Introduction Evidence-based parenting programmes are widely used to prevent violence against children and improve parenting and mental health. Despite hundreds of randomised trials, little is known about their outcomes when delivered at scale within routine delivery. This study assesses the WHO-endorsed and UNICEF-endorsed Parenting for Lifelong Health programme for caregivers and adolescents, delivered through non-governmental organisation and government in Botswana, the Democratic Republic of the Congo, Eswatini, South Africa, South Sudan, Tanzania, Zambia and Zimbabwe, with support from the President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID) and the European Union.Methods Pre-post surveys for caregivers and adolescents were integrated into service data collection between 2016 and 2022. Abbreviated standardised measures of physical abuse, emotional abuse, approval of corporal punishment, positive involved parenting, monitoring/supervision, caregiver depressive symptoms, parenting stress and adolescent depressive symptoms and externalising behaviour were used. Individual country scores were analysed separately for caregivers and adolescents using generalised linear mixed-effects models, and cross-country data were combined using a random-effects meta-analytic model.Results 123 050 participants were included (93% retention, 57 908 adolescents (96% female), 56 423 caregivers at follow-up). In all-country meta-analyses, estimates showed reduced physical abuse (−65%; 95% CI 51% to 74%), emotional abuse (−59%; 95% CI 48% to 68%) and approval of corporal punishment (−55%; 95% CI 48% to 60%). Positive involved parenting increased (+52%; 95% CI 24% to 87%) and poor supervision/monitoring decreased (−48%; 95% CI 34% to 58%). Caregiver depressive symptoms (−25%; 95% CI 8% to 48%), parenting stress (−46%; 95% CI 41% to 52%), adolescent depressive symptoms (−22%; 95% CI 1% to 38%) and adolescent externalising behaviour problems (−43%; 95% CI 29% to 54%) all declined. There was heterogeneity in pre-intervention scores and extent of change between humanitarian and development settings, and between different target groups, but strong consistency across caregiver and adolescent reports.Conclusion In eight African countries, including humanitarian and pandemic-affected contexts, an evidence-based parenting programme showed consistent associations with reduced violence against adolescent girls and improved parenting and mental health.

BACKGROUND:Achieving and sustaining viral load suppression (VLS) among children living with HIV remains challenging despite the availability of antiretroviral therapy (ART), primarily due to adherence difficulties. This study evaluated the effects of three interventions under the ACHIEVE project on viral load outcomes (viral rebound and viral suppression) among HIV-positive orphaned and vulnerable children aged 0-17 years (hereafter referred to as CLHIV) receiving ART in Tanzania. METHODS:This is a longitudinal analysis of 26,257 CLHIV who are beneficiaries of the ACHIEVE project in Tanzania, each with at least two viral load (VL) test results between 2021 and 2023. VL outcomes were assessed using two analytic groups: Group 1 included 21,448 CLHIV with undetectable VL (<50 copies/mL) at baseline, where those maintaining undetectable VL were compared with those experiencing viral rebound (VL ≥ 50 copies/mL) at follow-up. Group 2 comprised 4,809 CLHIV with detectable VL (≥50 copies/mL) at baseline, where those achieving undetectable VL at follow-up were compared with those who did not. The study used a multivariable logistic regression model and propensity score matching (PSM) to evaluate the effects of ACHIEVE project interventions-WORTH Yetu economic strengthening, linkage to teen/paediatric clubs, and health insurance-on viral rebound (Group 1), and the achievement of an undetectable viral load (Group 2). FINDINGS:Overall, 13.1% (2,805/21,448) of Group 1 CLHIV experienced viral rebound at follow-up. CLHIV who received ACHIEVE interventions were 23.2% less likely to experience viral rebound compared to those who did not (aOR = 0.768, 95% CI 0.668-0.882, p < 0.001). In Group 2, 70.9% (3,411/4,809) achieved an undetectable viral load at follow-up, with those who received ACHIEVE interventions being 31.9% more likely to achieve an undetectable viral load compared to those who did not (aOR = 1.319, 95% CI 1.059-1.643, p = 0.014). These findings were confirmed in the PSM analysis (viral rebound: β = - 0.047, 95% CI -0.072 - -0.021, p < 0.001; achieving undetectable viral load: β = 0.10, 95% CI 0.04-0.16, p = 0.001). CONCLUSION:The ACHIEVE project interventions were significantly associated with a reduced likelihood of viral rebound, and an increased likelihood of achieving undetectable viral load among CLHIV, highlighting their potential to enhance ART outcomes. These findings suggest that expanding similar community-based interventions could further contribute to HIV treatment efficacy and support more children in achieving and maintaining an undetectable viral load, particularly those at risk of viral rebound or persistent high viral load. Future research should explore strategies for scaling these interventions and evaluating their long-term impact.

