Accelerating COVID-19 Vaccination Among People Living With HIV and Health Care Workers in Tanzania: A Case Study.

BACKGROUND: There is limited evidence on COVID-19 vaccination uptake among people living with HIV (PLHIV) and health care workers (HCWs), with the current evidence concentrated in high-income countries. There is also limited documentation in the published literature regarding the feasibility and lessons from implementing targeted vaccination strategies to reach PLHIV and HCWs in low- and middle-income countries. PROGRAM DEVELOPMENT, PILOTING, AND IMPLEMENTATION: We designed and implemented multifaceted strategies to scale up targeted COVID-19 vaccination among PLHIV and HCWs in 11 administrative regions on the mainland of Tanzania plus Zanzibar. An initial 6-week intensification strategy was implemented using a diverse partnership model comprising key stakeholders at the national- and subnational levels. A layered package of strategies included expanding the number of certified vaccinators, creating vaccination points within HIV clinics, engaging HCWs to address their concerns, and building the capacity of HCWs as "champions" to promote and facilitate vaccination. We then closely monitored COVID-19 vaccination uptake in 562 high-volume HIV clinics. Between September 2021 and September 2022, the proportion of fully vaccinated adult PLHIV increased from <1% to 97% and fully vaccinated HCWs increased from 23% to 80%. LESSONS AND IMPLICATIONS: Our intra-action review highlighted the importance of leveraging a strong foundation of existing partnerships and platforms, integrating COVID-19 vaccination points within HIV clinics, and refining strategies to increase vaccination demand while ensuring continuity of vaccine supply to meet the increased demand. Lessons from Tanzania can inform targeted vaccination of vulnerable groups in future health emergencies.

Prevalence of HIV-1 infection in Zanzibar: results from a national HIV-1 serosurvey 2002.

OBJECTIVE: To determine the prevalence of HIV-1 infection in Pemba and Zanzibar islands METHODS: We used an interviewer-administered questionnaire that consisted of pre-coded and open-ended questions consisting of 29 items. The questionnaire was developed in English and translated into Swahili language before use. The questionnaire was pilot tested and modified before use. A total of 30 Shehias were randomly selected for the survey out of a total of 248 Shehias. A Shehia is the smallest government administrative unit in Pemba and Zanzibar that consists of two to three villages. The study sample was obtained through cluster random sampling of 76 households from each Shehia. Informed consent was sought from the Head of household and from each potential eligible participant. Eligibililty criteria included all persons aged 12 years and above who slept overnight in the selected household at the time of the study. Exclusion criteria included non-residents of Zanzibar and Pemba such as tourists, Informed consent from persons below the age of 18 years were witnessed and ratified by their parents, guardians, caretakers or neighbours. All consenting participants were included in the study sample. Blood sports were collected using filters and tested for HIV-1 using ELISA test at the Zanzibar Reference Laboratory. Samples found positive for ELISA were subjected to a 2nd ELISA test. RESULTS: The total number of persons who participated in the survey was 5852 out of 5868 eligible persons giving the overall response rate of 99.7%. Of the 5852 persons who participated in the survey, 41% (N = 2414) were males and 59% N = 3455) were females. The overall mean age of the study population was 30.4 years with age ranging from 12-65 years. The overall prevalence of HIV-1 infection was 0.6% with more women being significantly affected than men (0.9% versus 0.2%; adjusted OR = 2.88, 95% CI = 1.16-7.12). Of the 5852 persons who participated in the survey, 5.7% admitted having had casual partner in the past 6 months and of these 19.6% reported having used a condom during the most recent casual sex. CONCLUSION: We conclude that HIV-1 infection in Zanzibar is still low and women are more affected than men.

Risk factors for HIV/AIDS in a low HIV prevalence site of sub-Saharan Africa.

We conducted a hospital-based survey on prevalence and risk factors of HIV-1/2 and other viral infections in Zanzibar archipelago. Blood samples, socio-demographic and behavioural data were collected from 2697 patients. The overall HIV prevalence was 2.9%. About 1.4%, 2.1%, 4.2% of antenatal clinic (ANC) attendees and 2.1%, 3.7%, 5.3% of blood donors were, respectively, HIV-Abs-, HTLV-Abs- and HBs-Ag-positive; 5.5% of blood donors were HCV-affected. Co-infections were rare. Exactly 3.4% of the children aged 6-10 years were HIV-positive. People aged 26-35 years [adjusted odds ratio (AOR) 4.4, 95% CI (confidence interval) 1.72-11.22; P = 0.002], illiterate subjects (AOR 3.6, 95% CI 1.65-7.98; P = 0.001) mobile workers (AOR 7.0, 95% CI 1.41-34.62; P = 0.02) and previously operated patients (AOR 1.9, 95% CI 1.02-3.66; P = 0.04) were at higher risk for HIV/AIDS. Any of the examined factors were associated with hepatitis B virus, hepatitis C virus and human T lymphotropic virus type 1/2 transmission. HIV/AIDS prevention strategies must primarily be addressed to traditional high-risk groups and secondarily to unsafe health care procedures in relatively preserved sub-Saharan areas.