Retention in an mHealth App Aiming to Promote the Use of HIV Pre-Exposure Prophylaxis Among Female Sex Workers in Dar es Salaam, Tanzania: Prospective Cohort Study.

Background: Increasing access to smartphones in sub-Saharan Africa offers an opportunity to leverage mobile health (mHealth) technology to improve access to health care in underserved populations. In the domain of HIV prevention, mHealth interventions can potentially contribute to solving the challenges of suboptimal adherence to pre-exposure prophylaxis (PrEP) and low retention in PrEP services among populations most vulnerable to HIV acquisition. However, there is a gap in the knowledge about the use of such interventions in sub-Saharan Africa. Objective: This study aims to evaluate the extent and predictors of retention in an mHealth app (Jichunge) that aims to promote adherence to PrEP and retention in PrEP care among female sex workers in Dar es Salaam, Tanzania. Methods: A prospective cohort of female sex workers residing in Dar es Salaam were recruited, using respondent-driven sampling. All participants were provided with the Jichunge app as they started PrEP. A questionnaire was used to collect data on sociodemographics and other structural factors, while app use data for the 60-day period following the first 150 days of being in the intervention arm were extracted from the app's back end. A multivariable log-binomial model was used to determine predictors of 6-month retention in the Jichunge app. Results: A total of 470 female sex workers were recruited. Nearly three-quarters of participants (206/284, 72.5%) who came to the 6-month follow-up interview no longer had the Jichunge app on their phones. The majority of these participants (193/206, 93.7%) no longer had access to the app because of issues related to their phones. Data extracted from the back end of the app showed that the use of the app declined over time, and only 13.4% (63/470) of the participants were retained (continued to use the app) after 6 months of intervention. At 6 months, women aged ≥35 years were >2 times more likely to use the app than women aged 18 to 24 years (adjusted risk ratio [aRR] 2.2, 95% CI 1.2-4.1; P=.01). Furthermore, retention in the app was higher among participants who demonstrated high PrEP awareness at baseline (aRR 1.8, 95% CI 1.1-3; P=.01) and among those who had experienced financial difficulties due to health care spending (aRR 1.9, 95% CI 1.2-3.2; P=.01). Conclusions: Most female sex workers (206/284, 72.5%) who were enrolled in PrEP care in Tanzania no longer used the Jichunge app after 6 months. Retention in the app at 6 months was predicted by older age, high PrEP awareness, and financial difficulties due to health care spending. Strategies for the long-term retention of participants in mHealth apps, such as systems for reinstallations of apps, should be considered during the design phase.

Effect of an mHealth intervention on retention in HIV pre-exposure prophylaxis services among female sex workers: Preliminary evidence of the use of the Jichunge app in Dar es Salaam, Tanzania.

Background: Mobile health (mHealth) applications have been reported to be effective in promoting access and adherence to health services. However, knowledge about their effect on retention in HIV preventive services among at-risk populations in sub-Saharan Africa is limited. Objective: We aimed to evaluate the effect of the Jichunge mHealth application on retention in HIV pre-exposure prophylaxis (PrEP) services among female sex workers in Dar es Salaam, Tanzania. Methods: We used respondent-driven sampling to recruit female sex workers eligible for PrEP and who owned a smartphone. All study participants were provided with a smartphone application (Jichunge app) aiming to promote PrEP use through medication reminders, easy access to PrEP information, online consultations with a doctor and/or peer educator, and online discussions between PrEP users. The effect of optimal use of the Jichunge app on retention in PrEP services at 1-month was modelled using log-binomial regression. Results: A total of 470 female sex workers with a median age of 26 (interquartile range: 22-30) years were recruited. Overall, 27.7% of female sex workers were retained in PrEP services at 1 month. Retention was twice as high among optimal users of the app than among sub-optimal users (adjusted risk ratios = 2.00, 95% confidence interval (CI): 1.41-2.83, p < 0.001). Conclusion: The optimal use of the Jichunge mHealth application was significantly associated with higher retention in PrEP services among female sex workers in Dar es Salaam.