Background Orphaned and Vulnerable Children (OVC) are disproportionately found in economically disadvantaged households, where the added burden of caregiving often exacerbates financial hardship. In response, economic empowerment programmes have been recommended as a key strategy to enhance household economic stability and resilience. However, there is a limited understanding of the factors affecting participation in such programmes across different populations. This study examines the factors affecting OVC caregivers’ participation in the WORTH Yetu economic empowerment programme in Tanzania. Methods This longitudinal study utilises baseline (2016–2019) and follow-up (2019–2020) data from the USAID Kizazi Kipya project in Tanzania. The primary outcome was caregivers’ participation status in the WORTH Yetu programme at follow-up. Baseline factors associated with participation were examined using a multivariable binary logistic regression model, with a 5 % significance level. Results The analysis included 247,638 OVC caregivers with a mean age of 49.2 (±14.5) years at baseline. Of these, 70 % were women and 30 % were men. At follow-up, overall participation in WORTH Yetu was 10.1 %, with 10.4 % among women and 9.6 % among men (p < 0.001). Multivariable analysis identified several baseline factors significantly associated with participation in WORTH Yetu, including gender, age, place of residence, marital status, disability, health insurance, HIV status, family size, socioeconomic status (SES), and duration in the USAID Kizazi Kipya project. Some of these factors, particularly marital status, HIV status, and age showed significant variation between women and men. Conclusions Over an average follow-up period of 1.6 years, caregivers’ participation in the WORTH Yetu programme increased from 0 % at baseline to 10.1 % at follow-up, with women significantly more likely to participate compared to men. However, not all caregivers were equally positioned to engage in the programme, as participation varied according to their background characteristics. To enhance participation, targeted efforts are needed to address these disparities, particularly for caregivers with a lower likelihood of participation, such as men, individuals living with HIV, and those facing gender-specific barriers. Supporting these groups more effectively could enhance participation in economic empowerment programmes and contribute to improved socio-economic outcomes.

BACKGROUND:Inadequate impact evaluation methods such as percentage changes in outcomes between assessment points, persist as a significant challenge, undermining assessment accuracy. This study provides empirical evidence to enhance evaluation practices for non-experimental interventions by comparing Generalized Estimating Equations (GEE) and Multilevel Models (MLM), with the WORTH Yetu intervention's impact on food security as a case in point. METHODS:Guided by the Realist Evaluation (RE) framework which focuses on exploring what works, for whom, in what circumstances, and how, this study employed a longitudinal design using a difference-in-differences (DID) estimator to assess the impact of the WORTH Yetu economic empowerment intervention on food security among families caring for orphaned and vulnerable children (OVC) in Tanzania. Both GEE and MLM were applied to compare their performance and determine which approach, within the RE framework, offers a simpler and more practical option for improving impact evaluation practices in non-experimental settings. RESULTS:The analysis included 497,293 observations from 249,655 caregivers (aged ≥18 years) at baseline, 247,638 of whom were reassessed at follow-up. The study found a higher likelihood of enhanced food security among WORTH Yetu participants at follow-up compared to non-participants: aOR = 1.551 (95 % CI 1.509-1.594, p < 0.001) in GEE and aOR = 1.572 (95 % CI 1.528-1.616, p < 0.001), ICC = 28.2 % in MLM. In the computation process, GEE was simpler, estimating one set of parameters, while MLM estimated both fixed- and random-effects, requiring additional considerations and longer runtime. CONCLUSION:Both GEE and MLM produced comparable results in terms of the magnitude, direction, and statistical significance of the WORTH Yetu economic empowerment intervention's impact on food security. However, while GEE was simpler and more efficient as it estimated one set of parameters, MLM required additional steps and considerations to estimate both fixed-effects and random-effects. As a result, this study found greater advantages in using GEE over MLM, an option likely to improve longitudinal impact evaluation practices, especially in resource-constrained non-experimental settings, by streamlining the analysis without compromising the statistical rigor.

