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Background: School-based de-worming is advocated as a strategy for reducing the burden of soil-transmitted helminth (STH) infections among children. However, re-infection tends to occur rapidly, suggesting that comprehensive water, sanitation, and hygiene (WASH) improvements may be needed to prevent this. We qualitatively assessed the influence of parental engagement activities on parents' motivation to improve WASH infrastructure and hygiene practices at home in the context of a school-based de-worming programme. Methodology: We conducted a longitudinal qualitative study nested within the Mikono Safi trial, designed to assess the effect of a WASH intervention on STH infection prevalence in children. Meetings were organized for parents/guardians at schools where they were given information about STH infection, the role of WASH in STH infection prevention, and actionable steps they could take at home. During the meetings, parents/guardians received information about their own child's STH infection status. Twenty purposively selected households were visited and interviewed 3 times over a period of about 8-months. We employed thematic analysis; findings are reported following the Capability-Opportunity-Motivation and Behaviour (COM-B) framework. Principal findings: The engagement strategy improved parents'/guardians' knowledge and skills about handwashing with soap and its benefits. Parents/guardians reported that the sessions had motivated them to improve WASH infrastructure at home. Of 20 households included in this study, 17 renovated or built new latrines and 18 installed handwashing facilities. However, only 8 households established and maintained handwashing stations with both soap and water at 8 months. Conclusions: The engagement of parents/guardians in a school-based WASH education intervention as part of the Mikono Safi trial resulted in increased knowledge and motivation about handwashing and sanitation. This led to improvements in sanitation facilities and handwashing opportunities at home. However, long-term success in provision of water and soap was limited, indicating that sustained engagement may be required to encourage households to ensure these materials are consistently available at home. Author summary: School-based de-worming is used to reduce soil-transmitted helminth (STH) infections among children. However, re-infection occurs rapidly. The Mikono Safi trial focused on enabling and motivating children to wash their hands at key times, with the aim to reduce the proportion of children with STH infection. Parents/guardians invited to participate in parental engagement activities at school as part of the trial, were given information on how STHs can be avoided through improved handwashing practices at school and at home. To assess the effect on parental engagement activities, we conducted 20 qualitative interviews with parents/guardians and WASH observation in 20 households. We found that the engagement activities were successful in increasing parents'/guardians' concern about STH infection in their children, which in turn led them to improve handwashing opportunities and practices in the home. However, not all households had improved handwashing facilities at home or ensured that water and soap was available. [ABSTRACT FROM AUTHOR]

Objectives: To quantify the burden of HIV, syphilis and schistosome infection and associated risk factors among adults living in seven fishing communities of Lake Victoria in northwest Tanzania. Methods: Cross‐sectional study conducted between 2015 and 2016 in the selected communities. In each community, we randomly selected a sample of adults from the general population and from three putative risk groups including the following: (i) fishermen, (ii) fish processors and traders, and (iii) women working in the recreational facilities. Participants were interviewed to obtain information about potential risk factors, and venous blood was collected for detection of HIV, syphilis and schistosome infections. We used logistic regression models to quantify the associations between potential risk factors and HIV, and also between schistosome infection and HIV. Results: We enrolled 1128 people from selected fishing communities. The overall prevalence of HIV, syphilis and schistosome infection was 14.2%, 15.6% and 83.1%, respectively. Female recreational facility workers had the highest prevalence of HIV (30.4%) and syphilis (24%). The odds of being HIV infected were generally higher in all age categories. Transactional sex was commonly reported and especially receiving gifts for sex was found to be strongly associated with HIV (adjusted OR = 2.50; 95% CI: 1.44–4.34, P = 0.008). Confirmed serological syphilis was associated with increased odds of having HIV infection. HIV was not associated with schistosome infection in a combined dataset and when we examined this separately for men and women alone. Conclusions: We observed a high burden of HIV, syphilis and schistosome infections in the fishing communities. Targeted efforts to treat and control infections have the potential to improve health among their residents. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) is recognised as an important public health and social problem, with far reaching consequences for women's physical and emotional health and social well-being. Furthermore, controlling behaviour by a partner has a similar impact on women's well-being, yet little is known about the prevalence of this type of behaviour and other related abuses in Tanzania and in other sub-Saharan African countries.Methods: We conducted a cross-sectional study to determine the lifetime and past 12-month prevalence of physical and sexual IPV, economic abuse, emotional abuse and controlling behaviour among ever-partnered women in Mwanza, Tanzania. Women (N = 1049) were enrolled in an ongoing trial (Maisha study) to assess the impact of microfinance combined with gender training on participants' experience IPV, and other related outcomes. Interviews were conducted by same sex interviewers to collect information about socio-demographic characteristics, experiences of specific acts of IPV and abuse, and symptoms of poor mental health status.Results: Overall, about 61% of women reported ever experiencing physical and/or sexual IPV (95% CI: 58-64%) and 27% (95% CI: 24-29%) experienced it in the past 12 months. Partner controlling behaviour was the most prevalent type of abuse with 82% experiencing it in their lifetime and 63% during the past 12 months. Other types of abuses were also common, with 34% of women reporting economic abuse and 39% reporting emotional abuse during the past 12 months. The prevalence of IPV and abuses varied by socio-demographic characteristics, showing much higher prevalence rates among younger women, women with young partners and less educated women. After we adjusted for age and socio-economic status, physical violence (OR = 1.8; 95% CI: 1.3-2.7) and sexual violence (OR = 2.8; 95% CI: 1.9-4.1) were associated with increased reporting of symptoms of poor mental health. Similarly, experience of abuse during the past 12 months was associated with increased reporting of symptoms of poor mental health.Conclusions: The high prevalence of IPV and abuses and its strong links with symptoms of poor mental health underline the urgent need for developing and testing appropriate interventions in settings like Tanzania to tackle both violence and abusive behaviours among intimate partners.Trial Registration: ClinicalTrials.gov - ID NCT02592252 , registered retrospectively on 13 August 2015. [ABSTRACT FROM AUTHOR]

Heroin trafficking and consumption has increased steadily over the past decade in Tanzania, but limited information regarding HIV and drug use exists for the city of Mwanza. Our study investigates the epidemiology of drug use, and HIV risk behaviors among drug users in the northwestern city of Mwanza. Using a combination of targeted sampling and participant referral, we recruited 480 participants in Mwanza between June and August 2014. The sample was 92% male. Seventy-nine (16.4%) participants reported injecting heroin, while 434 (90.4%) reported smoking heroin. Unstable housing and cohabitation status were the only socioeconomic characteristics significantly associated with heroin injection. More than half of heroin injectors left syringes in common locations, and half reported sharing needles and syringes. Other risk behaviors such as lack of condom use during sex, and the use of illicit drugs during sex was widely reported as well. Among the study sample, there was poor awareness of health risks posed by needle/syringe sharing and drug use. Our results show that heroin use and HIV risk related behaviors are pressing problems that should not be ignored in Mwanza. Harm reduction programs are urgently needed in this population. [ABSTRACT FROM AUTHOR]

Objectives: To prepare for future HIV prevention trials, we conducted prospective cohort studies among women working in food and recreational facilities in northern Tanzania. We examined the prevalence and incidence of HIV and HSV-2, and associated risk factors. Methods: Women aged 18–44 years working in food and recreational facilities were screened to determine their eligibility for the studies. Between 2008–2010, HIV-negative women were enrolled and followed for 12 months. At enrolment and 3-monthly, we collected socio-demographic and behavioural data, and performed clinical examinations for collection of biological specimens that were tested for reproductive tract infections. Risk factors for HIV and HSV-2 incidence were investigated using Poisson regression models. Results: We screened 2,229 and enrolled 1,378 women. The median age was 27 years (interquartile range, IQR 22, 33), and median duration working at current facility was 2 years. The prevalences of HIV at screening and HSV-2 at enrolment were 16% and 67%, respectively. Attendance at the 12-month visit was 86%. HIV and HSV-2 incidence rates were 3.7 (95% confidence interval, CI: 2.8,5.1) and 28.6 (95% CI: 23.5,35.0)/100 person-years, respectively. Women who were separated, divorced, or widowed were at increased risk of HIV (adjusted incidence rate ratio, aRR = 6.63; 95% CI: 1.97,22.2) and HSV-2 (aRR = 2.00; 95% CI: 1.15,3.47) compared with married women. Women reporting ≥3 partners in the past 3 months were at higher HIV risk compared with women with 0–1 partner (aRR = 4.75; 95% CI: 2.10,10.8), while those who had reached secondary education or above were at lower risk of HSV-2 compared with women with incomplete primary education (aRR = 0.42; 95% CI: 0.22,0.82). Conclusions: HIV and HSV-2 rates remain substantially higher in this cohort than in the general population, indicating urgent need for effective interventions. These studies demonstrate the feasibility of conducting trials to test new interventions in this highly-mobile population. [ABSTRACT FROM AUTHOR]

Background: Factors related to specific sexual encounters can influence condom use during these encounters. These situation-specific factors have not been adequately studied in resource-poor countries where HIV infection has in some areas reached epidemic levels. This study was undertaken to identify situation-specific factors associated with condom use among 465 female bar and hotel workers in Moshi, Tanzania.Methods: We conducted a case-crossover study in which women provided information about their most recent unprotected and protected sexual encounters. Conditional logistic regression was used to estimate paired odds ratios and 95% confidence intervals for the association between situation-specific factors and condom use.Results: A subject-based or mutual decision about condom use (compared with partner based), casual partner type, a first-time sexual encounter and receiving gifts in exchange for sex were independently associated with increased odds of condom use, while sex at home and sex with a partner more than 10 years older was associated with reduced odds of use. There was also effect modification between partner type and decision-making: subject-based or mutual decisions were more protective with casual than regular partners; also, when the partner made the decisions about condom use, the type of partner had no effect.Conclusions: Decision-making about condom use is a potentially modifiable predictor of unprotected sex, but its effect varies by partner type. Behavioural interventions are needed that encourage discussion about condom use and increase women's self-efficacy, but other types of interventions as well as female-controlled HIV prevention methods are needed for women in regular partnerships. [ABSTRACT FROM AUTHOR]

The article presents a study on the risk factors for sexually transmitted infections (STIs) among women in Zambia, Tanzania, and South Africa. A total of 958 women who were at risk of STIs were enrolled in a prospective study between 2003 and 2004, in which interviews at each monthly visit was conducted, and samples for STI screening were quarterly collected. Results showed South African sites to have the highest percentage of STIs, with independent risk factors including the occurrence of anal sex, age, and sexual behavior. The study concludes that the incidence of STIs in women was high, which calls for an urgent need for effective programs to prevent STIs.