Entrepreneurship, beekeeping, and health training to decrease community violence in Dar es Salaam, Tanzania: a pilot study for an intervention trial.

BACKGROUND: High unemployment rates and limited access to resources, services, and economic opportunities are associated with many types of violence. In Dar es Salaam, Tanzania, most violence is experienced by unemployed, poorly educated men between the ages of 20 and 35 years. It is expected that community violence will decrease as the incomes of those most at risk increase. However, economic opportunity through formal employment is rarely available to uneducated men in Dar es Salaam. Giving them access to economic independence through entrepreneurship training is therefore supported by the World Bank and the government of Tanzania. There has been little research on the effectiveness of programs to encourage entrepreneurship. METHODS: To evaluate the feasibility of providing entrepreneurial training programs to young men in Dar es Salaam, especially those without formal employment, a pretest-posttest pilot study was conducted drawing a sample of young men from neighborhood camps called vijiweni. There were four interventions, each implemented in a single camp: Health/Control, Entrepreneurship + Health, Beekeeping + Health, and Entrepreneurship + Beekeeping + Health. The four camps received 2, 6, 6, and 10 training sessions, respectively. No start-up capital was provided. The participants were interviewed at baseline and 3 months, 6 months, and 1 year after the sessions were completed. Data were collected on demographics, household assets, experience of violence, and income. RESULTS: Fifty-seven respondents attended the first session. At baseline, the camps were not meaningfully different from one another in educational attainment, number of dependents, daily income, assets, or individual members' roles as victims, perpetrators, or witnesses of violence. Differences were found in age, occupation, and weekly income. Over a period of 2.25 years (from baseline to the end of the project), the weekly income of the Health/Control camp, which had been earning the most, decreased by 37% in a reflection of worsening economic conditions at the time. All three intervention camps increased their income: Beekeeping by 43%, All by 50%, and Entrepreneurship by 146%, with the latter almost reaching the minimum wage level. The most persistently reported constraint was insufficient start-up capital. CONCLUSIONS: The feasibility and potential effectiveness of a short training program on entrepreneurship skills for unemployed, poorly educated young men in urban Tanzania were demonstrated in this study. It has set the stage for an intervention trial to test an updated hypothesis: A 5-7-day intervention about entrepreneurship and microfinance savings groups will lead to increased income and decreased violence. TRIAL REGISTRATION: ClinicalTrials.gov NCT04602416 . Registered on 24 October 2020. Retrospectively registered.

Magnitude and factors associated with intimate partner violence in mainland Tanzania.

BACKGROUND: In Tanzania like in many sub-Saharan countries the data about Intimate Partner Violence (IPV) are scarce and diverse. This study aims to determine the magnitude of IPV and associated factors among ever partnered women in urban mainland Tanzania. METHODS: Data for this report were extracted from a big quasi-experimental survey that was used to evaluate MAP (MAP - Men as Partners) project. Data were collected using standard questions as those in big surveys like Demographic and Health Surveys. Data analyses involved descriptive statistics to characterize IPV. Associations between IPV and selected variables were based on Chi-square test and we used binary logistic regression to assess factors associated with women's perpetration to physical IPV and Odds Ratio (OR) as outcome measures with their 95 % confidence intervals (CI). RESULTS: The lifetime exposure to IPV was 65 % among ever-married or ever-partnered women with 34, 18 and 21 % reporting current emotional, physical and sexual violence respectively. Seven percent of women reported having ever physically abused partners. The prevalence of women perpetration to physical IPV was above 10 % regardless to their exposure to emotional, physical or sexual IPV. CONCLUSIONS: IPV towards women in this study was high. Although rates are low, there is some evidence to suggest that women may also perpetrate IPV against their partners. Based on hypothesis of IPV and HIV co-existence, there should be strategies to address the problem of IPV especially among women.