This observational cohort study explores the association between maternal, newborn and child health care (MNCH) implementation strength and child survival in rural Tanzania from 2011-2015. Measuring this relationship is crucial to improve health outcomes and inform decision-making by identifying which interventions are most effective, where gaps exist, and how to strengthen primary health care systems. We used data from a 2011 service availability and readiness assessment that quantified health facilities' ability to implement MNCH services and a household survey that measured MNCH service utilization to develop domain-specific summary measures of the effective coverage of MNCH. We reduced domain-specific effective coverage scores into fewer, independent scales of implementation strength of services that were delivered by facilities using principal components analysis and mixed effects models. We linked these scales to longitudinal data on the survival of children that were born in the catchment areas of the surveyed health facilities during the assessment period and followed up until December 31, 2015. We fit survival time models to estimate the relationship between implementation strength and child mortality. Increases in the implementation strength gauged by our first and second scales, which represented general facility readiness and the provision of preventive MNCH and sick childcare services, respectively, were associated with child mortality risks that were significantly lower (HR = 0.59, 95% CI = 0.37, 0.92; HR = 0.50, 95% CI = 0.27, 0.94). We detected no significant child mortality response to our third scale, which represented intrapartum care provision. The findings have implications for MNCH policy and health systems measurement. First, the analysis suggests that strong implementation of antenatal, postnatal, early childhood preventive services and sick childcare can accelerate child mortality reduction. Furthermore, the analysis demonstrates a methodological approach for using routine data on service availability and readiness to measure health systems strengthening and its impacts.

BACKGROUND:Although most of the livelihood programmes target women, those that involve women and men have been evaluated as though men and women were a single homogenous population, with a mere inclusion of gender as an explanatory variable. This study evaluated the impact of WORTH Yetu (an economic empowerment intervention to improve livelihood outcomes) on household hunger, and household socioeconomic status (SES) among caregivers (both women and men) of orphaned and vulnerable children (OVC) in Tanzania. The study hypothesized that women and men respond to livelihood interventions differently, hence a need for gender-disaggregated impact evaluation of such interventions.METHODS:This is a secondary analysis of longitudinal data, involving caregivers' baseline (2016-2019) and follow-up (2019-2020) data from the USAID Kizazi Kipya project in 25 regions of Tanzania. Two dependent variables (ie, outcomes) were assessed; household hunger which was measured using the Household Hunger Scale (HHS), and Socioeconomic Status (SES) using the Principal Component Analysis (PCA). WORTH Yetu, a livelihood intervention implemented by the USAID Kizazi Kipya project was the main independent variable whose impact on the two outcomes was evaluated using multivariate analysis with a multilevel mixed-effects, ordinal logistic regression model with difference-in-differences (DiD) estimator for impact estimation.RESULTS:The analysis was based on 497,293 observations from 249,655 caregivers of OVC at baseline, and 247,638 of them at the follow-up survey. In both surveys, 70% were women and 30% were men. Their mean age was 49.3 (±14.5) years at baseline and 52.7 (±14.8) years at the follow-up survey. Caregivers' membership in WORTH Yetu was 10.1% at the follow-up. After adjusting for important confounders there was a significant decline in the severity of household hunger by 46.4% among WORTH Yetu members at the follow-up compared to the situation at the baseline (adjusted Odds Ratio (aOR) = 0.536, 95% Confidence Interval (CI) [0.521, 0.553]). The decline was 45.7% among women (aOR = 0.543 [0.524, 0.563]) and 47.5% among men (aOR = 0.525 [0.497, 0.556]). Regarding SES, WORTH Yetu members were 15.9% more likely to be in higher wealth quintiles at the follow-up compared to the situation at the baseline (aOR = 1.159 [1.128, 1.190]). This impact was 20.8% among women (aOR = 1.208 [1.170, 1.247]) and 4.6% among men (aOR = 1.046 [0.995, 1.101]).CONCLUSION:WORTH Yetu was associated with a significant reduction in household hunger, and a significant increase in household SES among OVC caregivers in Tanzania within an average follow-up period of 1.6 years. The estimated impacts differed significantly by gender, suggesting that women and men responded to the WORTH Yetu intervention differently. This implied that the design, delivery, and evaluation of such programmes should happen in a gender responsive manner, recognising that women and men are not the same with respect to the programmes.

This research uniquely focused on non-assets such as living conditions and children’s quality of life as important indicators of household socioeconomic status, especially in low-income settings where acquiring assets may be challenging. The study assessed the impact of an economic empowerment programme, WORTH Yetu, on economic well-being of households caring for orphaned and vulnerable children (OVC) in Tanzania. Based on longitudinal data from the USAID Kizazi Kipya project, we counted the available non-assets at the household level for OVC well-being, including shelter conditions, clothing quality, school and medical support, and savings within households. The study included 249,655 households (70

