications of the trial results, which may leave participants feeling neglected or abandoned. Little is documented regarding participants' psychological wellbeing after HIV vaccine trials end. AIM:This study aimed to explore psychological harms experienced by former trial participants after participation in HIV vaccine trials in Tanzania. METHODOLOGY:This qualitative study is part of a larger sequential exploratory mixed-methods design that aimed to explore the nonphysical risks and benefits of HIV vaccine trial participation and their effects on peoples' willingness to participate in similar trials. A snowball technique was used to sample 25 former trial participants and 11 researchers who conducted HIV vaccine trials from 2007 to 2015 in Tanzania. In-depth interviews were conducted followed by thematic qualitative analysis. RESULTS:The findings of this study reveal that former trial participants experienced psychological harms, categorized by three distinct themes: (1) psychological uncertainties, (2) dependance on the trials and (3) unmet emotional needs. Both trial researchers and former trial participants concurred on the first two themes. But the third theme-unmet emotional needs-was deeply personal to individual participants and hence reported by only the former trial participants. CONCLUSION:The psychological uncertainties experienced by former trial participants were expected to be prevented by the extensive education and information provided during the trials. Dependance to the trial could indicate the need for continuation of incentives such as free medical care and it is not uncommon in most low- and middle-income settings. Researchers in collaboration with Institutional Review Boards/Research Ethics Committees (IRBs/RECs) and community research stakeholders should agree on balanced incentives for specific vaccine trials that will not instill unrealistic expectations. Continuous participant engagement could provide an opportunity for trial results dissemination and correcting misconceptions as well as addressing the emotional needs of former trial participants. Future research should assess the extent of post-trial uncertainties and their effect on participants' mental health, which may affect their attitudes toward participation in similar future trials and their trust in research.

Nurse counselors play a pivotal role in recruiting and facilitating the retention of volunteers in HIV vaccine trials. They act as the primary interface between the research team and volunteers, typically tasked with educating, supporting, and guiding participants through the trial process, including adherence to the study protocol for care and safety. There is limited research on the series of experiences and challenges faced by nurse counselors during the recruitment and retention of volunteers in HIV vaccine trials. This study aimed to describe the experiences of nurse counselors in recruiting and retaining female sex workers in the HIV PrEP and Vaccine (PrEPVacc) trial. This employed a descriptive qualitative study design nested within the larger phase IIb three-arm, two-stage HIV prophylactic vaccine trial conducted in Dar es Salaam, Tanzania. The qualitative data were collected among three nurse counselors and one field worker who participated in 16 debrief sessions. The participants were purposefully selected due to their roles and responsibilities in the recruitment and retention of volunteers. The audio-recorded sessions were transcribed verbatim, and the content analysis approach was applied. The study revealed that nurse counselors felt responsible and honored through enhancing volunteers’ recruitment and enrollment, ensuring retention, and facilitating trial interventions. The availability of a supportive trial environment, engagement meetings, collaboration among staff and volunteers, good staff performance, and volunteers’ positive attitude were the qualities for effective management of volunteers in the trial. However, the participants described encountering barriers to trial recruitment and retention, such as volunteers’ noncompliance with trial requirements, perceived lack of honesty, personal life and family resistance, stigma, and social perception. The nurse counselors can encounter great turmoil while ensuring recruitment and retention in an HIV vaccine trial. Despite the challenges, volunteer engagement and adherence to study protocol are important for maintaining the continuity of trial procedures over time. Collaboration among staff and engagement of volunteers are essential to enhancing retention until the end of the study. The trial was registered with the US clinicaltrials.gov on 29 September 2021 and can be found at https://clinicaltrials.gov/study/NCT04066881. Registration number: NCT04066881.

