Early Anal Sex Experience Among Men Who Have Sex with Men in Dar Es Salaam Tanzania: Implications for HIV Prevention and Care.

Early age at first sex experience has been attributed to medical and psychological consequences, including practice of risk behaviors and HIV infection later in life. Studies have examined early heterosexual experience, but little is known about early anal sexual experience among men who have sex with men (MSM) in Africa. We conducted a time to event analysis to examine the extent and role of early anal sexual experience and HIV risk and infection in the largest MSM survey in Africa. A total of 753 MSM with a mean age of 26.5 years and that at first anal sexual experience of 18.3 years participated. Of those who participated, 29.0% (219/753) had their first anal sexual experience at age below 15. MSM reporting early anal sexual experience were young, had men as first sexual partner (adjusted hazard ratio-AHR, 4.75; 95%CI: 3.51-6.43), assumed receptive position during last anal sex (AHR, 3.25; 95%CI: 2.42-4.35), had anal sex as first penetrative sexual experience (AHR, 5.05, 95%CI; 3.68-6.97), had unprotected first anal sex (AHR, 1.55, 95%CI: 1.03-2.33), not preferring women for sex (AHR, 2.78; 95%CI: 2.11-3.67), had non-consensual first sex (AHR, 1.53, 95%CI: 1.10-9.41), and HIV positive (AHR, 1.75; 95%CI: 1.21-2.50). A third of MSM engaged in anal sex at an early age and were more likely to report sexual abuse, practice HIV risk behaviors, and been HIV seropositive. Roll-out of the existing Comprehensive Guideline for HIV Treatment and Care for key population in Tanzania should be implemented alongside measures addressing sexual abuse among young people.

Prevalence and risk factors associated with HIV-1 infection among people who inject drugs in Dar es Salaam, Tanzania: a sign of successful intervention?

BACKGROUND: Prevalence of HIV infection among people who inject drugs (PWID) has been reported to be higher than that of the general population. The present study aimed to estimate the prevalence of HIV infection and associated risk factors among PWID in Dar es Salaam, Tanzania, following the introduction of a comprehensive HIV intervention package (CHIP) for PWID in the country in 2014. METHODS: We conducted an integrated bio-behavioral survey (IBBS) among PWID using respondent-driven sampling (RDS) in Dar es Salaam, Tanzania, between October and December 2017. Data on socio-demographic characteristics and risky behaviors were collected through face-to-face interviews. Blood samples were collected and tested for HIV infection. We accounted for weighting in the analyses, and logistic regression was performed to assess risk factors for HIV infection. RESULTS: A total of 611 PWID (94.4% males and 5.6% females) with a median age of 34 years (IQR 29-38) were recruited. The overall prevalence of HIV infection was 8.7% (95% CI 6.5-10.9). The prevalence of HIV infections for males and females were 6.8% (95% CI 4.7-8.9%) and 41.2% (95% CI 23.7-58.6%) respectively. Adjusted weighted logistic regression analysis (WLRA) showed that being a female (aOR 19.1; 95% CI 5.9-61.8), injecting drugs for more than 10 years (aOR = 7.32; 95% CI 2.1-25.5) compared to 1 year or less and being 45 years or older (aOR = 34.22; 95% CI 2.4-489.5) compared to being 25 years or younger were associated with increased odds of HIV infection. Use of a sterile needle at last injection decreased odds of HIV infection (aOR = 0.3; 95% CI 0.1-0.8). CONCLUSIONS: The present study observed a decline in prevalence of HIV infections among PWID in Dar es Salaam (8.7%) compared to a previous estimate of 15.5% from an IBBS conducted in 2013. Despite the decrease, HIV prevalence remains high among PWID compared to the general population, and women are disproportionally affected. The decline may be possibly attributed to the on-going implementation of CHIP for PWID, highlighting the need for strengthening the existing harm reduction interventions by incorporating access to sterile needle/syringe and addressing the layered risks for women.

Effectiveness of health care workers and peer engagement in promoting access to health services among population at higher risk for HIV in Tanzania (KPHEALTH): study protocol for a quasi experimental trial.