The article discusses a study which examines site preparedness for phase 2/IIb/III HIV prevention trials. The sites studied are Durban and Hlabisa in South Africa, Lusaka in Zambia and Moshi in Tanzania. Preparatory studies provide accurate local estimates of HIV incidence, recruitment and retention rates, and behavioral characteristics of targeted populations.

Background. We examined the role of herpes simplex virus type 2 (HSV-2) and other genital infections on human immunodeficiency virus type 1 (HIV-1) incidence in a cohort study conducted between 2002 and 2005 among female bar/hotel workers in Moshi, Tanzania. Methods. At baseline and every 3 months thereafter, participants were interviewed, and blood and genital samples were collected. Predictors of HIV-1 incidence were evaluated using a Cox proportional hazards regression model. Results. Of 845 women who were HIV-1 seronegative at baseline, 689 (81.5%) were monitored in the study for a total of 698.6 person-years at risk (PYARs). The overall HIV-1 incidence was 4.6/100 PYARs (95% confidence interval [CI], 3.0-6.2/100 PYARs), and condom use was very low. After adjustment for other risk factors, the risk of HIV-1 was increased among women with HSV-2 at baseline (hazard ratio [HR], 4.3 [95% CI, 1.5-12.4]) and in those who acquired HSV-2 during the study period (HR, 5.5 [95% CI, 1.2-25.4]). Other independent predictors of HIV-1 were baseline chlamydial infection (HR, 5.2), bacterial vaginosis (HR, 2.1), and the occurrence of genital ulcers (HR, 2.7). Conclusion. HSV-2 and other genital infections were the most important risk factors for HIV-1. Control of these infections could help to reduce HIV-1 incidence in this population. [ABSTRACT FROM AUTHOR]

The article presents a study on the risk factors for Trichomonas vaginalis infection among women and their male partners in Moshi Urban District, Northern Tanzania. The objective of the study is to know the predictors of T. vaginalis. A total of 1440 women and 588 men were interviewed and specimens for STD and T. vaginalis testing were collected. Having a partner with T. vaginalis is the key risk factor in acquiring such. There is higher prevalence of T. vaginalis in women than with men.

Background: Type-specific serological tests have allowed for a better understanding of the epidemiology of herpes simplex virus type 2 (HSV-2) infection in Africa.Goal: The goal was to determine risk factors for HSV-2 among bar and hotel workers in Moshi, Tanzania.Study Design: A cross-sectional study was conducted involving 515 workers in randomly selected bars and hotels in Moshi.Results: The seroprevalence of HSV-2 was 43.5%. Women were more likely to be HSV-2-seropositive than men (age-adjusted OR = 3.8; 95% CI = 2.5-5.8). In multivariate analyses, age was positively associated with HSV-2 in both women and men. HIV-1-seropositive women had a significantly increased risk of HSV-2 infection (adjusted OR = 2.8; 95% CI = 1.5-5.1). Other predictors of HSV-2 were religion and sexual behavior for women and level of education, frequency of alcohol use, and concurrent partners for men.Conclusion: The most common genital infection was that with HSV-2. Control of HSV-2 might be an important strategy for HIV-1 infection prevention in this population. [ABSTRACT FROM AUTHOR]

Presents a study that determined the prevalence and risk factors for HIV-1 infection among women who were working in the bars and hotels in Moshi, Tanzania. Estimated number of adults and children living with HIV/AIDS worldwide by the end of year 2001; Predictors of HIV-1 infection among women working in the bars and hotels; Rate of prevalence of HIV-1 among women; Several factors associated with HIV-1.

Alcohol use disorders (AUD) among people living with HIV (PLHIV) are associated with poor health outcomes. This cross-sectional study examined current alcohol use and AUD among 300 PLHIV on ART at four HIV care centres in Northwest Tanzania. Participants' data were collected using questionnaires. Alcohol use was assessed using Alcohol Use Disorders Identification Test (AUDIT). Logistic regression was used to examine associations between each outcome (current drinking and AUD) and sociodemographic and clinical factors. Association between alcohol use and ART adherence was also studied. The median age of participants was 43 years (IQR 19-71) and 41.3% were male. Twenty-two (7.3%) participants failed to take ART at least once in the last seven days. The prevalence of current drinking was 29.3% (95% CI 24.2-34.8%) and that of AUD was 11.3% (8.2%−15.5%). Males had higher odds of alcohol use (OR 3.03, 95% CI 1.79-5.14) and AUD (3.89, 1.76-8.60). Alcohol use was associated with ART non-adherence (OR = 2.78, 1.10–7.04). There was a trend towards an association between AUD and non-adherence (OR = 2.91, 0.92–9.21). Alcohol use and AUD were common among PLHIV and showed evidence of associations with ART non-adherence. Screening patients for alcohol use and AUD in HIV clinics may increase ART adherence. [ABSTRACT FROM AUTHOR]

Objective: The goal of this research is to establish the pathways through which romantic jealousy leads to intimate partner violence. Background: Physical and/or sexual intimate partner violence is widespread, with one in four women reporting it globally. Romantic jealousy is a known risk factor for intimate partner violence, yet little is known about the pathways that link it to intimate partner violence, especially in Africa. Method: We used a qualitative design, interviewing 18 adult women in Northern Tanzania to understand their experiences and reflections of intimate partner violence. To grasp the mechanisms through which jealousy can trigger intimate partner violence, our analysis utilizes the concept of hegemonic masculinity. Results: Intimate partner violence and romantic jealousy emerged as major issues in women's lives in this study. We established six pathways linking these variables: women confronting their partners because of infidelity, partners' anger because women confronted their mistress, women refusing to have sex or talk with their partners because they were jealous, male partners failing to control or regulate their emotions and becoming violent, and men feeling that their masculinity is threatened. Conclusion: In this study, intimate partner violence against women was largely men's reaction to their interpretation of perceived triggers of romantic jealousy and emotions as a threat to their masculinity and dominance. Implications: Interventions aiming to prevent intimate partner violence need to address the pathways linking the violence to romantic jealousy and include this connection in their programming. [ABSTRACT FROM AUTHOR]

Key Points: Question: Can a linkage case management intervention decrease mortality among people with HIV in Tanzania during the first year after hospital discharge? Finding: In this randomized clinical trial that involved 500 hospitalized people with HIV, a linkage case management intervention did not reduce 12-month mortality (17.2% with intervention vs 16.8% with standard care; hazard ratio, 1.01; 95% CI, 0.66-1.55; P =.96). Meaning: Among hospitalized people with HIV, linkage case management did not reduce 12-month mortality. Importance: Despite the widespread availability of antiretroviral therapy (ART), people with HIV still experience high mortality after hospital admission. Objective: To determine whether a linkage case management intervention (named "Daraja" ["bridge" in Kiswahili]) that was designed to address barriers to HIV care engagement could improve posthospital outcomes. Design, Setting, and Participants: Single-blind, individually randomized clinical trial to evaluate the effectiveness of the Daraja intervention. The study was conducted in 20 hospitals in Northwestern Tanzania. Five hundred people with HIV who were either not treated (ART-naive) or had discontinued ART and were hospitalized for any reason were enrolled between March 2019 and February 2022. Participants were randomly assigned 1:1 to receive either the Daraja intervention or enhanced standard care and were followed up for 12 months through March 2023. Intervention: The Daraja intervention group (n = 250) received up to 5 sessions conducted by a social worker at the hospital, in the home, and in the HIV clinic over a 3-month period. The enhanced standard care group (n = 250) received predischarge HIV counseling and assistance in scheduling an HIV clinic appointment. Main Outcomes and Measures: The primary outcome was all-cause mortality at 12 months after enrollment. Secondary outcomes related to HIV clinic attendance, ART use, and viral load suppression were extracted from HIV medical records. Antiretroviral therapy adherence was self-reported and pharmacy records confirmed perfect adherence. Results: The mean age was 37 (SD, 12) years, 76.8% were female, 35.0% had CD4 cell counts of less than 100/μL, and 80.4% were ART-naive. Intervention fidelity and uptake were high. A total of 85 participants (17.0%) died (43 in the intervention group; 42 in the enhanced standard care group); mortality did not differ by trial group (17.2% with intervention vs 16.8% with standard care; hazard ratio [HR], 1.01; 95% CI, 0.66-1.55; P =.96). The intervention, compared with enhanced standard care, reduced time to HIV clinic linkage (HR, 1.50; 95% CI, 1.24-1.82; P <.001) and ART initiation (HR, 1.56; 95% CI, 1.28-1.89; P <.001). Intervention participants also achieved higher rates of HIV clinic retention (87.4% vs 76.3%; P =.005), ART adherence (81.1% vs 67.6%; P =.002), and HIV viral load suppression (78.6% vs 67.1%; P =.01) at 12 months. The mean cost of the Daraja intervention was about US $22 per participant including startup costs. Conclusions and Relevance: Among hospitalized people with HIV, a linkage case management intervention did not reduce 12-month mortality outcomes. These findings may help inform decisions about the potential role of linkage case management among hospitalized people with HIV. Trial Registration: ClinicalTrials.gov Identifier: NCT03858998 This randomized trial assesses whether a linkage case management intervention reduces 12-month mortality compared with enhanced standard care among people with HIV not taking antiretroviral therapy (ART) who were hospitalized for any reason. [ABSTRACT FROM AUTHOR]