Vitamin A is essential for vision, immune function, growth, epithelial integrity, and reproduction. Adequate intake reduces all-cause and diarrhoea-specific mortality, especially in children aged 6–59 months. In Tanzania, insufficient consumption of vitamin A-rich foods necessitates routine supplementation to prevent vitamin A deficiency (VAD) complications. However, vitamin A supplementation (VAS) uptake rates remain low, and the factors influencing its uptake are not well understood, lacking evidence for interventions to improve VAS uptake and improve child health outcomes. To address this, data was analysed from the Tanzania Demographic and Health Surveys (TDHS) to assess VAS trends and identify factors associated with VAS uptake among children under five years in Tanzania. Secondary data analysis of Tanzania demographic Health Survey (TDHS) data from 2010 to 2022 was conducted. The Tanzania Demographic and Health Survey (TDHS) is a nationally representative survey conducted approximately every five years, designed to collect comprehensive data on population health, nutrition, and demographic indicators. Analysis was done on children between 6 and 59 months of age who had data on the status of VAS uptake and their caregivers. A logistic regression analysis was deployed to assess associations between VAS and factors associated with its uptake. The analysis was performed using STATA 17 software. A weighted sample of 23,950 children between 6 and 59 months of age and their parents were included in the trend analysis. The study found that VAS uptake among children aged 6–59 months were 61.6

BACKGROUND:F/TAF was shown to be noninferior to F/TDF as pre-exposure prophylaxis (PrEP) in men, but approval was not extended to cisgender women. We report the results of PrEPVacc, in which a predominantly female population was randomly allocated to receive daily oral F/TDF or F/TAF for ∼6 months within a HIV-1 prophylactic vaccine trial. SETTING:Four study sites in 3 African countries (Uganda, Tanzania, South Africa). METHODS:The 2 regimens were compared by the averted infections ratio (AIR)-the proportion of infections averted by F/TAF relative to F/TDF. The counterfactual HIV incidence, an essential component of this metric, was derived from a preceding registration cohort. Dried blood spots (DBS) were collected at regular time points for later assessment of tenofovir diphosphate levels in selected subpopulations. RESULTS:1380 participants (697 F/TDF, 683 F/TAF) were included in the primary analysis (total follow-up 709.2 person-years); 87% were cisgender women. Three HIV infections (0.86/100 person-years) occurred in the F/TAF group versus 2 in the F/TDF group (0.56/100 person-years). The counterfactual HIV incidence was estimated to be 2.59/100 person-years (90% CI: 1.86 to 3.52), giving an AIR of 0.85 (90% CI: 0.31 to 1.66). Based on the week 8 DBS sample, only an estimated 14% of participants were classified as taking 2-3 tablets per week and 9% ≥4 tablets per week. CONCLUSIONS:Despite similar HIV incidence rates, the noninferiority of F/TAF was not demonstrated, probably because of low statistical power primarily driven by low adherence. However, there is compelling evidence from multiple studies supporting the efficacy of F/TAF as PrEP regardless of sex.

In July 2022, during the COVID-19 era, Tanzania reported over 1500 laboratory-confirmed measles cases and more than 30 deaths, with about 80

BackgroundHand contamination by bacteria is a significant source of infection transmission, especially in hospital settings. A healthcare-associated infection is one that a person contracts as a result of their interaction with a hospital. Health care workers', patients' and visitors' hands are all transmission routes for infections, in particular bacterial infections. These infections elevate the economic burden on healthcare systems especially in low-income settings.ObjectiveTo determine the prevalence of gram-negative bacteria hand contamination among patients' visitors of referral hospitals in Dar es Salaam.MethodologyThis was a cross-sectional study conducted at 3 regional referral hospitals: Amana, Temeke and Mwananyamala in March 2023. Dominant hand swabs from 388 systematically selected visitors were taken for bacterial culture and a short interview was conducted to assess factors associated with Gram-negative bacterial hand contamination. Hand swabs collected were cultured on Mac Conkey Agar (MCA), isolates were identified by VITEK MS and appropriate antibiotics were employed in antibiotic susceptibility testing of the isolated Gram-negative bacteria.ResultsPrevalence of gram-negative bacterial contamination on visitors' hands was 91 (21.1%) on entry and 103 (30.2%) on exit. The most common bacteria contamination was from Klebsiella pneumoniae on both entry and exit points, 37 (41%) and 57 (43%) respectively. Resistance to cephalosporins (Cefotaxime and Ceftriaxone) were the most pronounced. Proportion of ESBL-producing bacteria was significantly higher at exit than at entry. Bacterial contamination was associated with not washing hands APR = 1.5 (95% CI:1.03-2.17), offering services to the patient APR = 1.9 (95% CI:1.21-2.87) and longer hospital stays (more than 7 days) APR = 1.5 (95% CI:1.1-2.0).ConclusionTo prevent the transmission of bacteria, it is important to emphasize hand hygiene and exposure limits for visitors entering hospital environments.