IntroductionIn Tanzania, only 66% children 0–14 years living with HIV know their HIV status, 66% are on treatment while 47% of children on ART are virally suppressed. Although retention on ART and poor adherence remain a challenge for children living with HIV, orphans and vulnerable children (OVC) face a greater limitation of access to and utilization of comprehensive HIV care and treatment. In response to this, the current study assessed the determinants of viral load suppression (VLS) among OVC aged 0–14 years living with HIV enrolled in HIV interventions.MethodsThis was a cross-sectional study that used secondary data collected by the USAID Kizazi Kipya project in 81 district councils of Tanzania. Included in this study are 1,980 orphans and vulnerable children living with HIV (OVCLHIV) (0–14 years) enrolled and served by the project for 24 months. Data analysis involved multivariable logistic regression, with viral load suppression as the outcome of interest and HIV interventions as the main independent variables.ResultsThe overall VLS rate among the OVCLHIV was 85.3%. This rate increased from 85.3, 89.9, 97.6 to 98.8% after 6, 12, 18, and 24 months of retention on ART, respectively. Similar rates were observed as the duration of adherence to ART increased. In the multivariable analysis, OVCLHIV attending people living with HIV (PLHIV) support groups were 411 times more likely to be virally suppressed than those not attending (aOR = 411.25, 95% CI 168.2–1,005.4). OVCLHIV with health insurance were 6 times more likely to achieve viral suppression than those without (aOR = 6.05, 95% CI 3.28–11.15). OVCLHIV with >95% adherence to ART were 149 times more likely to be virally suppressed than those not adherent to ART (aOR = 148.96, 95% CI 42.6–520.6, p < 0.001). Other significant factors included food security and family size. OVCLHIV reached by the different HIV community-based interventions were more likely to be virally suppressed than those who were not.DiscussionTo advance viral suppression, efforts should be made to ensure that all OVCLHIV are reached by community-based interventions as well as integrating food support in HIV treatment interventions.

IntroductionSupport groups for people living with HIV (PLHIV) are essential for increasing adherence, retention, addressing their psychosocial needs and improving patient literacy. However, factors that influence participation of caregivers living with HIV (LHIV) in these groups are scarcely documented, particularly for those caring for orphans and vulnerable children (OVC).MethodsThis study used baseline data collected between 1st October 2021 and 30th September 2022 from the PEPFAR/USAID-funded Adolescents and Children HIV Incidence Reduction, Empowerment and Virus Elimination (ACHIEVE) project in Tanzania to investigate factors that affect participation of caregivers LHIV in support groups for PLHIV. A total of 74,249 HIV-positive OVC caregivers who were already receiving antiretroviral therapy (ART) and had a confirmed care and treatment centre identification number were included in the analysis. Factors affecting group participation were identified through multilevel analysis using multivariable mixed-effects logistic regression.ResultsResults showed that 84.2% of the caregivers were participants in the support groups for PLHIV. Their mean age was 36 years, and the majority (82.1%) were female. Multivariable analysis revealed that participation in the groups was more likely among caregivers living in urban areas (aOR = 1.39 [1.24, 1.55]), with primary education (aOR = 1.17 [1.07, 1.28]), and without disabilities (aOR = 0.62 [0.47, 0.82]). However, participation was less likely among widowed (aOR = 0.91 [0.84, 0.999]), single or unmarried (aOR = 0.86 [0.78, 0.95]), and those with secondary education or higher levels than never attended (aOR = 0.69 [0.60, 0.80]), moderate hunger (aOR = 0.86 [0.79, 0.93]), and those aged 30 years or older (p< 0.001).DiscussionA sizeable proportion (15.8%) of the caregivers were not in support groups for PLHIV, ranging from 12.3% among those in households with severe hunger to 29.7% among disabled ones. The study highlights the need for tailored interventions to increase participation in support groups for PLHIV, particularly for caregivers who are disabled, live in rural areas, are older, widowed, and/or unmarried, and those in poor households.

Community health worker programs have proliferated worldwide based on evidence that they help prevent mortality, particularly among children. However, there is limited evidence from randomized studies on the processes and effectiveness of implementing community health worker programs through public health systems. This paper describes the results of a cluster-randomized pragmatic implementation trial (registration number ISRCTN96819844) and qualitative process evaluation of a community health worker program in Tanzania that was implemented from 2011-2015. Program effects on maternal, newborn and child health service utilization, childhood morbidity and sick childcare seeking were evaluated using difference-in-difference regression analysis with outcomes measured through pre- and post-intervention household surveys in intervention and comparison trial arms. A qualitative process evaluation was conducted between 2012 and 2014 and comprised of in-depth interviews and focus group discussions with community health workers, community members, facility-based health workers and staff of district health management teams. The community health worker program reduced incidence of illness and improved access to timely and appropriate curative care for children under five; however, there was no effect on facility-based maternal and newborn health service utilization. The positive outcomes occurred because of high levels of acceptability of community health workers within communities, as well as the durability of community health workers' motivation and confidence. Implementation factors that generated these effects were the engagement of communities in program startup; the training, remuneration and supervision of the community health workers from the local health system and community. The lack of program effects on maternal and newborn health service utilization at facilities were attributed to lapses in the availability of needed care at facilities. Strategies that strengthen and align communities' and health systems core capacities, and their ability to learn, adapt and integrate evidence-based interventions, are needed to maximize the health impact of community health workers.