Introduction: Women in fishing communities have both high HIV prevalence and incidence, hence they are a priority population for HIV prevention and treatment interventions. However, their mobility is likely to compromise the effectiveness of interventions. We assessed the acceptability, feasibility and of using phones and global positioning system (GPS) devices for tracking mobility, to inform future health research innovations. Methods: A mult-site formative qualitative study was conducted in six purposively selected Fishing Communities on the shores of Lake Victoria in Kenya, Tanzania, and Uganda. Participants were selected based on duration of stay in the community and frequency of movement. Sixty-four (64) women participated in the study (16 per fishing community). Twenty-four (24) participants were given a study phone; 24 were asked to use their own phones and 16 were provided with a portable GPS device to understand what is most preferred. Women were interviewed about their experiences and recommendations on carrying GPS devices or phones. Twenty four (24) Focus Group Discussions with 8–12 participants were conducted with community members to generate data on community perceptions regarding GPS devices and phones acceptability among women. Data were analyzed thematically and compared across sites/countries. Results: Women reported being willing to use tracking devices (both phones and GPS) because they are easy to carry. Their own phone was preferred compared to a study phone and GPS device because they were not required to carry an additional device, worry about losing it or be questioned about the extra device by their sexual partner. Women who carried GPS devices suggested more sensitization in communities to avoid domestic conflicts and public concern. Women suggested changing the GPS colour from white to a darker colour and, design to look like a commonly used object such as a telephone Subscriber Identity Module (SIM) card, a rosary/necklace or a ring for easy and safe storage. Conclusion: Women in the study communities were willing to have their movements tracked, embraced the use of phones and GPS devices for mobility tracking. Devices need to be redesigned to be more discrete, but they could be valuable tools to understanding movement patterns and inform design of interventions for these mobile populations. [ABSTRACT FROM AUTHOR]

Low adherence in vaginal microbicide clinical trials for HIV prevention has impeded interpretation of trial results and hindered evaluation of potentially efficacious HIV prevention gels. Understanding the underlying reasons why women join trials and their barriers to product use can support identification of ways to improve adherence and its reporting. Eight focus group discussion workshops were conducted with 46 former microbicide trial participants in Durban, South Africa and Mwanza, Tanzania. Participants provided feedback on why women join trials, the barriers to using study gel and reporting adherence accurately, and how clinical trial design can be improved to support better adherence and its reporting. Women join microbicide trials for a number of important reasons such as healthcare and financial reimbursement. Fear of adverse effects from the investigational product was the most important reason why participants reported not using the gel. The key reason for inaccurate reporting of gel use was fear of removal from the trial. Participants made concrete suggestions for improving microbicide trial design such as applicator use testing and real time feedback, improving education to participants about how trials answer their research questions, and improving transparency and clarity about study procedures. Participants also gave feedback on an innovative trial design with a non-randomised arm. Identifying HIV prevention products for women requires better understanding of the lives of women asked to join these trials, and application of that understanding to microbicide trial design. This study has demonstrated that participants and research teams can work collaboratively to design clinical trials that meet needs of both the research and of participants. [ABSTRACT FROM AUTHOR]

Background: Low adherence has contributed to disappointing results for trials testing vaginal microbicides for HIV prevention. This study engaged former gel trial participants to understand the reasons behind low adherence and seek suggestions on how to improve products and adherence to microbicides. This analysis examines the impact of participant perceptions of male partners on participant adherence and suggestions on how to address those issues. Methods: Eight focus group discussion workshops were conducted with 46 former microbicide trial participants in South Africa and Tanzania. Participants provided feedback on why women join trials, barriers to using gels and reporting adherence accurately, and how adherence and adherence reporting can be improved. Results: Participants reported that male partners can affect women's ability to use gels. For some, the lubricating effects caused relationship conflicts due to suspicion of male partners about infidelity. Needing to provide sex to partners on demand was a barrier to gel use. Participants suggested a gel formulation which was thicker and less noticeable, and explicit male partner engagement to enhance understanding of the purpose of the gels. Conclusions: The imbalance of power in intimate relationships affects the ability of women to use microbicides as directed. To improve adherence to HIV prevention methods within trials and for successful rollout of proven HIV prevention methods in populations, it is important that the complicated dynamics of sex and relationships be taken into greater consideration and that women receive targeted support to navigate product use and communication within the context of these gender dynamics. [ABSTRACT FROM AUTHOR]

Measuring hope reliably and accurately remains an important research objective, not least in less prosperous settings where 'holding on to hope' may be critically important in the struggle against adverse life conditions. The State Hope Scale was designed for use in the US. Despite reported application in diverse cultures and using translations the scale has not been extensively validated outside US populations. This study contributes to a larger project exploring the measurement of hope and provides a critique of Snyder's scale as used in a Tanzanian female population of 1021 urban microfinance participants. We evaluate the scale's validity through assessment of the empirical distribution of scores, item response profiles, internal consistency and discriminatory ability. Participants mostly scored very high and many reached very near the maximum attainable score. Hardly any endorsed the negative half of the response scale. Several problems are discussed including poor discrimination and strong evidence of acquiescence response bias. We also found little association of the scale scores with hypothesised correlates of hope. Future improvements on the measurement of hope are recommended, especially in studies outside the narrow Western context in which the scale was devised. [ABSTRACT FROM AUTHOR]

Background: The use of primaquine for mass drug administration (MDA) is being considered as a key strategy for malaria elimination. In addition to being the only drug active against the dormant and relapsing forms of Plasmodium vivax, primaquine is the sole potent drug against mature/infectious Plasmodium falciparum gametocytes. It may prevent onward transmission and help contain the spread of artemisinin resistance. However, higher dose of primaquine is associated with the risk of acute haemolytic anaemia in individuals with a deficiency in glucose-6-phosphate dehydrogenase. In many P. falciparum endemic areas there is paucity of information about the distribution of individuals at risk of primaquine-induced haemolysis at higher dose 45 mg of primaquine. Methods: A retrospective cross-sectional study was carried out using archived samples to establish the prevalence of G6PD deficiency in a malaria hotspot area in Misungwi district, located in Mwanza region, Tanzania. Blood samples collected from individuals recruited between August and November 2010 were genotyped for G6PD deficiency and submicroscopic parasites carriage using polymerase chain reaction. Results: A total of 263 individuals aged between 0 and 87 were recruited. The overall prevalence of the X-linked G6PD A− mutation was 83.7% (220/263) wild type, 8% (21/263) heterozygous and 8.4% (22/263) homozygous or hemizygous. Although, assessment of the enzymatic activity to assign the phenotypes according to severity and clinical manifestation as per WHO was not carried out, the overall genotype and allele frequency for the G6PD deficiency was 16.4% and 13. 2%, respectively. There was no statistically significant difference in among the different G6PD genotypes (p > 0.05). Out of 248 samples analysed for submicroscopic parasites carriage, 58.1% (144/248) were P. falciparum positive by PCR. G6PD heterozygous deficiency were associated with carriage of submicroscopic P. falciparum (p = 0.029). Conclusions: This study showed that 16.4% of the population in this part of North-western Tanzania carry the G6PD A− mutation, within the range of 15–32% seen in other parts of Africa. G6PD gene mutation is widespread and heterogeneous across the study area where primaquine would be valuable for malaria control and elimination. The maps and population estimates presented here reflect potential risk of higher dose of primaquine being associated with the risk of acute haemolytic anaemia (AHA) in individuals with a deficiency in glucose-6-phosphate dehydrogenase and call further research on mapping of G6PD deficiency in Tanzania. Therefore, screening and education programmes for G6PD deficiency is warranted in a programme of malaria elimination using a higher primaquine dose. [ABSTRACT FROM AUTHOR]

Food insecurity is a potential predictor of intimate partner violence. This study (1) describes the prevalence of food insecurity and various forms of intimate partner violence experience among women in Mwanza, Tanzania; and (2) assesses the effect of food insecurity and hunger on various forms of women's experience of intimate partner violence longitudinally. Women (aged 18–70 years) who reported being in a relationship in the past 12 months, who had participated in the control arms of two randomized controlled trials conducted as part of the MAISHA study were interviewed at four time points (N=1,004 at baseline in 2017). Analyses were conducted in 2022. Associations between food insecurity exposures and intimate partner violence outcomes were assessed, and univariate random effect logistic models were conducted to identify relevant sociodemographic variables (including age, education level, and SES) that were statistically significant. Multivariable random effects logistic models were conducted, including time as a fixed effect, to calculate odds ratios indicating associations between food insecurity exposures and intimate partner violence outcomes. Prevalence of food insecurity was 47.7%, 55.6%, 47.2%, and 50.8% for each of the 4 waves, respectively, with significant difference in proportion of food insecurity between baseline and Wave 2. Multivariable random effects models indicated that food insecurity was associated with increased odds of exposure to all forms of intimate partner violence outcomes, and hunger was significantly associated with increased odds of experience of all intimate partner violence outcomes, apart from controlling behaviors. Results from this longitudinal analysis of food insecurity and women's reports of intimate partner violence experience in a low- and middle-income country setting indicate that food insecurity is significantly associated with all forms of intimate partner violence, apart from controlling behaviors, among women in this sample in Mwanza, Tanzania. Policy and programmatic implications include the need for integrated intimate partner violence prevention programming to take into account household food needs. [ABSTRACT FROM AUTHOR]