Body-art practices among undergraduate medical university students in dar es salaam, Tanzania, 2014.

BACKGROUND: Body-art practices are increasing among adolescents and young adults. Although substantial data are available in developed countries, little has been documented about body-art practices in developing countries. OBJECTIVE: To determine the magnitude, types and reasons for practicing body-art practices among undergraduate medical University students in Dar es Salaam, Tanzania. MATERIALS AND METHODS: A cross-sectional descriptive study was conducteed among undergraduate University students in Dar es Salaam involving 536 respondents from two Universities. We used a self-administered questionnaire to collect data. Analyses were based on summary measures and bivariate analyses. RESULTS: While 7.5% of undergraduate students reported having tattoos, 20% reported having body puncturing or piercing. Body piercing is reported more among female university undergraduate students than their male counterparts. Reported main reasons for undergoing body-art include "a mark of beauty," 24%, "just wanted one," 18% and "a mark of femininity or masculinity," 17%. The majority (98%) of students were aware that unsafe body-art practices may lead to contracting HIV and more than half (52%) reported awareness of the risk of Hepatitis B infection. CONCLUSIONS: Despite high awareness of the potential risks involved in unsafe body arts that include tattoo and piercing, these practices are increasing among adolescents and young adults. There is need to have educational and counseling efforts so as to minimize associated health risks.

Understanding the link between trafficking in persons and HIV and AIDS risk in Tanzania.

The magnitude of trafficking in persons in Tanzania is unknown. Consequently, available information on health risks of persons trafficked for different forms of exploitation is extremely scanty. We conducted a baseline study in eight administrative regions of Tanzania using both qualitative and quantitative methods to generate data on the health conditions of trafficked persons to inform trafficking in persons control measures through HIV and AIDS interventions. Study participants included the national, regional and district community development officers, district medical officers, local government leaders, managers or representatives of non-governmental organizations involved in anti-trafficking in persons activities, members of the community and victims. Findings indicated that common forms of labour into which persons are trafficked include domestic services, agriculture (farming), construction, mining/quarrying, fishing, lumbering and manufacturing. Trafficked persons are reported to be exposed to risks like overcrowding, long working hours, psychological problems, physical injuries, impotence, breathing problems and sexually transmitted infections including HIV. It is concluded that the reported occupational hazards in industries where trafficked persons are forced into are not specific to trafficked persons as they affect all labourers. However, the underground nature of the trafficking in persons process increases health problems and risks, including the vulnerability to HIV infection. More tailored research is needed, especially to find means of how to reach out and provide services to this particular vulnerable population, validate labour forms of exploitation into which persons are trafficked to enable the integration or mainstreaming of HIV and AIDS and trafficking in persons at the policy and programmatic levels. In addition, findings would facilitate the understanding of the link between increased risk of IRV and trafficking in persons.

Understanding the Link between Trafficking In Persons and HIV and AIDS Risk in Tanzania

Abstract:The magnitude of trafficking in persons in Tanzania is unknown. Consequently; available information on health risks of persons trafficked for different forms of exploitation is extremely scanty. We conducted a baseline study in eight administrative regions of Tanzania using both qualitative and quantitative methods to generate data on the health conditions of trafficked persons to inform trafficking in persons control measures through HIV and AIDS interventions. Study participants included the national; regional and district community development officers; district medical officers; local government leaders; managers or representatives of non-governmental organizations involved in antitrafficking in persons activities; members of the community and victims. Findings indicated that common forms of labour into which persons are trafficked include domestic services; agriculture (farming); construction; mining/quarrying; fishing; lumbering and manufacturing. Trafficked persons are reported to be exposed to risks like overcrowding; long working hours; psychological problems; physical injuries; impotence; breathing problems and sexually transmitted infections including HIV. It is concluded that the reported occupational hazards in industries where trafficked persons are forced into are not specific to trafficked persons as they affect all labourers. However; the underground nature of the trafficking in persons process increases health problems and risks; including the vulnerability to HIV infection. More tailored research is needed; especially to find means of how to reach out and provide services to this particular vulnerable population; validate labour forms of exploitation into which persons are trafficked to enable the integration or mainstreaming of HIV and AIDS and trafficking in persons at the policy and programmatic levels. In addition; findings would facilitate the understanding of the link between increased risk of HIV and trafficking in persons

Reported human traffickers' profiles: a key step in the prevention of trafficking in persons through HIV and AIDS interventions in Tanzania.