BACKGROUND:HIV continues to be a significant global public health problem in low and middle-income countries. Efforts to search for an effective and affordable preventative HIV vaccine are on-going. We investigated the understanding of perceived risk for acquiring HIV and the experience of female sex workers (FSW) in Tanzania, before and after enrolling in an HIV vaccine and Pre-Exposure Prophylaxis Trial. METHODS:This was a descriptive qualitative study design nested in a multicentre Phase IIb three-arm, two-stage HIV prophylactic vaccine trial with a second randomization to compare two pre-exposure prophylaxes (PrEPVacc trial) regimens. We present findings from Dar es Salaam site in Tanzania. Fifteen in-depth interviews and four focus group discussions were conducted among FSW who participated in the HIV vaccine and Pre-Exposure Prophylaxis Trial between 2021 and 2023. Data analysis was done manually using the Framework and thematic content analysis approaches. RESULTS:Two themes emerged from the findings: `Apparent risk' of acquiring HIV infection before enrolling in the HIV vaccine trial and `Balancing perceived risk' of acquiring HIV infection and preventive measures after enrolling in the HIV Vaccine and Pre-Exposure Prophylaxis Trial. Before enrolling in the trial, the participants perceived themselves at high risk of acquiring HIV infection. They reported inconsistent condom use in multiple relationships with clients whose HIV status was unknown. After enrolling in the trial, the participants reported improved knowledge of HIV prevention, particularly the use of pre-exposure prophylaxis and compliance with preventive measures. However, some participants perceived that the experimental vaccine was an established HIV preventive measure. In addition, condomless sex was still practiced, mainly to get higher payments from the clients. CONCLUSION AND RECOMMENDATIONS:The knowledge gained on HIV preventive measures by FSW after participation in the trial was valued. However, continued engagement in risky sexual practices and poor compliance with HIV preventive measures highlights the need for continued risk-reduction interventions while searching for an effective HIV vaccine.

INTRODUCTION:HIV poses a significant global health concern, affecting adolescents among other populations. This is attributed to various vulnerabilities including biological factors, gender inequalities and limited access to comprehensive sexual and reproductive health services in sub-Saharan Africa. In Tanzania, adolescent girls, and young women (AGYW) face double the risk of HIV infection compared to their male counterparts. The introduction of pre-exposure prophylaxis (PrEP) in early 2018 brought hope for changing the HIV cascade in the country. However, numerous challenges still hinder PrEP uptake. Therefore, this study explored experiences of PrEP uptake among vulnerable AGYW in Tanzania. METHODS:This study employed a phenomenological qualitative approach; 52 semi-structured interviews were carried out between May to November 2022 in the selected healthcare facilities in Tanzania. The study adopted inductive-deductive thematic analysis guided by the Social Ecological Model (SEM) to elicit the views of AGYW aged 15-24. Nvivo software was utilised to organise data. RESULTS:This study has uplifted barriers and facilitators on PrEP uptake among AGYW in Tanzania. The barriers are categorized at individual, interpersonal, and institutional levels. The individual level barriers included pre-requisites for initiating PrEP, disbelief in the effectiveness of PrEP, interference of refill hours with working hours, financial constraints, and adherence to the pills. The interpersonal level barriers included misconceptions about PrEP pills, and labelling of PrEP users. The institutional level barriers included inadequate privacy, PrEP drug stockout, being turned away by health care facilities (HCF), long waiting times, and distance to the HCF. Facilitators included factors at individual level (experienced benefit of PrEP, adequate PrEP knowledge, having multiple partners, perceived risk due to the nature of the work, PrEP ensuring privacy), interpersonal level (support from social networks), and institutional level (Free availability of PrEP, receiving refill reminders). CONCLUSIONS:To overcome barriers to PrEP uptake among AGYW, it is crucial to develop multi-level interventions that consider personal, social, and structural factors hindering PrEP uptake. Implementing strategies like prioritizing off-site PrEP delivery and expanding community outreach for PrEP awareness can help dispel misconceptions and enhance uptake.