BACKGROUND: While there are indications of declining HIV infection rates in the general population globally, Tanzania included, men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID), now called Key Populations (KP) for HIV epidemic have 2-20 times higher infections rates and contributes up to 30% of new HIV infection. Tanzania have developed a Comprehensive Guideline for HIV prevention among key population (CHIP) to address the epidemic among KPs. However, these populations are stigmatized and discriminated calling for innovative approaches to improve access to CHIP. This project seeks to test the effectiveness of healthcare workers and peer-to-peer engagement in promoting access to CHIP among HIV at risk populations in Tanzania. METHODS: A quasi-experimental design involving Dar es Salaam City as an intervention region and Tanga as a control region will be done. Using respondent driven sampling, 1800 at risk population (900 from Intervention site and 900 from control site) will be recruited at baseline to identify pull and push factors for health services access. Stakeholder's consultation will be done to improve training contents for CHIP among health care workers and peers. Effectiveness of healthcare workers training and peer engagement will be tested using a quasi-experimental design. DISCUSSION: The results are expected to co-create service provision and improve access to services among KPs as a human right, reverse HIV infection rates among KPs and the general population, and improve social and economic wellbeing of Tanzanian. TRIAL REGISTRATION: Retrospectively registered on 28th August, 2019 with International Standard Randomized Clinical Trial Number ( ISRCTN11126469 ).

HIV/HCV co-infection and associated risk factors among injecting drug users in Dar es Salaam, Tanzania: potential for HCV elimination.

BACKGROUND: Chronic HCV infection causes substantial morbidity and mortality and, in co-infection with HIV, may result in immunological and virological failure following antiretroviral treatment. Estimates of HCV infection, co-infection with HIV and associated risk practices among PWID are scarce in Africa. This study therefore aimed at estimating the prevalence of HCV and associated risk factors among PWID in the largest metropolitan city in Tanzania to inform WHO elimination recommendations. METHODS: An integrated bio-behavioral survey using respondent-driven sampling was used to recruit PWID residing in Dar es Salaam, Tanzania. Following face-to-face interviews, blood samples were collected for HIV and HCV testing. Weighted modified Poisson regression modeling with robust standard errors was used in the analysis. RESULTS: A total of 611 PWID with a median age of 34 years (IQR, 29-38) were recruited through 4 to 8 waves. The majority of participants (94.3%) were males, and the median age at first injection was 24 years (IQR, 19-30). Only 6.55% (40/611) of participants reported to have been enrolled in opioid treatment programs. The weighted HCV antibody prevalence was 16.2% (95%CI, 13.0-20.1). The corresponding prevalence of HIV infection was 8.7% (95%CI, 6.4-11.8). Of the 51 PWID who were infected with HIV, 22 (43.1%) were HCV seropositive. Lack of access to clean needles (adjusted prevalence ratio (APR), 1.76; 95%CI, 1.44; 12.74), sharing a needle the past month (APR, 1.72; 95%CI, 1.02; 3.00), not cleaning the needle the last time shared (APR, 2.29; 95%CI, 1.00; 6.37), and having unprotected not using a transactional sex (APR, 1.87; 95%CI, 1.00; 3.61) were associated with increased risk of HCV infection. On the other hand, not being on opioid substitution therapy was associated with 60% lower likelihood of infection. CONCLUSIONS: The HCV antibody prevalence among PWID is lower than global estimates indicating potential for elimination. Improving access to safe injecting paraphernalia, promoting safer injecting practices is the focus of prevention programing. Screening for HIV/HCV co-infection should be intensified in HIV care, opioid substitution programs, and other point of care for PWID. Use of direct-acting antiretroviral treatment would accelerate the achievement of hepatitis infection elimination goal by 2030.

Training for health services and systems research in Sub-Saharan Africa--a case study at four East and Southern African universities.

BACKGROUND: The need to develop capacity for health services and systems research (HSSR) in low and middle income countries has been highlighted in a number of international forums. However, little is known about the level of HSSR training in Sub-Saharan Africa (SSA). We conducted an assessment at four major East and Southern African universities to describe: a) the numbers of HSSR PhD trainees at these institutions, b) existing HSSR curricula and mode of delivery, and c) motivating and challenging factors for PhD training, from the trainees' experience. METHODS: PhD training program managers completed a pre-designed form about trainees enrolled since 2006. A desk review of existing health curricula was also conducted to identify HSSR modules being offered; and PhD trainees completed a self-administered questionnaire on motivating and challenging factors they may have experienced during their PhD training. RESULTS: Of the 640 PhD trainees enrolled in the health sciences since 2006, only 24 (3.8%) were in an HSSR field. None of the universities had a PhD training program focusing on HSSR. The 24 HSSR PhD trainees had trained in partnership with a university outside Africa. Top motivating factors for PhD training were: commitment of supervisors (67%), availability of scholarships (63%), and training attached to a research grant (25%). Top challenging factors were: procurement delays (44%), family commitments (38%), and poor Internet connection (35%). CONCLUSION: The number of HSSR PhD trainees is at the moment too small to enable a rapid accumulation of the required critical mass of locally trained HSSR professionals to drive the much needed health systems strengthening and innovations in this region. Curricula for advanced HSSR training are absent, exposing a serious training gap for HSSR in this region.