About 2 billion people worldwide suffer moderate or severe forms of food insecurity, calling for correctional measures involving economic strengthening interventions. This study assessed the impact of household economic strengthening (HES) intervention on food security among caregivers of orphans and vulnerable children (OVC) in Tanzania. The study was longitudinal in design, based on OVC caregivers' baseline (2017-2018) and midline (2019) data from the USAID Kizazi Kipya project. Food security, the outcome, was measured using the Household Hunger Scale (HHS) in three categories: little to no hunger (food secure), moderate hunger, and severe hunger. Membership in the USAID Kizazi Kipya-supported economic strengthening intervention (i.e. WORTH Yetu) was the main independent variable. Data analysis involved generalized estimating equation (GEE) for multivariate analysis. With mean age of 50.3 years at baseline, the study analyzed 132,583 caregivers, 72.2% of whom were female. At midline, 7.6% of all caregivers enrolled at baseline were members in WORTH Yetu. Membership in WORTH Yetu was significantly effective in reducing household hunger among the caregivers: severe hunger dropped from 9.4% at baseline to 4.1% at midline; moderate hunger dropped from 65.9% at baseline to 62.8% at midline; and food security (i.e., little to no hunger households) increased from 25.2% at baseline to 33.1% at midline. In the multivariate analysis, membership in WORTH Yetu reduced the likelihood of severe hunger by 47% (OR = 0.53, 95% CI 0.48-0.59), and moderate hunger by 21% (OR = 0.79, 95% CI 0.76-0.83), but increased the likelihood of food security by 45% (OR = 1.45, 95% CI 1.39-1.51). The USAID Kizazi Kipya's model of household economic strengthening for OVC caregivers was effective in improving food security and reducing household hunger in Tanzania. This underscores the need to expand WORTH Yetu coverage. Meanwhile, these results indicate a potential of applying the intervention in similar settings to address household hunger.

The association between hunger and adherence to antiretroviral therapy (ART) is less known especially in vulnerable populations receiving HIV care and treatment services. Caregivers of orphans and vulnerable children (OVC) are vulnerable and likely to experience hunger due to additional economic pressure in caring for OVC. Using data from the community–based, USAID–funded Kizazi Kipya project, this study assesses the association between hunger and ART adherence among caregivers of OVC in Tanzania. HIV positive caregivers enrolled in the project from January to July 2017 were analyzed. The outcome variable was adherence to ART, defined as “not having missed any ART dose in the last 30 days,” and household hunger, measured using the Household Hunger Scale (HHS), was the main independent variable. Data analysis included multivariable logistic regression. The study analyzed 11,713 HIV positive caregivers who were on ART at the time of enrollment in the USAID Kizazi Kipya project in 2017. Aged 48.2 years on average, 72.9% of the caregivers were female. While 34.6% were in households with little to no hunger, 59.4 and 6.0% were in moderate hunger and severe hunger households, respectively. Overall, 90.0% of the caregivers did not miss any ART dose in the last 30 days. ART adherence rates declined as household hunger increased (p < 0.001). Multivariable analysis showed that the odds of adhering to ART was significantly lower by 42% among caregivers in moderate hunger households than those in little to no hunger households (OR = 0.58, 95% CI 0.50–0.68). The decline increased to 47% among those in severe hunger households (OR = 0.53, 95% CI 0.41–0.69). Hunger is an independent and a significant barrier to ART adherence among caregivers LHIV in Tanzania. Improving access to adequate food as part of HIV care and treatment services is likely to improve ART adherence in this population.