Background: Routine adolescent health screening aiming at the detection of unnoticed medical problems may increase awareness among policy makers and contribute to improved health in this population. Research is needed to inform the World Health Organization (WHO) and national health programs to provide evidence-based guidance on whether public health systems should offer comprehensive adolescent health screening, what should be included in different contexts, and how it should be delivered. We conducted formative research to define the content and delivery strategies for health check-ups to be performed in young (10–14 years) and older (15–19 years) adolescents, and to assess whether such services are likely to be acceptable and feasible in Tanzania. Methods: As part of a collaborative research program coordinated by WHO in Chitungwiza, Zimbabwe; Mwanza City, Tanzania; and Cape Coast, Ghana a series of key informant interviews were conducted from April to July 2020, using a semi-structured guide with purposively selected stakeholders from government departments, non-governmental and community-based organisations, schools and health facilities. Data transcripts were coded using NVivo 12 software and thematic analysis was performed. Results: We report results from 31 key informant interviews to address four main domains: proposed health conditions for routine health check-ups, health interventions to be combined with such check-ups, preferable venues, and the mode for delivering such screening activities. Stakeholders were supportive of introducing routine health check-ups among adolescents. They recommended focusing on non-communicable diseases, physical disabilities, common mental health problems, reproductive health problems, specific communicable diseases, and hygiene-related problems. They also recommended combining counselling and family planning information with these check-ups. Three venues were proposed: schools, community settings (to reach out-of-school adolescents), and youth-friendly health facilities (for conditions requiring a high level of confidentiality). Conclusions: Stakeholders were supportive of the proposed routine health check-ups for adolescents, recommending specific health conditions to be screened for in both community and school settings. Based on the above, we plan to conduct implementation research to determine the number of new treatable conditions detected, and the costs of offering such services. In the longer term, evaluation of their health impact and cost-effectiveness will be required to guide policy. [ABSTRACT FROM AUTHOR]

Romantic jealousy is a prominent trigger for intimate partner violence. Yet, there are few studies on this relationship in sub-Saharan Africa and none captures men's perspectives. To expand the existing knowledge on romantic jealousy and its relation to intimate partner violence, our study analyzed 30 in-depth interviews with male participants. Triggers of romantic jealousy included suspicion or confirmed infidelity, reduced attention from their partners, and challenges to male supremacy. Men reported that intimate partner violence was a frequently used response to triggers of romantic jealousy. Social norms and inequitable gender norms were key underlying factors to all those triggers. [ABSTRACT FROM AUTHOR]

In this qualitative study of women participating in an intimate partner violence (IPV) prevention trial, experiences of IPV and the context that shapes support-seeking were explored through in-depth interviews and focus groups discussions. Decisions to seek support were influenced by a range of factors including fear of further abuse, shame, acceptance of IPV as normal, belief that IPV is a private matter between the couple, economic dependence on male partners, and a poorly responsive legal and justice system. Gender empowerment programs need to intervene at the social, cultural, political, and economic levels that shape justification and meanings attached to IPV and women's decisions in seeking support. [ABSTRACT FROM AUTHOR]

Background: Data on the burden of dysglycemia among HIV-infected patients on antiretroviral therapy (ART) in Africa are limited. We determined the prevalence of pre-diabetes and diabetes among HIV-infected patients who started ART when malnourished 2 to 3 years previously and investigated the association of dysglycemia with body composition.Methods: Malnourished (body mass index (BMI) < 18.5 kg/m2) HIV-infected patients who were enrolled in the Nutritional Support for Africans Starting Antiretroviral Therapy (NUSTART) trial from 2011 to 2013 were followed-up from March to August 2015. Anthropometric, fat mass and fat-free mass by bioelectrical impedance, and C-reactive protein (CRP) data were collected at baseline and follow-up. At follow-up, we defined fasting glucose of 6.1-6.9 mmol/L as impaired fasting glucose (IFG) and 2-h oral glucose tolerance test (OGTT) glucose of ≥7.8 to <11.1 mmol/L as impaired glucose tolerance (IGT). Both of these were considered pre-diabetes. Fasting glucose of ≥7.0 mmol/L or impaired glucose tolerance of ≥11.1 mmol/L was defined as diabetes mellitus. The relation of pre-diabetes and diabetes with body composition was assessed using logistic regression.Results: Two hundred seventy-three (57%) of 478 patients who were alive at trial conclusion were followed-up. The mean age was 41.5 (SD 9.8) years and 65.2% (178) were females. The mean follow-up BMI was 19.9 (SD 2.8) kg/m2, 12 (4.4%) were either overweight or obese, and 61 (22.3%) patients had pre-diabetes or diabetes. In multiple regression, upper tertiles of baseline hip circumference (OR: 0.41, 95% CI: 0.2, 0.8) and fat mass index (OR: 0.20 (0.1, 0.5), and upper tertiles of follow-up waist circumference (OR: 0.22 (0.1, 0.5), BMI (OR: 0.32 (0.1, 0.7), fat mass index (OR: 0.19 (0.1, 0.5) and the middle tertile of follow-up fat-free mass (OR: 0.36, 95% CI: 0.1, 0.8) were associated with lower risk of pre-diabetes and diabetes (P < 0.05 for all). Baseline and follow-up CRP were not predictors.Conclusions: Low rather than high measures of adipose tissue were associated with increased risk of pre-diabetes and diabetes. Additional studies are needed to further investigate the role of body composition and control of glucose metabolism in the pathogenesis of diabetes among persons living with HIV in Africa. [ABSTRACT FROM AUTHOR]

Background: Globally, helminth infections and cardiometabolic diseases often overlap in populations and individuals. Neither the causal relationship between helminth infections and cardiometabolic diseases nor the effect of helminth eradication on cardiometabolic risk have been reviewed systematically in a large number of human and animal studies. Methods: We conducted a systematic review assessing the reported effects of helminth infections and anthelmintic treatment on the development and/or severity of cardiometabolic diseases and risk factors. The search was limited to the most prevalent human helminths worldwide. This study followed PRISMA guidelines and was registered prospectively in PROSPERO (CRD42021228610). Searches were performed on December 10, 2020 and rerun on March 2, 2022 using Ovid MEDLINE ALL (1946 to March 2, 2022), Web of Science, Cochrane Library, Global Index Medicus, and Ovid Embase (1974 to March 2, 2022). Randomized clinical trials, cohort, cross-sectional, case-control, and animal studies were included. Two reviewers performed screening independently. Results: Eighty-four animal and human studies were included in the final analysis. Most studies reported on lipids (45), metabolic syndrome (38), and diabetes (30), with fewer on blood pressure (18), atherosclerotic cardiovascular disease (11), high-sensitivity C-reactive protein (hsCRP, 5), and non-atherosclerotic cardiovascular disease (4). Fifteen different helminth infections were represented. On average, helminth-infected participants had less dyslipidemia, metabolic syndrome, diabetes, and atherosclerotic cardiovascular disease. Eleven studies examined anthelmintic treatment, of which 9 (82%) reported post-treatment increases in dyslipidemia, metabolic syndrome, and diabetes or glucose levels. Results from animal and human studies were generally consistent. No consistent effects of helminth infections on blood pressure, hsCRP, or cardiac function were reported except some trends towards association of schistosome infection with lower blood pressure. The vast majority of evidence linking helminth infections to lower cardiometabolic diseases was reported in those with schistosome infections. Conclusions: Helminth infections may offer protection against dyslipidemia, metabolic syndrome, diabetes, and atherosclerotic cardiovascular disease. This protection may lessen after anthelmintic treatment. Our findings highlight the need for mechanistic trials to determine the pathways linking helminth infections with cardiometabolic diseases. Such studies could have implications for helminth eradication campaigns and could generate new strategies to address the global challenge of cardiometabolic diseases. Author summary: Helminth infections are caused by parasitic worms and affect over 1.5 billion people worldwide. Helminth infections and cardiometabolic diseases are both common and overlap with one another in many parts of the world. Studies have separately examined the relationship between helminth infections and various cardiometabolic diseases, but the relationships overall, as well as the impact of treatment of parasitic worms, have not been studied systematically. The authors conducted a systematic review to assess the impact of helminth infections, and treatment of helminth infections, on cardiometabolic diseases and risk factors. Eighty-four total studies were analyzed and included in the final review. People and animals infected with helminths were generally found to have fewer cardiometabolic disease risk factors including better overall cholesterol profiles, less diabetes, and less atherosclerotic heart disease than uninfected study participants. After treatment of helminth infections, participants frequently experienced worsening in those cardiometabolic measurements. There were no consistent effects of helminth infections on blood pressure, high-sensitivity CRP (an inflammatory marker), or other cardiac function. In summary, helminth infections may offer protection against certain cardiometabolic diseases and risk factors. More studies are needed to elucidate the pathways linking helminth infections with cardiometabolic diseases as it may impact how we treat both disease processes in regions where both are prevalent. [ABSTRACT FROM AUTHOR]

Although alcohol consumption is a well-known risk factor for intimate partner violence (IPV) perpetration, few studies have been conducted among young males in low- and middle-income countries. Alcohol consumption and IPV are both complex phenomena, whose association requires more in-depth exploration regarding drinking patterns and the alcohol-related manifestation of five different forms of IPV. In this study, we sought to explore the relationship between alcohol use and IPV in young Tanzanian men and to identify differences in the magnitude of past-year IPV perpetration among alcohol drinkers and abstainers. Furthermore, we aimed to assess the association between various drinking patterns with the perpetration of different forms of IPV. A cross-sectional survey of 1002 young males residing in Mwanza, Tanzania, was conducted in 2021–2022. Data on alcohol consumption were collected using the alcohol use disorder identification test. IPV perpetration was assessed using an index total of 19 items on acts of physical, sexual, economic, emotional abuse, and controlling behaviour. Logistic regression models were conducted to estimate the relationship between alcohol use and the perpetration of each form of IPV. Among partnered respondents currently consuming alcohol (n = 189, 18.8%), the most and the least prevalent IPV forms in the past 12 months were controlling behaviour (84.1%) and physical IPV (25.4%), respectively. Those reporting recent alcohol consumption reported higher rates of all forms of past-year IPV perpetration compared to abstainers. While no form of IPV was associated with low-risk consumption versus abstention, all forms of IPV were associated with hazardous drinking. Young men who drink alcohol, especially those drinking hazardously, are also more likely to report perpetrating IPV. An understanding of the different drinking patterns and manifestations of forms of IPV can contribute to better-tailored alcohol-related interventions and has the potential to improve young adults' health and reduce IPV perpetration. [ABSTRACT FROM AUTHOR]