High prevalence of self-reported sexually transmitted infections among older adults in Tanzania: results from a list experiment in a population-representative survey.

PURPOSE: Self-report of sensitive or stigmatized health states is often subject to social desirability and interviewer biases. To reduce such biases, we estimated the rate of sexually transmitted infections (STIs) using a list experiment. METHODS: This population-representative study was nested within the Dar es Salaam Urban Cohort Study, a Health and Demographic Surveillance System (HDSS) in the Ukonga ward of Dar es Salaam, Tanzania. Men and women aged ≥40years were randomly assigned to receive a list of either four control items (i.e., the control group) or four control items plus an additional item on having had a disease through sexual contacts in the past 12months (i.e., the treatment group). We calculated the mean difference in the total number of items to which respondents answered "yes" in the treatment versus control group and compared this prevalence estimate to the one measured by the direct question. RESULTS: A total of 2310 adults aged ≥40years were enrolled in the study: 32% were male and 48% were aged 40-49years. The estimated prevalence of having STIs in the past 12months was 17.8% (95% confidence interval [CI] 12.3-23.3) in the list experiment, almost 10 times higher than the estimated prevalence of 1.8% (95%CI 1.3-2.4) based on the direct question (P < .001). STI prevalence remained high after adjusting for age, the number of lifetime sex partners, alcohol consumption and smoking in multivariate linear regression (15.6%; 95% CI 7.3-23.9). CONCLUSIONS: We found a substantially higher prevalence of STIs among older adults in urban Tanzania when we based our estimation on a list experiment rather than a direct question in a population-representative survey. List experiments should be considered to elimnate social desirability and interviewer biases in surveys of sensitive or stigmatized health states. The very high prevalence of STIs highlights the need for improved access to STI screening, prevention and treatment for older adults in urban Africa.

A mixed methods needs assessment and gap analysis for establishment of a cancer research training program in East Africa.

BACKGROUND: The burden of non-communicable diseases (NCDs), including cancer, in Africa is rising. Policymakers are charged with formulating evidence-based cancer control plans; however, there is a paucity of data on cancers generated from within Africa. As part of efforts to enhance cancer research training in East Africa, we performed a needs assessment and gap analysis of cancer-related research training resources in Tanzania. METHODS: A mixed-methods study to evaluate existing individual, institutional, and national resources supporting cancer research training in Tanzania was conducted. Qualitative data were collected using in-depth interviews while quantitative data were collected using self-administered questionnaires and online surveys. The study also included a desk-review of policy and guidelines related to NCD research and training. Study participants were selected to represent five groups: (i) policymakers; (ii) established researchers; (iii) research support personnel; (iv) faculty members in degree training programs; and (v) post-graduate trainees. RESULTS: Our results identified challenges in four thematic areas. First, there is a need for coordination and monitoring of the cancer research agenda at the national level. Second, both faculty and trainees identified the need for incorporation of rigorous training to improve research competencies. Third, sustained mentoring and institutional investment in development of mentorship resources is critical to empowering early career investigators. Finally, academic institutions can enhance research outputs by providing adequate research infrastructure, prioritizing protected time for research, and recognizing research accomplishments by trainees and faculty. CONCLUSIONS: As we look towards establishment of cancer research training programs in East Africa, investment in the development of rigorous research training, mentorship resources, and research infrastructure will be critical to empowering local health professionals to engage in cancer research activities.

Risk factors associated with under nutrition among children aged 6-59 months in Ngorongoro, Arusha region, Tanzania: a case-control study, 2017.

