Although parenting programmes may be effective at reducing violence against children (VAC), there is a limited understanding on how acceptable and appropriate such programmes are among parents/caregivers (‘caregivers’) when delivered at scale. This paper explores the acceptability and cultural appropriateness of a parenting programme for caregivers and their adolescent girls, Parenting for Lifelong Health for Teens (PLH-Teens), which was delivered at scale in rural and semi-urban Tanzania. This paper employed a qualitative research design involving 18 focus group discussions (FGDs) with caregivers (N = 120) and adolescent girls (N = 60). Participants reported that the programme was acceptable, culturally appropriate, and beneficial. The use of participatory approaches and in-person group sessions was appealing to caregivers. However, several challenges hindered consistent engagement. These factors ranged from initial community mistrust about the programme, social norms on parenting, and group interactions to individual-level participant factors, stigma, and feeling of shame for being selected to join a programme. Overall, PLH-Teens programme was perceived as addressing the real parenting needs of caregivers and their adolescents. There is a need to address the challenges families experienced as these could hinder the acceptability, sustainability, and continued scale up of PLH-Teens in future programme delivery.

Program adaptations or modifications are often necessary to suit local contexts, populations, and resources available. Despite the frequency with which program modifications are made in practice, they are rarely systematically recorded and reported comprehensively, particularly in the context of scale-up delivery led by implementers and in low- and middle-income countries. We use the FRAME framework to document the modifications of a parenting program called Parenting for Lifelong Health for Parents and Adolescents, locally known as Furaha Teens, which was delivered to over 30,000 families in Tanzania in 2020–2021. We draw on thematic analysis of 12 focus groups and 67 semi-structured interviews with program facilitators, coaches, coordinators, and managers (164 participants). Both proactive and reactive modifications were made to the program context and content. Proactive modifications included delivering the program as part of a wider package of services for families with adolescent girls, focused on HIV prevention, and adding HIV-related content. Both proactive and reactive modifications were made to make the material more acceptable to participants, such as by translating into local languages. Modifications to condense the number and frequency of sessions were reactively made by implementers to meet delivery timelines, particularly due to COVID-related closures. Study findings suggest that a range of program modifications may be required to scale programs to large cohorts as well as new contexts. To ensure successful delivery at scale, funders can support implementers in learning from the modifications and encouraging reflection on whether and how modifications affect program fidelity.

BackgroundParenting programmes, including those delivered in the Global South, are effective strategies to reduce violence against children (VAC). However, there is limited evidence of their impact when implemented at scale within routine delivery systems. This study aimed to address this gap by evaluating the real-world delivery of Parenting for Lifelong Health for Teens in Tanzania.MethodsParticipating parents/caregivers and their adolescent girls were recruited by local implementing partners in 2020–2021 as part of a community-based HIV prevention initiative focused on addressing drivers of female adolescent HIV-vulnerability such as VAC, caregiver–adolescent relationships and sexual reproductive health communication. The 14-session, group-based parenting programme was delivered by trained teachers and community facilitators. Quantitative surveys administered by providers measured a variety of outcomes including child maltreatment (primary outcome) and multiple secondary outcomes linked to increased risk of VAC. Multilevel models examined pre–post effects as well as variation by attendance and baseline demographic variables.ResultsPre–post data from 27 319 parent/caregiver–child dyads were analysed, of which 34.4% of parents/caregivers were male. Analyses showed large reductions in child maltreatment (parents/caregivers: IRR=0.55, (95% CI 0.54, 0.56); adolescents: IRR=0.57, (95% CI 0.56, 0.58)), reduced intimate partner violence experience, reduced school-based violence, increased communication about sexual health, reduced poor supervision, reduced financial insecurity, reduced parenting stress, reduced parent and adolescent depression, and reduced adolescent conduct problems. In contrast to these positive outcomes, parents/caregivers and adolescents also reported reduced parental positive involvement and support of education, with those experiencing greater adversity reporting less change than those with less adversity.ConclusionsThis study is the first to examine the large-scale implementation of an evidence-based parenting programme in the Global South. Although additional research is necessary to examine potential negative effects on positive parenting and parent support of education, findings suggest that Furaha Teens can sustain its impact on key outcomes associated with VAC when delivered at scale.