Background: Population mobility is a demonstrated barrier to reducing HIV incidence. A clear understanding of social networks and their influence on mobility among women in the fishing communities of Lake Victoria may contribute to tailoring effective interventions that suit the needs of these mobile women. Methods: A cross-sectional qualitative methods study was conducted to understand mobility patterns among women resident and or working in fishing communities of Lake Victoria in Kenya, Tanzania, and Uganda. The study was conducted in six fishing communities from March 2018 to June 2019. The communities were purposively selected, based on population size (1000 people or more) and HIV prevalence of > 15% among women aged 18 years or older who had lived in the fishing community for at least six months. In-depth interviews were conducted with 24 key informants and 72 women from the sites in the three countries. Questions focused on women’s social networks and other factors that fuelled or facilitated women’s mobility as well as challenges they faced due to mobility. Data analysis followed a thematic framework approach. Results: Different social groupings/networks existed among women in the fishing communities of Lake Victoria. These included female sex workers, women fish processors/traders, women bar workers/owners, restaurant workers, and family networks. Networks encouraged mobility, supporting finding work opportunities, but also increased sexual risks through partner changes. The benefits of networks included information sharing, financial support, and group protection, especially against violence. Conclusion: Social networks and groupings among women in the fishing communities of Lake Victoria could be useful in tailoring HIV prevention and HIV care interventions to suit the needs of these highly mobile populations. [ABSTRACT FROM AUTHOR]

Adolescence is a crucial phase in life, when foundations are established for future health. Therefore, supporting adolescents is necessary to meet the sustainable development goals by 2030. Evidence on the intergenerational transmission of poverty, education and violence suggests that to improve adolescents' well-being, the broader context in which they grow up needs to be understood when developing programmes and approaches to improve their lives. Our study explored intergenerational factors and early childhood influences on adolescent education, employment and parenthood, using the fourth wave of the MAISHA longitudinal study. This study took place in 2016–2021 among 986 adult women in Mwanza, Tanzania, including questions answered by the women on their adolescent's (aged 13–18) education, employment and parenthood, as well as their participation in early childhood programmes, education attainment and other socio-economic variables. Among the 577 mothers in our analysis who had adolescents living in their households, 32% reported that their adolescents did not attend secondary school, 11% were employed, 4% were pregnant or parents. For adolescents in secondary school, 15% ever failed a grade and 10% missed school more than 2 weeks in the last term. Grandparents' not having secondary education was significantly associated with adolescents not attending secondary education and being employed. Living in a female-headed household and mother's experience of intimate partner violence was associated with adolescent early employment. Early childhood influences showed no impact on any outcome in the multivariate analysis. Overall, we report a strong intergenerational impact of education on adolescent outcomes, suggesting the adoption of a strong policy focus on the provision of secondary education for both men and women due to its long-lasting effect. Interventions aimed at improving adolescent outcomes need to be long-term and invest in whole family poverty reduction measures. [ABSTRACT FROM AUTHOR]

In 2014, there were 1.8 billion young people aged 10–24 years globally, 16% of whom live in sub-Saharan Africa. Young people are met with significant technological advancement but also constraints in securing stable livelihoods and broader cultural and societal changes. While praised for their ingenuity and resourcefulness, young people also face high expectations and judgment, both in terms of their capacity to contribute to their communities and in maintaining the moral and societal fabric. We conducted a photovoice exercise with 16 adult men aged 22 to 42 in Mwanza, Tanzania. After two days of training, participants were given nine days to take pictures of their family lives, activities outside their home and what is important to them. Thereafter, they were asked to choose, rank and provide captions for 25 photos and interviewed about their choices. The interviews were recorded, summarised, and analysed thematically. Young people, capturing anyone from a teenager to a 25-year-old, emerged as a key theme in all interviews and photographs. Other key themes in relation to young people were livelihood opportunities, with a strong connotation on 'hard work'; education, with an emphasis on the importance of letting young people attend school; gender equality in respect to fair distribution of household chores and women working to supplement family income; recreational activities and challenging environments for young men, capturing bad nutrition, poor road conditions, harmful work and living conditions, as well as decaying morals. Overall, adult participants both admired young men and women for their energy and innovation while also expecting them to prescribe to existing moral and community standards. Understanding the high expectations and concerns of adults and how those shape the environment in which young people transition into adulthood is key to develop programmes for young people by considering their local context. [ABSTRACT FROM AUTHOR]

The use of mobile phones and other communication technologies is booming in low-income contexts. Yet there is lack of detailed analyses of their impact to social interactions, including intimate relationships between men and women and gender-based violence. Drawing on Bourdieu's concepts of habitus and field, we argue that mobile phones reproduce gender inequality and negative masculinities in these relationships. This happens through the diverse use of phones, and the interactive interface of the physical, electronic and social spaces within the broader social and economic context. We analyzed 48 in-depth interviews with men and women in Mwanza, Tanzania to explore how mobile phone use reproduces entrenched masculinities, gender norms, and power struggles in their daily lives and social interactions. Intimate partners navigate these complexities in several ways, including by creating 'private spaces' through their phones and concealing their communications. Men draw on negative masculinities to dominate their partner's phone use, while women engage social recognition and family custodianship to influence their partner's behaviour. These endeavours redefine concepts such as love and care, trust and faithfulness in the relationships. It is crucial to assess how technological advances are transforming intimate relationships and impacting gender-based violence in low-income countries. [ABSTRACT FROM AUTHOR]

Background: Pregnancy among study participants remains a challenge for trials of new HIV prevention agents despite promotion and provision of contraception. We evaluated contraceptive use, pregnancy incidence, and study drug adherence by contraceptive method among women enrolled in the FEM-PrEP trial of once-daily oral tenofovir disoproxil fumarate and emtricitabine (TDF-FTC) for HIV prevention. Methods: We required women to be using effective non-barrier contraception at enrollment. At each monthly follow-up visit, women were counseled on contraceptive use and tested for pregnancy. TDF-FTC adherence was determined by measuring plasma drug concentrations at 4-week intervals. We used Cox proportional hazards models to assess factors associated with incident pregnancy and multivariate logistic regression to examine the relationship between contraceptive method used at enrollment and TDF-FTC adherence. Results: More than half of women were not using effective contraception before enrollment. Ninety-eight percent of these women adopted either injectable (55%) or oral (43%) contraceptives. The overall pregnancy rate was 9.6 per 100 womanyears. Among injectable users and new users of combined oral contraceptives (COCs), the rates were 1.6 and 35.1, respectively. New users of injectables had significantly greater odds of adhering to TDF-FTC than new COC users [odds ratio (95% confidence interval): 4.4 (1.7 to 11.6), P = 0.002], existing COC users [3.1 (1.3 to 7.3), P = 0.01], and existing injectable users [2.4 (1.1 to 5.6), P = 0.04]. Conclusions: Women using COCs during FEM-PrEP, particularly new adopters, were more likely to become pregnant and less likely to adhere to study product than injectable users. HIV prevention trials should consider requiring long-acting methods, including injectables, for study participation. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) against women is pervasive throughout the world, with profound consequences for women's health. Research to understand the extent, causes and consequences of IPV relies on self-reported data on violence, and yet there is a paucity of research into the consistency with which women report lifetime IPV over time.Methods: We use data from the control group of the cluster randomised trial and a follow-on longitudinal study in Tanzania to examine discrepancies in women's reported experience of lifetime physical IPV and sexual IPV over three time-points (T0, T29, T53 months). Among those reporting lifetime history of IPV at T0, we calculate the proportion who subsequently report no lifetime history at T29 and/or T53 ('discrepant' reporting). We use logistic regression to explore associations between discrepant reporting and respondent baseline characteristics, the nature of their IPV experiences at baseline, and situational factors at T53.Results: Complete IPV data were available for 301 women. At T0, 154 (51%) women reported lifetime history of physical IPV, of whom 62% gave a discrepant 'never' report in a subsequent round. Among 93 (31%) with lifetime history of sexual IPV at T0, 73% provided a subsequent discrepant report. 73% of women reported lifetime physical IPV, and 55% lifetime sexual IPV in at least one survey round. For both IPV outcomes, women were less likely to provide discrepant reports if they had recent IPV at baseline, poor mental health (T53) and poor communication with partner (T53). For physical IPV only, reduced discrepant reporting was also associated with baseline household-level financial hardship and more severe or extensive experience of IPV.Conclusions: A large proportion of women provided discrepant reports over the course of the study. Prevalence estimates of lifetime IPV from one-off cross-sectional surveys are likely to be underestimates, biased towards more recent and severe cases. To improve the stability of IPV measures, researchers should explicitly clarify the meaning of reference periods such as 'ever', consider using shorter reference periods (e.g. past-year), and avoid filter questions that use positive reports of lifetime IPV as a gateway to asking about more recent experiences.Trial Registration: Maisha CRT01 registered at ClinicalTrials.gov #NCT02592252, registered retrospectively (13/08/2015). [ABSTRACT FROM AUTHOR]