INTRODUCTION: childhood undernutrition is one of the leading causes of morbidity and mortality in children below five years of age especially in developing countries like Tanzania, particularly in rural area. Inappropriate child caring and feeding practices have been strongly associated with it. Many actions have been taken to reduce prevalence of undernutrition in children in Ngorongoro district, however, the problem persist. This study identified risk factors associated with undernutrition in children under-five years of age in Ngorongoro district, Arusha region. METHODS: a health facility-based unmatched case-control study was conducted with 400 (100 cases and 300 controls) children aged 6-59 months. Cases included children with undernutrition according to the WHO anthropometric indicators. Controls were children within the normal range of these indicators. Both cases and controls, were obtained from children attending the Reproductive and Child Health (RCH) for assessment of growth and development or admitted in pediatric ward. A questionnaire was used to collect demographic characteristics, child health and caring practices and environmental factors. Height, weight and Mid Upper Arm Circumference (MUAC) were measured using standard approaches. We employed logistic regression analysis to identify significant risk factors for undernutrition. RESULTS: undernutrition was associated with young age of mothers/caregivers (adjusted Odds Ratio (aOR)=38.8, 95% CI: 15.38-59.03.); early age of initiation complementary foods (aOR=13.6, 95%CI: 3.15-59.06); a child having diarrhoea in past one month (aOR=4.0; 95%CI: 1.76-12.85); large family size (aOR=6.1, 95% CI: 2.16-16.90); low frequency of feeding (aOR=3.9, 95%CI: 1.59-9.58); low birth weight (aOR:=7.3, 95%: CI: 1.15-46.70); and source of drinking water; well (aOR=16.3, 95%: CI: 1.81-147.05) and surface water (aOR=16.18, 95%CI: 1.85-141.71). CONCLUSION: household and individual characteristics of the children and mother/caregiver are important predictors of undernutrition in this community. Tailored interventions, instead of blanket approaches, should be designed to mitigate and eliminate childhood undernutrition in Ngorongoro.

Knowledge, Perceived Risk and Utilization of Prostate Cancer Screening Services among Men in Dar Es Salaam, Tanzania.

BACKGROUND: Late diagnosis of prostate cancer is common in low and middle income countries and contributes to high morbidity and mortality of the disease. Utilization of prostate cancer screening services plays a major role in prevention of adverse outcomes. However, there is limited information on the knowledge about, the perceived risk of, and the utilization of prostate cancer screening in Tanzania. OBJECTIVE: To determine knowledge and perceived risk of prostate cancer, and the utilization of prostate cancer screening services, and associated factors, among men in Dar es Salaam, Tanzania. DESIGN: A population-based cross-sectional study involving men aged 40 years and above living in Dar es Salaam was conducted between May and August, 2018. METHODOLOGY: Participants were recruited through multistage random sampling and took part in structured face-to-face interviews. Categorical variables were summarized using proportions while continuous variables were summarized as medians and inter-quarterly range (IQR). Chi square test was used to compare differences between proportions, and logistic regression modelling was used to determine factors associated with utilization of prostate cancer screening. Both crude and adjusted odds ratios (OR), with corresponding 95% confidence intervals, are reported. All analyses were two-tailed and the significance level set at 5%. RESULTS: A total of 388 men with a median age of 53 years (IQR 44-55) participated. Half (52.1%) had poor knowledge about prostate cancer and prostate cancer screening. A third (32.3%, n = 125) perceived the risk of prostate cancer to be low. Only 30 respondents (7.7%) had ever been screened for prostate cancer. Utilization of prostate cancer screening services was independently associated with age above 60 years [AOR = 21.46, 95% CI: 6.23, 73.93], monthly income above 305 US Dollars [AOR = 15.68, 95% CI: 4.60, 53.48], the perceived risk of prostate cancer [AOR = 16.34, 95% CI: 7.82, 14.92] and knowledge about prostate cancer [AOR = 67.71, 95% CI: 8.20, 559.57]. CONCLUSIONS: Knowledge about prostate cancer and prostate cancer screening services was low among men in Dar es Salaam with a third perceiving themselves to be at no risk for the disease. Utilization of screening services was low and associated with low income, younger age, low perceived risk of prostate cancer and low knowledge about the disease. Intervention measures aiming to increase knowledge about prostate cancer and screening services, and affordable provision of services, are urgently called for.

Social Capital as a Determinant of Pregnant Mother's Place of Delivery: Experience from Kongwa District in Central Tanzania.