IntroductionThe interplay between HIV and Taenia solium cysticercosis in co-endemic regions remains poorly understood, particularly regarding the immune responses but is relevant for an effective treatment strategy. This study aimed to investigate the relationship between peripheral cytokine profiles, CD4+ T-cell counts, and cysticercosis infection status in HIV-positive individuals in Tanzania’s southern highlands.MethodsWe conducted a cross-sectional study involving 110 HIV-positive individuals. Cysticercosis was diagnosed using antibody and antigen tests, with neurocysticercosis confirmed by CT imaging. CD4 counts and serum cytokine levels (pro- and anti-inflammatory) were analyzed using multivariate regression and MANOVA, including sex-stratified analyses.ResultsAmong participants, 20.9% tested positive for cysticercosis antibodies, 43.6% for antigens and 20.2% presented with brain cysts, with 10.6% showing active neurocysticercosis. Cysticercosis-positive individuals showed positive correlations between CD4 counts and pro-inflammatory cytokines (e.g., TNF-α, IL-1β), contrasting with negative correlations in cysticercosis-negative individuals. Sex-stratified analysis showed stronger regulatory cytokine responses in males compared to females, particularly involving higher levels of IL-10 and IL-4 indicating sex-specific immune modulation in co-infected individuals. However, overall cytokine profiles were not significantly influenced by CD4 categories or cysticercosis status.ConclusionThese results contribute to our understanding of immunological interactions in HIV-cysticercosis co-infection and underscore the need for further research with larger sample sizes to elucidate the clinical implications of these findings. Such studies could inform the development of more effective, sex-personalized treatment strategies for HIV patients in cysticercosis-endemic regions.

Globally, HIV vaccine clinical trials are conducted in the quest for an effective preventive vaccine. Volunteers' participation is vital to the success of these trials. However, disclosing involvement in a vaccine trial may have significant consequences, potentially affecting key aspects such as recruitment, retention, and overall engagement. This study aimed to explore the experiences of disclosure and non-disclosure of participation in a Phase IIb HIV Vaccine Trial among female sex workers in Dar es Salaam, Tanzania, and used a descriptive qualitative design. Fifteen in-depth interviews and four focus group discussions were conducted among volunteers who were participating in the HIV vaccine trial. Data analysis was done manually using the framework method. Three themes emerged: reasons for disclosure, reasons for non-disclosure, and consequences of disclosure. Reasons for disclosure were grouped into two categories: intended disclosure and unintended disclosure. Intended disclosure occurred to seek support for trial participation and to share information within trusted relationships. Unintended disclosure arose from circumstances related to trial participation. Reasons for non-disclosure had two categories: perceived lack of understanding about trial participation and concerns about inadequate support. Consequences of disclosure encompassed three categories: uncertainty about the vaccine's side effects, the perception of volunteers being infected with HIV, and disapproval of the vaccine trial. The findings reveal that volunteers experienced a complex interplay between disclosure and non-disclosure of their participation in the PrEPVacc trial. The key themes - reasons for disclosure, non-disclosure, and consequences of disclosure - underscore the importance of understanding the personal and social factors influencing these decisions. These insights highlight the need for enhanced community education and support mechanisms to address concerns, mitigate misconceptions, and improve participation in HIV vaccine trials. Trial Registration: This study was conducted as part of a multicenter phase IIb three-arm, two-stage HIV prophylactic vaccine trial with Registration Number NCT04066881, accessible at https://clinicaltrials.gov/study/NCT04066881.