Despite the global progress in response to HIV and AIDS, notable challenges remain for children, especially identification, linkage, and retention in HIV care and treatment services. To succeed in pediatric HIV programming requires the linkage and retention of the children in those services over time. This study assessed the level of retention to antiretroviral therapy (ART) and its associated factors among orphans and vulnerable children living with HIV (OVCLHIV) in Tanzania. Data were obtained from the USAID Kizazi Kipya project that collected pediatric ART data from October 2017 to October 2019 in 81 district councils of Tanzania. Community-based volunteers supported the linkage and retention of the OVCLHIV on ART. Analysis of on-ART status was conducted in a cohort of OVCLHIV aged 0–20 years enrolled in the project and monitored for 24 months. OVCLHIV who remained on ART until the end of the follow-up period were referred to as “retained,” otherwise, “not retained”. Multivariable analysis was conducted using logistic regression, adjusting for baseline characteristics. Of the 5,304 OVCLHIV analyzed, the mean age was 13.1 years, 51.5% were female, and 72.2% were living with female caregivers. Their overall rate of retention on ART over the 24 months was 86.7%. Multivariable analysis showed that as the higher frequency of home visit by the project staff increased, the likelihood of retention increased by 8% [adjusted odds ratio (aOR) = 1.08, 95% CI 1.06–1.11, p < 0.001]. Membership in people living with HIV (PLHIV) support groups was associated with a higher likelihood of retention compared to nonmembership (aOR = 3.31, 95% CI 2.60–4.21, p < 0.001). Children in larger family size were 22% less likely to sustain ART (aOR = 0.78, 95% CI 0.72–0.84, p < 0.001). Urban OVCLHIV were 18% less likely to remain on ART than their rural counterparts (aOR = 0.82, 95% CI 0.69–0.98, p = 0.030). Remaining on ART was 49% more likely for OVC in economically better-off households than those in destitute households (aOR = 1.49, 95% CI 1.22–1.81, p < 0.001). Male OVC were 17% less likely to be retained on ART than their female counterparts (aOR = 0.83, 95% CI 0.71–0.99, p = 0.033). Community-based OVC support resulted in a high pediatric retention rate over the 24 months of follow-up. While key enablers of retention were higher frequency of home visits by the project volunteer, participation in PLHIV support groups, and better economic status, large family sizes, urban place of residence, and male gender of the OVC were barriers. This study brings useful evidence to inform strategies for advancing retention of OVCLHIV on ART for their better health outcomes and overall wellbeing.

Background Despite extensive efforts to scale up counseling and testing services and care and treatment clinics (CTCs) in Tanzania, linkage between points of diagnosis and CTCs remains low. Studies have looked at barriers such as lack of trained health providers, poor referral system, economic costs or distance to health facilities, but fewer assessed the association between caregivers’ vulnerability such as disability and linkage of orphans and vulnerable children (OVCs) in their care to health facilities. This study describes the magnitude of caregivers’ disability and assesses its relationship with successful linkage to care of their OVC living with HIV/AIDS in Tanzania. Methods Data for this analysis came from the USAID Kizazi Kipya project in 79 councils of Tanzania. Data on HIV risk, service use and ART adherence among OVC aged 0–19 years were collected during the project’s quarterly routine data collection (Oct 2017-Sep 2018). Characteristics of caregivers were collected during the project beneficiary screening and enrollment process. Generalized estimating equation models were used to analyze the factors that are associated with linkage of 14,538 HIV positive OVC to CTC, who were taken care of by 11,834 caregivers. Results The majority of caregivers (70%) were females, had completed primary education (67%), 54% were married or cohabiting. Of all the OVC, 3% were living with disabled caregivers; of whom 89% were physically disabled while 11% were mentally disabled. OVCs living with disabled caregivers were less likely to be linked to care (OR 0.76, 95% CI 0.58, 0.99). Factors positively associated with OVC linkage to care were high caregivers’ education level (OR 1.99, 95% CI 1.51, 2.63) and OVC living with a HIV positive caregivers (OR 1.25, 95% CI 1.12, 1.41). OVC living in household with high socio-economic status were less likely to be linked to care (OR 0.76, 95% CI 0.67, 0.86) than those in low-SES households. Conclusion These results suggest HIV positive OVC living with disabled caregivers had poor linkage to care. The findings highlighted the need to focus attention to the disabilities-led household to promote inclusion and improve access to the HIV services.