Background: Despite the rapid dissemination of parenting programmes aiming to reduce violence against children (VAC), there is limited evidence of their effectiveness when implemented at scale in the Global South. The Furaha Adolescent Implementation Research study aimed to address this gap by evaluated the scale-up of Parenting for Lifelong Health for Teens (locally known as Furaha Teens), delivered within the context of a community-wide intervention focused on reducing HIV infection amongst adolescent girls in Tanzania. Methods: Participating families were recruited by local implementing partners in collaboration with Pact Tanzania from 2020-2021. The group-based 14-session programme was delivered to adolescent girls and their parents/caregivers in community or school settings. Quantitative surveys were administered by providers. The primary outcome was child maltreatment with multiple secondary outcomes linked to increased risk of VAC. Multilevel models were used to examine pre-post effects as well as variation by attendance and baseline variables.Results: Pre-post data from 27,319 parent/caregiver-child dyads were analysed, of which 34.4% of parents/caregivers were male. Analyses showed large reductions in child maltreatment (parents/caregivers: IRR=0.55, [0.54,0.56]; adolescents: IRR=0.57, [0.56,0.58]). Female parents/caregivers also reported reduced intimate partner violence experience, and adolescents reported reduced school-based violence. Parents/caregivers and adolescents also reported increased communication about sexual health and reduced poor supervision, financial insecurity, parenting stress, parent and child depression, and child conduct problems. Parents/caregivers and adolescents also reported reduced parental positive involvement and support of education, with those experiencing greater adversity reporting less change than those with less adversity.Conclusions: This study is the first to examine the large-scale implementation of an evidence-based parenting programme in the Global South. Although additional research is necessary to examine potential negative effects on positive parenting and parent support of education, findings suggest that Furaha Teens can sustain its impact on key outcomes associated with VAC when delivered at scale.

Workplaces have been increasingly promoted as key sites for HIV interventions, with cost-benefit analyses employed to demonstrate the financial benefits to employers for implementing workplace HIV programmes. In these analyses, the potential costs of having HIV positive employees are weighed against the costs of the workplace programmes. Despite evidence that shows some firms have saved significant sums of money through these interventions, the general response from the private sector has been limited, with most positive case studies originating from high prevalence settings. This article reports findings from qualitative fieldwork conducted in Tanzania with private and public sector employers that aimed to understand how HIV was addressed in their organisations. Our findings suggest that HIV is not generally a serious issue, and hence HIV interventions are primarily ad-hoc with few formal HIV workplace programmes. We also found that in cases where compulsory testing programmes were implemented, employees did not turn up for testing and thus lost access to employment. Our findings suggest that relying on workplace programmes in lower prevalence settings is no substitute for investment in public health systems. Employer interventions should emphasise education and awareness, condom distribution and the promotion and provision of self-testing kits.

Evidence from nationally representative surveys conducted in sub-Saharan Africa shows that significant proportions of men in the wealthiest quintile report never having tested for HIV. Despite high prevalence rates in this quintile, no research has been conducted on the HIV testing attitudes and practices of wealthier men. This article reports findings from qualitative research conducted with 23 wealthy men in Tanzania. Whilst wealthy men reported barriers to and enablers of HIV testing previously reported by the general population, concerns around loss of social status and community standing were amplified for members of this demographic. Furthermore, HIV stigma among members of this group remains high. However, enhanced access to HIV testing through private clinics, regular healthcare appointments, health insurance schemes and the means to travel to other countries enables wealthy men to avoid stigma. In settings such as the workplace, wealthy men were able to test in public in their roles as 'leaders' to encourage others to test. Future interventions to increase testing amongst men should target settings in which these leadership roles can be taken advantage of. HIV services also need integrating into the health system to remove the need for testing and treatment to be accessed at separate clinics.

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.

It is well-known that conducting research with elite groups presents a range of unique methodological challenges including gaining access to and recruiting a demographic group that is underrepresented if not entirely absent from most research. This issue is particularly pronounced when the research topic is sensitive or potentially politicized and conducted in low-income settings in which large wealth inequalities are apparent. Drawing on recent experiences from fieldwork conducted in Tanzania that aimed to explore attitudes toward HIV testing among wealthy men, we reflect on significant challenges in the recruitment process. These included the framing of the research project, the (often unspoken) politicized subtext of the (sensitive) research, the socioeconomic climate, and the navigation of time requirements. Our experiences suggest that a careful consideration of these methodological issues will help researchers recruit elite participants and ensure that data are collected from appropriate samples.