Human immunodeficiency virus (HIV) vaccine trials are needed in efforts to prevent infection and acquired immunodeficiency syndrome (AIDS). Like other types of research, HIV vaccine trials present benefits and risks that may or may not be anticipated by participants. Perceptions of risks and benefits often vary with contextual factors, such as sociocultural and economic variables, which are important in low- and middle-income countries (LMICs). This integrative review aimed to determine the risks and benefits of HIV vaccine trial participation reported in the LMICs from 1995 to 2024. The risks and benefits were reported by participants and potential participants during trial preparations, recruitment, actual trial participation or after trial participation. In this review we assessed on how the risks and benefits were described by the authors of the reviewed studies. We also sought to categorize these risks and benefits, consider ethical implications, identify gaps for further research, and recommend actions for policy improvement. The integrative review screened studies from four databases (CINAHL, Embase, MEDLINE and Web of Science). Studies were eligible if they involved interactions with human subjects and were written in English. Covidence software was used to organize the search outcomes. Twenty-five studies met inclusion criteria. Identified benefits included a sense of altruism, free healthcare, financial incentives and HIV education. Risks included stigma and discrimination associated with vaccine-induced seropositivity, perceived racism and fear of delayed harms. Important descriptions of risks and benefits (e.g., magnitude and likelihood) were missing. Free healthcare and financial incentives may render participants too influenced to enter consent, which is an important ethical concern in LMICs. The literature was scant, highlighting a need for research on how participants in LMICs are informed about weighing risks and benefits of HIV vaccine trial participation. More in-depth description of risks and benefits is warranted. Standardized risk/benefit assessment frameworks tailored to the context of these trials in LMICs are needed.

COVID-19 vaccine became available in Tanzania during the first wave of the Omicron variant. During that time community seroprevalence of SARS-CoV-2 was already at 50%-80%. To date, it remains largely unknown whether ongoing vaccination with the primary series vaccines has any meaningful immune-boosting effects against newer Omicron subvariants. Therefore, we tested cross-neutralizing capacity of antibodies elicited by infection, vaccination, or both against SARS-CoV-2 Omicron subvariants BA.1, and the newer subvariants BQ.1.1 and XBB.1.5. that were unexperienced by this population. Participants who were either SARS-CoV-2 infected-only (n = 28), infected vaccinated (n = 22), or vaccinated-only (n = 73) were recruited from Dar-es-Salaam, Tanzania, between April and December 2022. Plasma 50% neutralization titers (NT50) against SARS-CoV-2 wild-type strain and Omicron subvariants were quantified by a lentiviral-based pseudo-virus assay. Percentage of participants with neutralizing activity against WT and BA.1 was high (>85%) but was reduced against BQ.1.1 (64%-77%) and XBB.1.5 (35%-68%) subvariants. The low median cross-neutralization titer was slightly higher in the infected vaccinated group compared to vaccine-only group against BQ.1.1 (NT50 148 vs. 85, p = 0.032) and XBB.1.5 (NT50 85 vs. 37 p = 0.022) subvariants. In contrast, vaccine-boost among the infected vaccinated did not result to increased cross-neutralization compared to infected-only participants (BQ.1.1 [NT50 of 148 vs. 100, p = 0.501] and XBB.1.5 [NT50 86 vs. 45, p = 0.474]). We report severely attenuated neutralization titers against BQ.1.1 and XBB.1.5 subvariants among vaccinated participants, which marginally improved in the infected vaccinated participants. Our findings call for further studies to evaluate effectiveness of the primary series vaccines in preventing severe infection and mortality against the newer variants.