Despite the rapid dissemination of parenting programs aiming to reduce and prevent violence against children (VAC) worldwide, there is limited knowledge about and evidence of the implementation of these programs at scale. This study addresses this gap by assessing the quality of delivery and impact of an evidence-based parenting program for parents/caregivers and their adolescent girls aged 9 to 14—Parenting for Lifelong Health Teens (PLH-Teens), known locally as Furaha Teens—on reducing VAC at scale in Tanzania. The study will explore participating family and staff perspectives on program implementation and examine factors associated with implementation and how implementation quality is associated with intervention outcomes when the program is delivered to approximately 50,000 parent-child dyads (N = 100,000) in schools and community centers across eight districts of Tanzania. This mixed-methods study will answer the following research questions: (1) what is the implementation quality and fidelity of PLH-Teens at scale in Tanzania; (2) what factors are associated with the quality of delivery and implementation fidelity of PLH-Teens; (3) how are implementation quality and fidelity associated with intervention outcomes; (4) what are participant and implementing staff perspectives on the acceptability, appropriateness, feasibility, benefits, and challenges of delivering PLH-Teens in their schools and communities; (5) what is the impact of PLH-Teens on VAC and participant well-being; and (6) how much does it cost to deliver PLH-Teens at scale? Qualitative and quantitative data will be collected directly from implementers, parents/caregivers, and adolescents using pre-post questionnaires, observational assessments, cost surveys, focus groups, and interviews. Qualitative data will be analyzed thematically with the aid of NVIVO software. Quantitative data will be cleaned and analyzed using methods such as correlation, regression, and structural equation models using Stata and R. COREQ and TREND guidelines will be used, where appropriate. Findings will provide vital insights into some of the factors related to quality implementation at scale. Lessons learned regarding the implementation of PLH-Teens at scale will be applied in Tanzania, and also in the delivery of PLH parenting programs globally.

Background HIV status disclosure facilitates access to HIV-related prevention and treatment services and increases opportunities for social support, HIV risk reduction with partners, and index testing for sexual partners or children. This study assessed the effect of a program model of community-based social welfare volunteers on HIV status disclosure among caregivers of orphans and vulnerable children (OVC). Methods This was a longitudinal study, which was based on OVC caregivers who were beneficiaries of the USAID Kizazi Kipya project in Tanzania. They were enrolled (baseline) by community social welfare volunteers during 2017–2018, received services, and reassessed at midline in 2019. Caregivers who reported having been HIV tested, were asked to voluntarily report the status in order for the volunteers to establish and provide needed services. Those who reported their HIV status as negative or positive were grouped as “disclosed”, and those who knew their status but did not report it were documented as “undisclosed”. McNemar’s tests compared disclosure rates at baseline and midline. Multivariable analysis was conducted using generalized estimating equation (GEE). Results The study analyzed 140,664 caregivers (72% female) from 81 district councils of Tanzania. Their mean age at enrollment was 47.4 years. Overall, 81.3% of the caregivers disclosed their HIV status to the project staff at baseline; this increased significantly to 96.1% at midline (p < 0.001). Disclosure at baseline varied significantly by sociodemographic characteristic (p < 0.05), with higher disclosure in females, among urban residents, and higher educated caregivers. However, the observed disclosure variations by sociodemographic characteristics at baseline disappeared at midline and disclosure reached around 96% across the characteristics (p > 0.05). In the multivariable analysis, caregivers’ likelihood of HIV status disclosure was nearly 6 times higher at midline than at baseline, when baseline characteristics were adjusted for (OR = 5.76, 95% CI 5.59–5.94, p < 0.001). There were 26,329 caregivers who did not disclose their HIV status at baseline (i.e., 0% diclosure rate at baseline), but 94.7% (n = 24,933) had disclosed by midline, and their disclosure trend was rapidly increasing as their duration of exposure to the project increased. Conclusions This study detected an increased caregivers’ HIV status disclosure to the USAID Kizazi Kipya project staff by 14.8%, from 81.3% at baseline to 96.1% at midline within an average project exposure period of 1.4 years. The observed loss of sociodemographic differences in HIV status disclosure rate at midline implies that community-based interventions may be well-positioned to successfully address and eliminate sociodemographic barriers to service uptake and consequently improve services coverage and health outcomes.