Purpose: Depression and suicidal thoughts are associated with intimate partner violence, a major public health problem. Yet little is known about this association among young men in sub-Saharan Africa. This study aims to investigate the relationship between depression, suicidal thoughts and intimate partner violence perpetration, among young men in Tanzania from a representative community-based sample.We conducted a cross sectional survey among 1002 young men aged between 18 and 24 years residing in Mwanza city, Tanzania. Participants were randomly selected from 6 wards that included 3 densely and 3 sparsely populated wards from the Ilemela and Nyamagana districts that were selected using a probability-based multi-stage cluster sampling approach. We collected data on participant’s socio-demographics, depression symptoms using the PHQ9, suicidal thoughts, other psychosocial factors, and perpetration of different forms of intimate partner violence. Analysis was done using Stata version 17.0 and restricted to 828 participants who self-reported being in intimate relationships in the past twelve months. Bivariate and multivariable logistic regression models were employed to determine the association between the outcome variables with intimate partner violence perpetration and other psychosocial factors.Out of 828 young men, 333(40.2%) reported depressive symptoms and 93(11.9%) suicidal thoughts, with 725(87.6%) reporting ever perpetrating any form of intimate partner violence and 653(78.9%) reporting it in the past 12 months. After adjusting for other factors in multivariable models, depressive symptoms were significantly associated with sexual intimate partner violence perpetration (aOR = 2.19, 95%CI = 1.57, 3.04), economic intimate partner violence perpetration (aOR = 1.32 95%CI = 1.01, 1.74), emotional intimate partner violence perpetration (aOR = 1.76, 95%CI = 1.26, 2.46) and controlling behaviours (aOR = 1.46 95%CI = 1.10, 1.93).Depression is a common health problem strongly associated with intimate partner violence perpetration in this study population. Effective interventions to address depression and other mental health problems may help to reduce intimate partner violence perpetration in this population.Researchers and practitioners should develop theory-based research and intervention programmes to address mental health problems such as depression and suicidal thoughts and the perpetration of intimate partner violence. The socio-ecological framework provides an insightful model for multiple level analysis and intervention.Methods: Depression and suicidal thoughts are associated with intimate partner violence, a major public health problem. Yet little is known about this association among young men in sub-Saharan Africa. This study aims to investigate the relationship between depression, suicidal thoughts and intimate partner violence perpetration, among young men in Tanzania from a representative community-based sample.We conducted a cross sectional survey among 1002 young men aged between 18 and 24 years residing in Mwanza city, Tanzania. Participants were randomly selected from 6 wards that included 3 densely and 3 sparsely populated wards from the Ilemela and Nyamagana districts that were selected using a probability-based multi-stage cluster sampling approach. We collected data on participant’s socio-demographics, depression symptoms using the PHQ9, suicidal thoughts, other psychosocial factors, and perpetration of different forms of intimate partner violence. Analysis was done using Stata version 17.0 and restricted to 828 participants who self-reported being in intimate relationships in the past twelve months. Bivariate and multivariable logistic regression models were employed to determine the association between the outcome variables with intimate partner violence perpetration and other psychosocial factors.Out of 828 young men, 333(40.2%) reported depressive symptoms and 93(11.9%) suicidal thoughts, with 725(87.6%) reporting ever perpetrating any form of intimate partner violence and 653(78.9%) reporting it in the past 12 months. After adjusting for other factors in multivariable models, depressive symptoms were significantly associated with sexual intimate partner violence perpetration (aOR = 2.19, 95%CI = 1.57, 3.04), economic intimate partner violence perpetration (aOR = 1.32 95%CI = 1.01, 1.74), emotional intimate partner violence perpetration (aOR = 1.76, 95%CI = 1.26, 2.46) and controlling behaviours (aOR = 1.46 95%CI = 1.10, 1.93).Depression is a common health problem strongly associated with intimate partner violence perpetration in this study population. Effective interventions to address depression and other mental health problems may help to reduce intimate partner violence perpetration in this population.Researchers and practitioners should develop theory-based research and intervention programmes to address mental health problems such as depression and suicidal thoughts and the perpetration of intimate partner violence. The socio-ecological framework provides an insightful model for multiple level analysis and intervention.Results: Depression and suicidal thoughts are associated with intimate partner violence, a major public health problem. Yet little is known about this association among young men in sub-Saharan Africa. This study aims to investigate the relationship between depression, suicidal thoughts and intimate partner violence perpetration, among young men in Tanzania from a representative community-based sample.We conducted a cross sectional survey among 1002 young men aged between 18 and 24 years residing in Mwanza city, Tanzania. Participants were randomly selected from 6 wards that included 3 densely and 3 sparsely populated wards from the Ilemela and Nyamagana districts that were selected using a probability-based multi-stage cluster sampling approach. We collected data on participant’s socio-demographics, depression symptoms using the PHQ9, suicidal thoughts, other psychosocial factors, and perpetration of different forms of intimate partner violence. Analysis was done using Stata version 17.0 and restricted to 828 participants who self-reported being in intimate relationships in the past twelve months. Bivariate and multivariable logistic regression models were employed to determine the association between the outcome variables with intimate partner violence perpetration and other psychosocial factors.Out of 828 young men, 333(40.2%) reported depressive symptoms and 93(11.9%) suicidal thoughts, with 725(87.6%) reporting ever perpetrating any form of intimate partner violence and 653(78.9%) reporting it in the past 12 months. After adjusting for other factors in multivariable models, depressive symptoms were significantly associated with sexual intimate partner violence perpetration (aOR = 2.19, 95%CI = 1.57, 3.04), economic intimate partner violence perpetration (aOR = 1.32 95%CI = 1.01, 1.74), emotional intimate partner violence perpetration (aOR = 1.76, 95%CI = 1.26, 2.46) and controlling behaviours (aOR = 1.46 95%CI = 1.10, 1.93).Depression is a common health problem strongly associated with intimate partner violence perpetration in this study population. Effective interventions to address depression and other mental health problems may help to reduce intimate partner violence perpetration in this population.Researchers and practitioners should develop theory-based research and intervention programmes to address mental health problems such as depression and suicidal thoughts and the perpetration of intimate partner violence. The socio-ecological framework provides an insightful model for multiple level analysis and intervention.Conclusions: Depression and suicidal thoughts are associated with intimate partner violence, a major public health problem. Yet little is known about this association among young men in sub-Saharan Africa. This study aims to investigate the relationship between depression, suicidal thoughts and intimate partner violence perpetration, among young men in Tanzania from a representative community-based sample.We conducted a cross sectional survey among 1002 young men aged between 18 and 24 years residing in Mwanza city, Tanzania. Participants were randomly selected from 6 wards that included 3 densely and 3 sparsely populated wards from the Ilemela and Nyamagana districts that were selected using a probability-based multi-stage cluster sampling approach. We collected data on participant’s socio-demographics, depression symptoms using the PHQ9, suicidal thoughts, other psychosocial factors, and perpetration of different forms of intimate partner violence. Analysis was done using Stata version 17.0 and restricted to 828 participants who self-reported being in intimate relationships in the past twelve months. Bivariate and multivariable logistic regression models were employed to determine the association between the outcome variables with intimate partner violence perpetration and other psychosocial factors.Out of 828 young men, 333(40.2%) reported depressive symptoms and 93(11.9%) suicidal thoughts, with 725(87.6%) reporting ever perpetrating any form of intimate partner violence and 653(78.9%) reporting it in the past 12 months. After adjusting for other factors in multivariable models, depressive symptoms were significantly associated with sexual intimate partner violence perpetration (aOR = 2.19, 95%CI = 1.57, 3.04), economic intimate partner violence perpetration (aOR = 1.32 95%CI = 1.01, 1.74), emotional intimate partner violence perpetration (aOR = 1.76, 95%CI = 1.26, 2.46) and controlling behaviours (aOR = 1.46 95%CI = 1.10, 1.93).Depression is a common health problem strongly associated with intimate partner violence perpetration in this study population. Effective interventions to address depression and other mental health problems may help to reduce intimate partner violence perpetration in this population.Researchers and practitioners should develop theory-based research and intervention programmes to address mental health problems such as depression and suicidal thoughts and the perpetration of intimate partner violence. The socio-ecological framework provides an insightful model for multiple level analysis and intervention.Implications: Depression and suicidal thoughts are associated with intimate partner violence, a major public health problem. Yet little is known about this association among young men in sub-Saharan Africa. This study aims to investigate the relationship between depression, suicidal thoughts and intimate partner violence perpetration, among young men in Tanzania from a representative community-based sample.We conducted a cross sectional survey among 1002 young men aged between 18 and 24 years residing in Mwanza city, Tanzania. Participants were randomly selected from 6 wards that included 3 densely and 3 sparsely populated wards from the Ilemela and Nyamagana districts that were selected using a probability-based multi-stage cluster sampling approach. We collected data on participant’s socio-demographics, depression symptoms using the PHQ9, suicidal thoughts, other psychosocial factors, and perpetration of different forms of intimate partner violence. Analysis was done using Stata version 17.0 and restricted to 828 participants who self-reported being in intimate relationships in the past twelve months. Bivariate and multivariable logistic regression models were employed to determine the association between the outcome variables with intimate partner violence perpetration and other psychosocial factors.Out of 828 young men, 333(40.2%) reported depressive symptoms and 93(11.9%) suicidal thoughts, with 725(87.6%) reporting ever perpetrating any form of intimate partner violence and 653(78.9%) reporting it in the past 12 months. After adjusting for other factors in multivariable models, depressive symptoms were significantly associated with sexual intimate partner violence perpetration (aOR = 2.19, 95%CI = 1.57, 3.04), economic intimate partner violence perpetration (aOR = 1.32 95%CI = 1.01, 1.74), emotional intimate partner violence perpetration (aOR = 1.76, 95%CI = 1.26, 2.46) and controlling behaviours (aOR = 1.46 95%CI = 1.10, 1.93).Depression is a common health problem strongly associated with intimate partner violence perpetration in this study population. Effective interventions to address depression and other mental health problems may help to reduce intimate partner violence perpetration in this population.Researchers and practitioners should develop theory-based research and intervention programmes to address mental health problems such as depression and suicidal thoughts and the perpetration of intimate partner violence. The socio-ecological framework provides an insightful model for multiple level analysis and intervention. [ABSTRACT FROM AUTHOR]

This study sought to explore the variety of coping strategies that women employ in response to intimate partner violence. Coping strategies can help women tolerate, minimise and deal with difficult challenges or conflicts in their relationships, such as learning to be independent from their husbands and surviving trauma. Drawing on 18 in-depth interviews conducted in Mwanza, Tanzania, we examined two different coping strategies - engagement and disengagement coping - with respect to how women react to economic, emotional, physical and sexual intimate partner violence. While the choice of coping methods remains a complex issue, most women employed engagement strategies as a response to economic violence and disengagement coping for sexual violence. We explore the implications of gender and societal roles for coping decisions and analyse how access to resources may provide women with the tools to limit future violence. [ABSTRACT FROM AUTHOR]

The article presents a study that compares the situational characteristics of protected and unprotected sexual encounters involving alcohol use among high-risk African women. Based on results, if someone had been drinking in advance of the encounter, there is condom failure. It is inferred that alcohol use before sex has a great possibility of condom failures and shows consistent situational characteristics regardless whether the condoms are used or not.