Background The parasitic infection caused by Taenia solium represents a significant public health concern in developing countries. Larval invasion of body tissues leads to cysticercosis (CC), while central nervous system (CNS) involvement results in neurocysticercosis (NCC). Both conditions exhibit diverse clinical manifestations, and the potential impact of concomitant HIV infection especially prevalent in sub-Saharan Africa on peripheral and CNS immune responses remains poorly understood. This study aimed to identify the potential impact of HIV coinfection in CC and NCC patients. Methodology A nested study within a cross-sectional analysis in two Tanzanian regions was performed and 234 participants (110 HIV+ and 124 HIV-) were tested for cysticercosis antibodies, antigens, CD4 counts and serum Th1 and Th2 cytokines via multiplex bead-based immunoassay. 127 cysticercosis seropositive individuals underwent cranial computed tomography (CCT) and clinical symptoms were assessed. Multiple regression analyses were performed to identify factors associated with cytokine modulation due to HIV in CC and NCC patients. Results Serologically, 18.8% tested positive for cysticercosis antibodies, with no significant difference HIV+ and HIV+. A significantly higher rate of cysticercosis antigen positivity was found in HIV+ individuals (43.6%) compared to HIV- (28.2%) (p = 0.016). CCT scans revealed that overall 10.3% had active brain cysts (NCC+). Our study found no significant changes in the overall cytokine profiles between HIV+ and HIV- participants coinfected CC and NCC, except for IL-5 which was elevated in HIV+ individuals with cysticercosis. Furthermore, HIV infection in general was associated with increased levels of pro-and some anti-inflammatory cytokines e.g. TNF-α, IL-8, and IFN-γ. However, based on the interaction analyses, no cytokine changes were observed due to HIV in CC or NCC patients. Conclusions In conclusion, while HIV infection itself significantly modulates levels of key cytokines such as TNF-α, IL-8, and IFN-γ, it does not modulate any cytokine changes due to CC or NCC. This underscores the dominant influence of HIV on the immune system and highlights the importance of effective antiretroviral therapy in managing immune responses in individuals coinfected with HIV and CC/NCC.

The global resurgence of coronaviruses and the move to incorporate COVID-19 vaccines into the expanded program for immunization have warranted for a high-throughput and low-cost assay to measure and quantify mounted neutralizing antibodies as an indicator for protection against SARS-CoV-2. Hence, we evaluated the surrogate-virus-neutralization-assay (sVNT) as an alternative assay to the pseudo-virus neutralization assay (pVNT). The sVNT was used to measure neutralizing antibodies among 119 infected and/or vaccinated blood samples, against wild-type SARS-CoV-2 (WT) and the Omicron-variant with reference to the pVNT. Four different cut-offs were assessed for suitability in distinguishing neutralizers: the manufacturer (>30%), literature-based (>50%) and (>80%), and population-based (>27.69%). The obtained data was analyzed using "R" through its integrated development environments; JAMOV and R-Studio. Using the WT strain, only the population-based cut-off was able to differentiate neutralizers from non-neutralizers beyond chance, with an area under the curve (AUC) of 0.833 (95%CI, 0.505-1.0; P = .049). Applying the population-based cut-off, improved the sensitivity to 100% from 91.4% obtained from the manufacturer cut-off (P = .002). However, the specificity remained low (67%). The negative-predictive-value also improved to 100% vs 16.4% (P = .006), but there was no difference in the positive-predictive-value (99.1% vs 99.1%) (P = .340). When we used the Omicron-variant, the sVNT titers were not able to predict the neutralizers and non-neutralizers with reference to pVNT (AUC of 0.649) (P = .221). The sVNT assay is a potential alternative for screening individuals harboring potent neutralizing antibody with high sensitivity, although we recommend continuous improvement of the assay in line with the viral mutations. Further, we recommend that individual users establish a population-based cut-off while using the sVNT assay.

The pathogenesis of hypertension (HTN) in people living with HIV/AIDS (PLHIV) is complex and remains not fully understood. Chronic immune activation (IA) is postulated to be one of the culprits. This notion is derived from studies in HIV-uninfected populations and/or animals while data on HTN and how it relates to IA in PLHIV remains scarce. We determined the relationship between HTN and IA among antiretroviral therapy (ART) naïve PLHIV. We analysed baseline data of 365 out of 430 clinical trial participants whose main aim was to investigate the effect of low-dose aspirin on HIV disease progression in PLHIV starting ART. Soluble CD14 (sCD14), T cells co-expressing CD38 and HLA-DR, and PD-1 were the IA and exhaustion markers, respectively studied and were analysed by flow cytometry. Mann-Whitney U-test was used for comparison of the markers by HTN status. A robust Poisson regression model was used to determine the predictors for HTN. A quarter of the 365 were hypertensive (25.3