Amon Exavery 1 John Charles Erica Kuhlik Asheri Barankena Amal Ally Tumainiel Mbwambo 1 Christina Kyaruzi Godfrey Martin Mubyazi Levina Kikoyo Elizabeth Jere 1Pact, Dar es Salaam, Tanzania; 2Pact, Inc., Washington, DC, WA 20036, USA; 3National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania Background: In 2018, only 65% of Tanzanian children aged 0–14 years living with human immunodeficiency virus (HIV) were on treatment, suggesting that challenges exist. This study explores factors associated with uptake of antiretroviral therapy (ART) among HIV-positive orphans and vulnerable children (OVC). Methods: Data are from the USAID Kizazi Kipya project that aims to increase the uptake of HIV/AIDS and other health and social services by OVC and their caregivers. HIV-positive OVC aged 0–14 years who were enrolled in the project from January 2017 to September 2018 were analyzed. ART status (off ART or on ART) was the outcome variable. Multivariate analysis was performed using multilevel logistic regression. Results: Of the 10,047 HIV-positive OVC aged 0–14 years analyzed, 93.5% were currently on ART at enrollment. In the multivariate analysis, OVC with male caregivers were 4-times more likely than those with female caregivers to be on ART (OR=4.03, 95% CI=1.49–10.90). OVC with HIV-positive caregivers were 12-times more likely than those with HIV-negative caregivers to be on ART (OR=12.0, 95% CI=3.81–37.70). OVC with caregivers who did not disclose their HIV status were 74% less likely to be on ART than OVC of HIV-negative caregivers (OR=0.26, 95% CI=0.08–0.90). OVC living in urban areas were more than 5-times as likely as their rural counterparts to be on ART (OR=5.55, 95% CI=2.21–14.0). Conclusion: The majority of the OVCLHIV in the current study were currently on ART (93.5%) at enrollment. However, uptake of ART by the OVC was dependent on factors external to themselves. Advancing ART uptake may require targeting OVC of female caregivers, OVC of HIV-negative caregivers, as well as OVC of caregivers of undisclosed HIV statu, and rural areas.

Background: In 2018, only 65% of Tanzanian children aged 0-14 years living with human immunodeficiency virus (HIV) were on treatment, suggesting that challenges exist.This study explores factors associated with uptake of antiretroviral therapy (ART) among HIV-positive orphans and vulnerable children (OVC).Methods: Data are from the USAID Kizazi Kipya project that aims to increase the uptake of HIV/AIDS and other health and social services by OVC and their caregivers.HIV-positive OVC aged 0-14 years who were enrolled in the project from January 2017 to September 2018 were analyzed.ART status (off ART or on ART) was the outcome variable.Multivariate analysis was performed using multilevel logistic regression.Results: Of the 10,047 HIV-positive OVC aged 0-14 years analyzed, 93.5% were currently on ART at enrollment.In the multivariate analysis, OVC with male caregivers were 4-times more likely than those with female caregivers to be on ART (OR=4.03,95% CI=1.49-10.90).OVC with HIV-positive caregivers were 12-times more likely than those with HIV-negative caregivers to be on ART (OR=12.0,95% CI=3.81-37.70).OVC with caregivers who did not disclose their HIV status were 74% less likely to be on ART than OVC of HIV-negative caregivers (OR=0.26,95% CI=0.08-0.90).OVC living in urban areas were more than 5-times as likely as their rural counterparts to be on ART (OR=5.55,95% CI=2.21-14.0). Conclusion:The majority of the OVCLHIV in the current study were currently on ART (93.5%) at enrollment.However, uptake of ART by the OVC was dependent on factors external to themselves.Advancing ART uptake may require targeting OVC of female caregivers, OVC of HIV-negative caregivers, as well as OVC of caregivers of undisclosed HIV statu, and rural areas.

BACKGROUND:Although Tanzania experiences a general decline in HIV prevalence, some populations such as caregivers of orphans may be at a higher risk than the general population, suggesting that infection pathways still need further exploration. This study examines how food insufficiency relates to HIV infection among caregivers of orphans and vulnerable children (OVC) in Tanzania.DATA AND METHODS:Data are from a community-based, USAID-funded Kizazi Kipya project that aims at increasing the uptake of HIV services, as well as other health and social services by OVC and their caregivers in Tanzania. Caregivers who were enrolled in the project from January to July 2017 in seven regions of Tanzania, and had reported their HIV status to the project, were included in the analysis. While HIV status was the outcome, the main independent variable was food insufficiency which was assessed using the Household Hunger Scale (HHS). Using Stata (version 14.0; StataCorp LP, College Station, TX, USA), data analysis involved multilevel mixed-effects logistic regression..RESULTS:Of the 47,617 caregivers analyzed (73.7% females), 61.8% and 4.6% were experiencing moderate and severe hunger, respectively. The overall HIV prevalence among the caregivers was 28.3%. Nevertheless, the prevalence was as high as 34.2% among caregivers in severe hunger households. Multivariate analysis revealed an increasing likelihood of being HIV positive as hunger increased (moderate hunger: OR=1.10, 95%CI: 1.03-1.18; severe hunger: OR=1.51, 95%CI: 1.32-1.74). These observations were adjusted for marital status, age, sex, education, place of residence, family size, disability status, and health insurance.CONCLUSION:Food insufficiency is associated with a higher likelihood of HIV infection among OVC caregivers in Tanzania, suggesting that improving access to adequate food has a potential to reduce HIV risks among them. Furthermore, food insufficiency could be considered an important criterion for targeting HIV testing and treatment services to expand coverage.