OBJECTIVE: a gap in comprehensive knowledge of trafficking in persons and the traffickers exists globally and in Tanzania in particular. Consequently, information on the profiles of human traffickers in the country is tremendously scanty. METHODS: we conducted a baseline study in eight administrative regions of Tanzania Mainland using both qualitative and quantitative methods to generate data in to inform anti-human trafficking health interventions and programs to be implemented in the country. Study participants included the national, regional and district Community Development Officers, District Medical Officers, local government leaders, managers or representatives of non-governmental organizations involved in anti-trafficking in persons activities, members of the community and victims. RESULTS: different individuals or groups, knowingly or ignorantly, contribute to trafficking in persons and their roles differ at the places of origin, transit and destinations. Traffickers are males or females with varied age, marital status, relationships with victims, socio-economic status, experience and occupations. CONCLUSIONS: active traffickers at many stages of this crime rarely come into contact with the law enforcement system; fled or rescued victims may not be willing or unable to testify against their traffickers and coercing victims to do so could further traumatize them. Further research in needed to generate knowledge on human traffickers' profiles to inform trafficking in persons control programs through HIV and AIDS interventions in Tanzania.

Sexual practices among unmarried adolescents in Tanzania.

BACKGROUND: Sexual activities are increasingly changing from the cultural point of view what they used to be. Knowledge of these practices among adolescents may be a basis to create awareness among adolescents on practices that involve risks. This study aims to assess sexual practices among unmarried adolescents in Tanzania. METHODS: A cross-sectional survey was conducted among in-school and out-of-school but unmarried adolescents aged 10 to 19 in five locations in Tanzania. A questionnaire was used to collect information and to characterize sexual practices among these adolescents. RESULTS: About 32% of adolescents reported being sexually active; a higher proportion being males than females. The only inquired and reported sexual practices include vaginal sex, masturbation, oral and anal sex. About 15% of sexually active adolescents reported having multiple sexual partners. Significantly more males reported having multiple partners than females. Nearly 42% of sexually active adolescents reported having used a condom during most recent sexual act. Females reported older partners at first sexual act. CONCLUSION: Adolescents experience several sexual practices that include penetrative and non-penetrative. More males reported being sexually active than females. Despite adolescents reporting having multiple sexual partners, reported condom use during the most recent sexual act was low. We advocate for a more enhanced approach of reproductive health education that includes safer sex to adolescents without forgetting those in-schools.

Predictors of risky sexual behavior among adolescents in Tanzania.

Studies on sexual behavior among adolescents are fundamental in understanding and fighting against outcomes of unprotected sex that include unplanned/unwanted pregnancies and sexually transmitted diseases. This survey conducted among in- and out-of-schools adolescents measured prevalence of sexual behavior variables, including risky sexual behavior and associated factors. Risky sexual behavior was defined as having first sex before 16 years, inconsistent condom use and having multiple sexual partners. About 30% of adolescents reported being sexually active; a higher proportion being among males than females and 24.5% of sexually active adolescents reported having multiple sexual partners. More males (37%) reported having multiple sexual partners than females (26%). Nearly 48% of unmarried sexually active adolescents reported having used a condom during the most recent sexual intercourse. Predictors of risky sexual behavior were being male, young age (10-14 years) and being inschool. Preventive information and education should take into consideration these factors.

Suicide in the Dar es Salaam region, Tanzania, 2005.