Background HIV partner counselling and testing in antenatal care (ANC) is a crucial strategy to raise the number of males who know their HIV status. However, in many settings like Tanzania, male involvement in antenatal care remains low, and there is a definite need for innovative strategies to increase male partner involvement. This study was designed to evaluate the efficacy of mobile phone intervention increase male partner ANC attendance for HIV testing in Moshi municipal, Tanzania.Methods Between April and July 2022, we enrolled pregnant women presenting to a first ANC visit at Majengo and St. Joseph reproductive health facilities without their male partners. Eligible pregnant women were randomly assigned to invitation of their male partners either via phone calls, text messages from clinic staff and verbal invites from pregnant partners (intervention arm) or verbal invites only from the pregnant partners (control arm). Neither healthcare provider nor participant were blinded. The primary outcome was the proportion of male partners who attended ANC with their pregnant partners during a follow-up period of two consecutive visits. The secondary outcome measure was HIV testing among male partners following the invitation. Participants were analyzed as originally assigned (intention to treat).Results A total of 350 pregnant women presenting to ANC for the first time were enrolled, with 175 women enrolled in each arm. The efficacy of male attendance with their pregnant women following the invitations was 83.4% (147/175) in the intervention arm and 46.3% (81/175) in the control arm. Overall, the results suggest a positive and statistically significant average treatment effect among men who received mobile phone intervention on ANC attendance. For the secondary outcome, the percent of male partners who accepted HIV counselling and testing was 99.3% (146/147) in the intervention arm and 93.8% (76/81) in the control arm. Married men were having higher odds of ANC attendance compared with single men (aOR:6.40(3.26-12.56), Males with multigravida women were having lower odds of ANC attendance compared with primigravida women (aOR:0.17(0.09-0.33).Conclusion The study demonstrates that supplementing verbal invitations with mobile phone calls and text messages from clinic staff can significantly increase male partner ANC attendance and HIV testing. This combined approach is recommended in improving ANC attendance and HIV testing of male partners who do not accompany their pregnant partners to antenatal clinics in the first visits.Trial registration PACTR202209769991162.

ObjectivesThe objectives are to determine the prevalence of urinary tract infection (UTI) and associated factors among patients diagnosed with benign prostatic hyperplasia and prostate cancer.DesignHospital-based cross-sectional study.SettingsUrology clinic and urology ward at Muhimbili National Hospital, which is the main tertiary hospital in Tanzania’s largest city.ParticipantsPatients with benign prostate hyperplasia and prostate cancer presenting with genitourinary symptoms.Main outcome measureThe primary outcome was the occurrence of UTI and factors associated with UTI in patients with benign prostatic hyperplasia and prostate cancer.Results402 participants were enrolled, with a median age of 68 years and IQR of 61–75 years. The proportion of UTI was 46.5% (95% CI 41.56% to 51.53%). UTI was more prevalent among inpatients, patients with indwelling urinary catheters, patients with prostate size>80 cm3and those with residual urine volume of >100 mL. In multivariate analysis, age>60 years (adjusted OR (aOR)=2.0, 95% CI 1.13 to 3.55, p=0.018), post-void residual urine volume>100 mL (aOR 1.32, 95% CI 0.67 to 2.59 p=0.001), patient with incomplete bladder emptying (aOR=2.57, 95% CI 1.44 to 4.59, p=0.001) and prolonged catheter duration (aOR=1.24, 95% CI 1.11 to 1.38, p=0.005) were significantly associated with UTI.ConclusionAlmost half of the patients with an enlarged prostate and genitourinary symptoms had a laboratory-confirmed UTI. The risk of UTI increases with age, incomplete bladder emptying and increased duration of catheterisation. A 1-day increase in the duration of catheterisation increased the risk of UTI by 24%.