INTRODUCTION: Maternal ill health contributes highly to the global burden of diseases in countries South of Sahara including Tanzania. Ensuring that all deliveries take place in health facilities and hence attended by skilled health personnel is one of the strategies advocated by global and national policies, including the Millennium Development Goals (MDGs). However, the number of women delivered by skilled health personnel has remained low in sub Saharan Africa despite of a number of interventions. We sought to determine the role of social capital in facilitating health facility delivery. METHODS: We randomly selected 744 households with children aged less than five years from two randomly selected wards in a rural area in Tanzania. Mothers were enquired about place of delivery of the last child. Social capital was assessed using a modified questionnaire with both structural and cognitive aspects of social capital, administered in face-to-face interviews. Principal Component Analysis (PCA) was used to develop asocial capital index measure. Uni-variate and multivariable regression models were run using STATA 12. RESULTS: Majority (85.9%) of the mothers reported to have delivered in a health facility during their last birth. Compared to the lowest social capital quintile, delivering in a health facility increased significantly with increase in social capital level: low (Adjusted Odds Ratio (AOR) = 2.9; Confidence Interval (CI): 1.4-6.1, p = 0.004); moderate (AOR = 5.5, CI: 2.3-13.3, p-value<0.001); high (AOR = 4.7; CI: 1.9-11.6, p-value<0.001) and highest (AOR = 5.6, CI: 2.4-13.4, p-value<0.001) and χ2-test for the trend was significant (χ2 = 17.21, p<0.001). CONCLUSION: Overall, social capital seems to play an important role in enhancing health facility delivery that may lead to improved maternal and child health. Concerted efforts should focus on promoting and supporting effective social capital and in particular cognitive social capital.

Incidence and predictors of adolescent's early sexual debut after three decades of HIV interventions in Tanzania: a time to debut analysis.

PURPOSE: To determine the incidence and predictors of adolescent's early sexual debut after three decades of HIV interventions in Tanzania. METHODS: In a cross-section study of adolescents aged 16-19 residing in Morogoro Municipality, information on socio-demographic, parental-and-peer communication, and sexual behaviors were collected. Cox-regression analysis was used to examine predictors of time to sexual debut. RESULTS: A total of 316 adolescents with mean age of 17.5±0.9 were recruited. Half (48.7%) of adolescent were sexually active with mean age at sexual debut of 14.6±2.3. Of these, 57.8% had sex before their 15(th) birthday with incidence of early sexual debut of 17.4/1000 person-years at risk. Adolescent family characteristics, peer pressure, alcohol use, parental and peer communication were key predictors of early sexual debut. CONCLUSION: Parental and peer communication strategies works calling for efforts to increase its scope to reach all adolescents alongside promoting family stability and reducing adolescent alcohol consumption.

High Initial HIV/AIDS-Related Mortality and -Its Predictors among Patients on Antiretroviral Therapy in the Kagera Region of Tanzania: A Five-Year Retrospective Cohort Study.

We examined mortality rates and its predictors from a five years retrospective cohort data of HIV/AIDs patients attending care and treatment clinic in Biharamulo Tanzania. Cox regression analysis was used to identify predictors of mortality. Of the 546 patient records retrieved, the mean age was 37 years with median CD4 count of 156 cells. The mortality rate was 4.32/100 person years at risk with males having three times higher mortality compared to females. Starting Antiretroviral treatment with advanced disease state, body weight below 45 kegs, WHO stage 4 disease, and CD4 cells below 50 were main predictors of mortality. Promoting early voluntary counselling and testing should be given a priority to facilitate timely start of treatment.

Herpes simplex virus type-2 and human immunodeficiency virus infections in a rural population in Kilimanjaro Tanzania.

OBJECTIVES: To estimate the seroprevalence of Herpes Simplex Type 2 (HSV-2) and its association with Human Immunodeficiency Virus type 1 (HIV-1) infections in rural Kilimanjaro Tanzania. METHODS: A cross-sectional survey was conducted in Oria village from March to June 2005 involving all individuals aged 15-44 years with permanent address in the village. Following an informed written consent, participants gave blood for HIV-1 testing and further interviewed regarding their risk behaviours. All HIV cases and randomly selected controls were tested for HSV-2 antibodies. RESULTS: The weighted HSV-2 seroprevalence estimate in the whole population was 33.2%. The HSV-2 seroprevalence was 87.5% and 29.5% among HIV-1 seropositive cases and seronegative controls respectively (Odds ratio (OR) 2.9; 95% Confidence interval: 1.9-4.3). After adjusting for sexual risk behaviors, the association between HSV-2 and HIV-1 infections remained strong (adjusted OR 14.1; CI: 5.0-28.3). Multiple sexual partners, transactional sex and unprotected casual sex were independently associated with HIV-1 infection. CONCLUSIONS: These results demonstrate that HSV-2 is highly prevalent in rural communities in Tanzania and strongly associated with HIV-1 infection. Sexual risk behaviours may play a major role in the transmission of both HSV-2 and HIV-1 infection. Due to lack of HSV-2 suppressive antiretroviral therapy in this and similar communities, prevention through promotion of behavioural change might be the most important strategy to mitigate HSV-2 and HIV-1 transmission.