The article discusses the systematic review of the scientific literature and a meta-analysis of the reported risks associated with alcohol use and human immunodeficiency virus (HIV) to quantify the association between the alcohol drinking behavior and HIV infection in Africa. The study has observed evidence of a strong relationship between alcohol use and HIV infection wherein drinkers have a 70% greater chance of being HIV positive when compared with nondrinkers in the bivariate case and a 57% increased risk of HIV infection when potential confounders were controlled in multivariate analysis. Furthermore, it confirmed that alcohol is an important risk factor for HIV infection in Africa.

Alcohol, tobacco, and other drug (ATOD) use by adolescents are major contributors to death and disability in sub‐Saharan Africa (SSA). This paper reviews the extent of adolescents' ATOD use, risk and protective factors, and studies evaluating prevention interventions for adolescents in SSA. It also describes the harms associated with adolescents' ATOD use in SSA, which mainly include interpersonal violence, sexual risk behaviours, and negative academic outcomes. We use the socio‐ecological model as our framework for understanding ATOD use risk and protective factors at individual, interpersonal, peer/school, and societal/structural levels. We used two strategies to find literature evaluating ATOD interventions for adolescents in SSA: (a) we sought systematic reviews of adolescent ATOD interventions in SSA covering the period 2000–2020; and (b) we used a comprehensive evidence review strategy and searched for studies that had evaluated ATOD interventions in all SSA countries between 2000 and 2020. Only two community interventions (a brief intervention and an HIV prevention intervention), out of four that were identified, were partially effective in reducing adolescent ATOD. Furthermore, only one school‐based intervention (HealthWise), out of six that we uncovered, had any effect on ATOD use among adolescents. Possible reasons why many interventions were not effective include methodological limitations, involvement of non‐evidence‐based education‐only approaches in some studies, and shortcomings in adaptations of evidence‐based interventions. The scale of ATOD and related problems is disproportionate to the number of evaluated interventions to address them in SSA. More ATOD interventions need to be developed and evaluated in well‐powered and well‐designed studies. [ABSTRACT FROM AUTHOR]

Intimate partner violence is an important public health problem, with far-reaching consequences for women's physical and emotional health and social well-being. There is evidence that intimate partner violence is preventable. The MAISHA study, a randomised controlled trial of the impact of a gender training intervention on intimate partner violence for women in Tanzania, found that those who participated in gender training were less likely to report past-year physical violence. As part of the study, a sample of women participated in longitudinal qualitative enquiry. To better understand the processes of change associated with intimate partner violence prevention, we explored narratives from in-depth interviews and focus group discussions with women who had participated in the training. The study drew on feminist political theory on agency and change, which we sought to understand in a setting with high rates of intimate partner violence that a standalone intervention was unlikely to change. The study found that gender training, which seeks to develop political consciousness and transformation, can promote a sense of efficacy amongst participants who feel validated through the collective learning process. Important yet under examined cognitive elements of change processes deserve more attention in the design, delivery and evaluation of violence prevention gender training. [ABSTRACT FROM AUTHOR]

People with HIV (PWH) have a >2‐fold greater risk for development of cardiovascular disease (CVD), which may be associated with abnormalities in 24‐h ambulatory blood pressure measurement (ABPM) profile. We conducted a nested case‐control study of ABPM in 137 PWH and HIV‐uninfected controls with normal and high clinic blood pressure (BP) in Tanzania. Nocturnal non‐dipping of heart rate (HR) was significantly more common among PWH than HIV‐uninfected controls (p =.01). Nocturnal non‐dipping of BP was significantly more common in PWH with normal clinic BP (p =.048). Clinical correlates of nocturnal non‐dipping were similar in PWH and HIV‐uninfected adults and included higher BMI, higher CD4+ cell count, and high C‐reactive protein for HR and markers of renal disease for BP. In conclusion, nocturnal non‐dipping of both BP and HR was more common in PWH but further research is needed to determine causes and consequences of this difference. [ABSTRACT FROM AUTHOR]

Background: Objective measurement of alcohol consumption is important for clinical care and research. Adjusting for self‐reported alcohol use, we conducted an individual participant data (IPD) meta‐analysis to examine factors associated with the sensitivity of phosphatidylethanol (PEth), an alcohol metabolite, among persons self‐reporting unhealthy alcohol consumption. Methods: We identified 21 eligible studies and obtained 4073 observations from 3085 participants with Alcohol Use Disorders Identification Test—Consumption (AUDIT‐C) positive scores (≥3 for women and ≥4 for men) and PEth measurements. We conducted 1‐step IPD meta‐analysis using mixed effects models with random intercepts for study site. We examined the associations between demographic (sex, race/ethnicity, and age) and biologic (body mass index—BMI, hemoglobin, HIV status, liver fibrosis, and venous versus finger‐prick blood collection) variables with PEth sensitivity (PEth≥8 ng/ml), adjusting for the level of self‐reported alcohol use using the AUDIT‐C score. Results: One third (31%) of participants were women, 32% were African, 28% African American, 28% White, and 12% other race/ethnicity. PEth sensitivity (i.e., ≥8 ng/ml) was 81.8%. After adjusting for AUDIT‐C, we found no associations of sex, age, race/ethnicity, or method of blood collection with PEth sensitivity. In models that additionally included biologic variables, those with higher hemoglobin and indeterminate and advanced liver fibrosis had significantly higher odds of PEth sensitivity; those with higher BMI and those living with HIV had significantly lower odds of PEth sensitivity. African Americans and Africans had higher odds of PEth sensitivity than whites in models that included biologic variables. Conclusions: Among people reporting unhealthy alcohol use, several biological factors (hemoglobin, BMI, liver fibrosis, and HIV status) were associated with PEth sensitivity. Race/ethnicity was associated with PEth sensitivity in some models but age, sex, and method of blood collection were not. Clinicians should be aware of these factors, and researchers should consider adjusting analyses for these characteristics where possible. [ABSTRACT FROM AUTHOR]

Although a growing number of studies suggest interactions between Schistosoma parasites and viral infections, the effects of schistosome infections on the host response to viruses have not been evaluated comprehensively. In this systematic review, we investigated how schistosomes impact incidence, virulence, and prevention of viral infections in humans and animals. We also evaluated immune effects of schistosomes in those coinfected with viruses. We screened 4,730 studies and included 103. Schistosomes may increase susceptibility to some viruses, including HIV and Kaposi's sarcoma-associated herpesvirus, and virulence of hepatitis B and C viruses. In contrast, schistosome infection may be protective in chronic HIV, Human T-cell Lymphotropic Virus-Type 1, and respiratory viruses, though further research is needed. Schistosome infections were consistently reported to impair immune responses to hepatitis B and possibly measles vaccines. Understanding the interplay between schistosomes and viruses has ramifications for anti-viral vaccination strategies and global control of viral infections. Author summary: Many studies have described the effects of parasitic Schistosoma worm infections on the way that humans and animals respond to a variety of viral infections. Our goal was to evaluate, in a systematic manner, how having a schistosome parasitic infection affects a host's susceptibility to viral infections, the clinical disease course of viral infections, and prevention of viral infections by vaccines. We also assessed the effects of schistosome infection on the host immune response to viruses. We screened 4,730 studies for potential relevance and included 103 of them in this review. Overall, our analysis showed that schistosome infection impairs the host response to many viruses. This includes increasing host susceptibility to HIV and possibly Kaposi's sarcoma-associated herpesvirus, worsening the severity of clinical disease in hepatitis B and C infections, and decreasing immune responses to vaccines for hepatitis B and possibly measles. The studies that we analyzed also suggested that schistosome infection may protect the host against poor clinical outcomes from some viral infections including Human T-cell Lymphotropic Virus-Type 1, respiratory viruses, and chronic HIV. We discuss how these findings might be interpreted, and the additional research needed, in order to improve anti-viral vaccination strategies and control of viral infections globally. [ABSTRACT FROM AUTHOR]