Background: In 2012, the Muhimbili University of Health and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its programmes. Other health profession training institutions continued with their traditional way of teaching and thus causing variability in the competencies of the graduates. We aimed to analyze the experiences of different stakeholders on the implementation of CBC specifically on biomedical sciences by MUHAS to inform the development of harmonized competency-based curricula in three health professional training institutions in Tanzania.Methods: We adopted an exploratory case study to analyse the implementation of CBC in programmes of Medicine and Nursing involving MUHAS graduates, immediate supervisors at the employment sites, faculty, and continuing students at MUHAS. Kiswahili guides were used to conduct the in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted for analysis.Results: From the 38 IDIs and 15 FGDs, four categories of human resources teaching and learning environment; curriculum content; and support systems emerged. Human resources were attributed to the shortage of an adequate number of faculty and teaching skills variation. The curriculum content category was linked to the redundancy of courses or topics, poor sequencing of some topics or courses, and limited time for teaching some essential courses or topics. Training and practice area mismatch, accommodation to students, teaching space, and library were the sub-categories linked to teaching and learning environment. Lastly, support systems related to teaching methods and opportunities for improving teaching and learning were revealed.Conclusion: The findings of this study highlight the challenges and opportunities for the implementation of CBC. The solutions to the revealed challenges are beyond the training institutions' capacity. The latter call for multi-stakeholder engagement including those from the public and private sectors in health, higher education and finance for common and sustainable solutions.

Background Cardiovascular diseases (CVDs) have become an important cause of ill health and death among people living with HIV and/or AIDS (PLHIV) in the antiretroviral therapy (ART) era. There is scarce data on the burden of hypertension (HTN) and risk factors for CVDs among PLHIV in developing countries, including Tanzania during the ART era. Objective(s) To determine the prevalence of HTN and risk factors for CVDs among ART naïve PLHIV initiating ART. Methods We analysed baseline data of 430 clinical trial participants on the effect of low-dose aspirin on HIV disease progression among HIV-infected individuals initiating ART. HTN was the outcome CVD. Traditional risk factors for CVDs studied were age, alcohol consumption, cigarette smoking, individual and family history of CVDs, diabetes mellitus (DM), obesity/overweight, and dyslipidaemia. A generalized linear model (robust Poisson regression) was used to determine the predictors for HTN. Results The median (IQR) age was 37 (28, 45) years. Females were the majority contributing 64.9% of all participants. The prevalence of HTN was 24.8%. The most prevalent risk factors for CVDs were dyslipidaemia (88.3%), alcohol consumption (49.3%), and overweight or obesity (29.1%). Being overweight or obese predicted the occurrence of HTN, aPR 1.60 (95% CI 1.16–2.21) while WHO HIV clinical stage 3 was protective against HTN, aPR 0.42(95% CI 0.18–0.97). Conclusion The prevalence of HTN and traditional risk factors for CVDs in the treatment naïve PLHIV initiating ART are significant. Identifying these risk factors and managing them at the time of ART initiation may lower future CVDs among PLHIV.

Background: The extent of the burden of erectile dysfunction and its associated factors remains unclear. The aim of this study was to investigate the factors associated with ED and its prevalence among MLHIV in northern Tanzania. Methods: A hospital-based, multi-center, cross-sectional study was conducted on MLHIV aged 18 years and above in northern Tanzania. Outcome: The risk factors for ED and the prevalence of such risk factors among MLHIV was assessed and evaluated through a multivariate logistic regression analysis adjusted for depression symptoms using the Patient Health Questionnaire-9 (PHQ9) scale; anxiety disorders using the Generalized Anxiety Disorder Assessment (GAD-7); ART adherence; viral load; initial regimen date; ART regimen; and sexual risk behaviors. Results: Data for 366 participants with amedian age of 50 years (IQR 38-57 years) were available for analysis. Approximately three in four (74.6%) MLHIV had ED (of any severity), whereas 37.7% had mild ED. The majority (96.5%) of the participants had low testosterone, two in three (66.7%) had depressive symptoms, and close to half of the participants (48.4%) had anxiety. Age, lack of engagement in vigorous physical activity, depression, and self-reported good adherence to antiretroviral therapy (ART) were associated with ED in a multivariate logistic regression analysis (p=0.004, p =0.006, p=0.07, p=0.006, and p=0.004, respectively). Conclusion: There is a high prevalence of ED among MLHIV in northern Tanzania. Erectile dysfunction should be regarded as one of the comorbidities associated with HIV and should be routinely screened for among MLHIV in CTC clinics.