Suicide surveillance was launched at the Muhimbili National Hospital mortuary in Dar es Salaam Region, Tanzania from 1st January to 31st December, 2005 to determine its magnitude and characteristics. Following the WHO guidelines with minor modifications, information on sex, dates of birth and death, places of residence and death, occupation, reasons and means of suicide were collected. There were 65 (2.3 per 100,000 population) suicides recorded in 2005. The suicide rate for males was 3.4/100,000 and for females was 1.2/100,000 which maybe some of the lowest rates ever reported in the world. The mean age at suicide was 32.9 (SD=13.1) years. Males were about three times more likely to commit suicide as females. The main motive behind suicide was recorded for 26 (40%) victims as family-related and for 11 (17%) as health related. Although there was a wide range of ages at which people committed suicide, the average age seems to be very low. Since reasons for suicide are coated with family problems, strategies to improve awareness of psychological and mental health services and to provide alternative economic and social support networks are advocated.

Grandparents' age and the risk of Down's syndrome in Norway.

BACKGROUND: High maternal age is a well-recognized risk factor for Down's syndrome. There are also several studies of a possible effect of paternal age, but no consistent evidence of an association is found. Less is known about any effects of the age of grandparents. Objective. To assess whether maternal or paternal grandparents' age is associated with the risk of Down's syndrome. METHODS: We used logistic regression analyses with data from the Medical Birth Registry of Norway, adjusting for possible confounding factors. RESULTS: We found no evidence of an association with the risk of Down's syndrome either for a maternal grandmother's age (odds ratio 0.9, 95% confidence interval 0.6-1.5 per 10-year increase in grandmother's age) or for any of the other grandparents' age. CONCLUSIONS: High maternal age remains the only well-established age-related risk factor for Down's syndrome. There is little evidence that the increased risk represented by older mothers is passed on to offspring of her non-affected daughters.

Increasing risk of gastroschisis in Norway: an age-period-cohort analysis.

The prevalence of gastroschisis in Norway, as reported to the Medical Birth Registry of Norway, increased regularly and sixfold from 0.5 to 2.9 per 10,000 births during 1967-1998. The prevalence was also consistently higher among children of younger mothers. The authors used age-period-cohort analysis to assess effects of both parents' age and year of birth (parental cohorts). Mother's and father's age were included in three different regression models. Apart from a significantly higher risk at a young maternal age, the authors also found higher risk at a young paternal age (1.6-fold per 10 years' reduction in father's age, 95% confidence interval: 1.0, 2.4). The time trend was highly significant regardless of whether it was ascribed to period, mother's year of birth, or father's year of birth. However, when father's year of birth was used to describe the time trend, no apparent additional effect of father's age was found, only for mother's age. The time trend is likely caused by environmental factors. Persistently increasing risks among children of young mothers may hypothetically be related to lifestyle factors. A contribution to risk also from fathers born in more recent years or from young fathers increases the likelihood that a factor related to modern lifestyles of young couples may be related to risk.

Down's syndrome and paternal age in Norway.

There is strong evidence for an effect of maternal age on the risk of Down's syndrome. An effect of paternal age has been suspected, but so far neither confirmed nor completely excluded. Large population-based data that allow detailed adjustment for maternal age are needed for a definitive analysis of the paternal age effect. We used data from the Medical Birth Registry of Norway recorded from 1967 to 1998. A total of 1738852 children were included in the analysis. A total of 10.3 per 10000 newborns had Down's syndrome. The data were fitted to logistic regression models with careful control for maternal age, birth calendar year and place of birth. When maternal age was adjusted for using categories of 5-year intervals, residual confounding still resulted in a strong effect of paternal age. However, when the shape of the effect of maternal age was well captured by the model, the estimated effect of paternal age was weak (1.11-fold increased risk per 10 years of paternal age, 95% CI of odds ratio 0.99, 1.22) and not statistically significant.