Background: Soil-transmitted helminth (STH) infections are highly prevalent in resource-limited countries. We assessed the effect of a combination intervention aiming to enhance handwashing with soap on STH reinfection following mass drug administration among primary school children in Kagera region, Northwestern Tanzania.Methods: We conducted a cluster randomised trial in sixteen primary schools with known high STH prevalence. Schools were randomly assigned in a 1:1 ratio to either receive the intervention or continue with routine health education. The intervention included teacher-led classroom teaching, parental engagement sessions, environmental modifications and improved handwashing stations. The evaluation involved two cross-sectional surveys in a representative sample of students, with the end-line survey conducted 12 months after the baseline survey. The primary outcome was the combined prevalence of Ascaris lumbricoides and Trichuris trichiura infections at the end-line survey. Secondary outcomes included reported handwashing behaviour, the prevalence and intensity of individual STHs, and hand contamination with STH ova and coliform bacteria. End-line STH prevalence and intensity were adjusted for baseline differences of potential confounders.Results: At the end-line survey, 3081 school children (1566 from intervention schools and 1515 from control schools) provided interview data and stool specimens. More school children in the intervention group reported the use of water and soap during handwashing compared to school children in the control group (58% vs. 35%; aOR=1.76, 95%CI 1.28-2.43, p=0.001). The combined prevalence of A. lumbricoides and T. trichiura infections was 39% in both trial arms (aOR = 1.19; 95%CI 0.74-1.91). The prevalence of A. lumbricoides was 15% in the intervention and 17% in the control arm (aOR =1.24, 95%CI 0.59-2.59) and that of T. trichiura was 31% in both arms (aOR=1.17, 95%CI 0.73-1.88). No significant differences were found for STH infection intensity in both the main study and the hand contamination sub-study.Conclusions: The intervention was effective in increasing reported handwashing behaviour at school, but failed to show a similar effect in the home. The intervention had no effect on STH infection, possibly due to infection in the home environment, other transmission routes such as contaminated water or food or limited changes in school children's handwashing behaviour.Trial Registration: The trial was registered on June 21, 2017, by the International Standard Randomised Controlled Trial Number ( ISRCTN45013173) . [ABSTRACT FROM AUTHOR]

Background: COVID-19 has caused worldwide fear and uncertainty. Historically, the biomedical disease paradigm established its dominance in tackling emerging infectious illnesses mainly due to innovation in medication and advances in technology. Traditional and religious remedies have emerged as plausible options for prevention and treatment of COVID-19, especially in Africa and Asia. The appeal of religious and traditional therapies against COVID-19 in the African setting must be understood within the historical, social, and political context. This study explored how women and community members dealt with suspected symptoms of COVID-19 in Mwanza, Tanzania. Methods: This study was conducted in Nyamagana and Ilemela districts of Mwanza, Tanzania, between July and August 2020. We conducted 18 mobile phone in-depth interviews with a purposively selected sample of women aged 27–57 years participating in an existing longitudinal study. For safety reasons, smart mobile phones were used to collect the data. Each interview was audio recorded after obtaining verbal consent from the participants. The audio files were transferred to computers for analysis. Four researchers conducted a multistage, inductive analysis of the data. Results: Participants reported wide use and perceived high efficacy of traditional remedies and prayer to prevent and treat suspected symptoms of COVID-19. Use was either alone or combined with public health recommendations such as hand washing and crowd avoidance. Despite acknowledging that a pathogen causes COVID-19, participants attested to the relevance and power of traditional herbal medication and prayer to curb COVID-19. Four main factors underline the symbolic efficacy of the traditional and religious treatment paradigms: personal, communal, and official reinforcement of their efficacy; connection to local knowledge and belief systems; the failure of biomedicine to offer a quick and effective solution; and availability. Conclusions: In the context of emerging contagious illnesses, communities turn to resilient and trusted treatment paradigms to quell fear and embrace hope. To tackle emerging infections effectively, it is essential to engage the broader sociopolitical landscape, including communal considerations of therapeutic efficacy. [ABSTRACT FROM AUTHOR]

Estimates for prevalence of high blood pressure (BP) among adolescents in Africa vary widely and few studies, if any, have documented the results of the recommended stepwise BP screening. In this cross-sectional study in Tanzania, we aimed to estimate prevalence of sustained high BP in 3 public secondary schools using the American Academy of Pediatrics BP screening strategy. On Day 1, one screening automated office BP (AOBP) measurement (Step 1) was followed by two more AOBP measurements (Step 2). Repeat AOBP measurements were obtained after about one month on adolescents with high AOBP measurements on Day 1 (Step 3). Participants with sustained high BP underwent 24-h ambulatory BP monitoring (step 4). Of all 500 enrolled participants, the prevalence of high blood pressure at each step in the process was 36.6% (183), 25.6% (128), 10.2% (51), and 2.6%(13) respectively for Steps 1–4. All except 6 students completed all 4 steps of the BP screening algorithm as indicated. We conclude that diagnosis of hypertension in African adolescents should use multiple AOBP measurements over multiple days followed by 24-h ABPM. Screening for high BP in school settings appears to be feasible and could provide a platform for cardiovascular disease education and health promotion. [ABSTRACT FROM AUTHOR]

Background: Gender-based violence (GBV) undermines HIV prevention and treatment cascades, particularly among women who report partner violence. Screening for violence during HIV testing, and prior to offering pre-exposure prophylaxis (PrEP) to HIV uninfected women, provides an opportunity to identify those at heightened HIV risk and greater potential for non-adherence or early discontinuation of PrEP. The paper describes our experience with offering integrated GBV screening and referral as part of HIV counselling and testing. This component was implemented within EMPOWER, a demonstration project offering combination HIV prevention, including daily oral PrEP, to young women in South Africa and Tanzania.Methods: Between February 2017 and March 2018, a process evaluation was conducted to explore views, experiences and practices of stakeholders (study participants and study clinical staff) during implementation of the GBV screening component. This article assesses the feasibility and acceptability of the approach from multiple stakeholder perspectives, drawing on counselling session observations (n = 10), in-depth interviews with participants aged 16-24 (n = 39) and clinical staff (n = 13), and notes from debriefings with counsellors. Study process data were also collected (e.g. number of women screened and referred). Following a thematic inductive approach, qualitative data were analysed using qualitative software (NVivo 11).Results: Findings show that 31% of young women screened positive for GBV and only 10% requested referrals. Overall, study participants accessing PrEP were amenable to being asked about violence during HIV risk assessment, as this offered the opportunity to find emotional relief and seek help, although a few found this traumatic. In both sites, the sensitive and empathetic approach of the staff helped mitigate distress of GBV disclosure. In general, the delivery of GBV screening in HCT proved to be feasible, provided that the basic principles of confidentiality, staff empathy, and absence of judgment were observed. However, uptake of linkage to further care remained low in both sites.Conclusion: Most stakeholders found GBV screening acceptable and feasible. Key principles that should be in place for young women to be asked safely about GBV during HIV counselling and testing included respect for confidentiality, a youth-friendly and non-judgmental environment, and a functioning referral network. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were (1) to compare the prevalence of myocardial diastolic dysfunction (DD) in antiretroviral therapy (ART)-naive people living with human immunodeficiency virus (PLWH) to human immunodeficiency virus (HIV)-uninfected adults in East Africa and (2) to determine the association between serum concentration of the cardiac biomarkers ST2 and DD.Methods: In this cross-sectional study, we enrolled PLWH and uninfected adults at a referral HIV clinic in Mwanza, Tanzania. Standardized history, echocardiography, and serum were obtained. Regression models were used to quantify associations.Results: We enrolled 388 ART-naive PLWH and 461 HIV-uninfected adults with an average age of 36.0 ± 10.2 years. Of PLWH in the third, fourth, and fifth decades of life, 5.0%, 12.5%, and 32.7%, respectively, had DD. PLWH had a higher prevalence of DD (adjusted odds ratio, 2.71 [95% confidence interval, 1.62-4.55]; P < .0001). PLWH also had a higher probability of dysfunction with one or fewer traditional risk factors present. Serum ST2 concentration was associated with dysfunction in PLWH but not uninfected participants (P = .04 and P = .90, respectively).Conclusions: In a large population of young adults in sub-Saharan Africa, DD prevalence increased starting in the third decade of life. HIV was independently associated with dysfunction. Serum ST2 concentration was associated with DD in PLWH but not HIV-uninfected participants. This pathway may provide insight into the mechanisms of HIV-associated dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Soil transmitted helminths (STH) can affect over 50% of children in some parts of Tanzania. Control measures involve annual deworming campaigns in schools, but re-infection is rapid. This paper presents the design and baseline survey results of an ongoing school-based cluster-randomised controlled trial in Kagera region, NW Tanzania. The trial aims to determine whether the effect of routine deworming on the prevalence of Ascaris lumbricoides and Trichuris trichiura infections among school aged children can be sustained when combined with a behaviour change intervention promoting handwashing with water and soap. Methods: As part of the trial, a total of 16 schools were randomised to receive the intervention (N = 8) or as controls (N = 8). Randomisation was stratified per district and restricted to ensure pre-trial STH prevalence was balanced between study arms. The combination intervention to be tested comprises class-room based teacher-led health education, improvement of handwash stations, coloured nudges to facilitate handwashing and parental engagement sessions. The impact evaluation involves two cross-sectional surveys conducted at baseline and endline. The objectives of the baseline survey were: (i) to confirm whether the deworming campaign was successful, and identify and treat students still infected about 2 weeks after deworming, (ii) to document any baseline differences in STH prevalence between trial arms, and (iii) to assess handwashing behaviours, and access to water and sanitation at school and home. We randomly sampled 35 students per class in Grades 1–6 (an average of 200 children per school), stratified to ensure equal representation between genders. Assenting students were interviewed using a structured questionnaire and asked to provide a stool specimen. Results: Results of the baseline survey conducted about 2 weeks after deworming shows balanced demographic and STH prevalence data across trial arms. We observed a low prevalence of ascariasis (< 5%) as expected; however, the prevalence of trichuriasis was still about 35% in both arms. Conclusion: The randomisation procedure was successful in achieving a balanced distribution of demographic characteristics and helminth infections between trial arms. The intervention is being rolled out. The current deworming treatment regimen may need to be revised with regards to the treatment of trichuriasis. [ABSTRACT FROM AUTHOR]