23 results on '"Tarimo E"'
Search Results
2. Examining oral pre-exposure prophylaxis (PrEP) literacy among participants in an HIV vaccine trial preparedness cohort study
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Chimukuche, RS, Kawuma, R, Mahapa, N, Mkhwanazi, S, Singh, N, Siva, S, Ruzagira, E, Seeley, J, Gray, G, Gaffoor, Z, Morar, N, Sithole, T, Woeber, K, Hwengwere, E, Chidawanyika, RS, Khanyile, P, Jani, I, Viegas, E, Remane, I, Bule, O, Nhacule, E, Ramgi, P, Chissumba, R, Namalango, E, Manganhe, Y, Massingue, C, Capitine, I, Ribeiro, J, Maganga, L, William, W, Kapesa, E, Danstan, E, Pamba, D, Kway, MMA, Kisinda, A, Njovu, L, Sudi, L, Kunambi, R, Aboud, S, Munseri, P, Lyamuya, E, Msafiri, F, Joachim, A, Tarimo, E, Nagu, DFT, Buma, D, Bakari, M, Kaleebu, P, Kibengo, FM, Kakande, A, Serwanga, J, Holmes, CH, Kansiime, S, Kusemererwa, S, Masawi, S, Basajja, V, Vudriko, T, Hughes, P, Nabukenya, S, Mutonyi, G, Nakiboneka, R, Mugaba, S, Weber, J, Kingsley, C, Miller, T, McCormack, S, Crook, A, Dunn, D, Bern, H, Sy, A, Brodnicki, L, Joseph, S, Wenden, C, Chinyenze, K, Musau, J, Matsoso, M, Amondi, M, Chetty, P, Gumbe, A, Pantaleo, G, Ding, S, Nilsson, C, Kroidl, A, Fox, J, Doncel, G, Matthews, A, Rooney, J, Lee, C, and Robb, M
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AIDS Vaccines ,Cohort Studies ,Literacy ,Anti-HIV Agents ,Health Policy ,Humans ,Pre-Exposure Prophylaxis ,HIV Infections - Abstract
Background PrEP literacy is influenced by many factors including the types of information available and how it is interpreted. The level of PrEP literacy may influence acceptability and uptake. Methods We conducted 25 in-depth interviews in a HIV vaccine trial preparedness cohort study. We explored what participants knew about PrEP, sources of PrEP knowledge and how much they know about PrEP. We used the framework approach to generate themes for analysis guided by the Social Ecological Model and examined levels of PrEP literacy using the individual and interpersonal constructs of the SEM. Results We found that PrEP awareness is strongly influenced by external factors such as social media and how much participants know about HIV treatment and prevention in the local community. However, while participants highlighted the importance of the internet/social media as a source of information about PrEP they talked of low PrEP literacy in their communities. Participants indicated that their own knowledge came as a result of joining the HIV vaccine trial preparedness study. However, some expressed doubts about the effectiveness of the drug and worried about side effects. Participants commented that at the community level PrEP was associated with being sexually active, because it was used to prevent the sexual transmission of HIV. As a result, some participants commented that one could feel judged by the health workers for asking for PrEP at health facilities in the community. Conclusion The information collected in this study provided an understanding of the different layers of influence around individuals that are important to address to improve PrEP acceptability and uptake. Our findings can inform strategies to address the barriers to PrEP uptake, particularly at structural and community levels. Trial registration https://clinicaltrials.gov/ct2/show/NCT04066881
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- 2022
3. Preparing Institutions to Implement Harmonized Medicine and Nursing Curricula Through the Use of Cross-Institutional Faculty Developers
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Mloka DA, Sakita F, Minja IK, Dika H, Tarimo EAM, Sirili N, Mselle LT, Kisenge RR, Sasi P, Nsemwa L, Msanga DR, Matayan EY, Ngowi NB, Moshi MJ, Bartlett J, Macfarlane SB, Kaaya E, and O'Sullivan PS
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faculty development across institutions ,Special aspects of education ,LC8-6691 ,Medicine (General) ,R5-920 - Abstract
Doreen Anna Mloka,1 Francis Sakita,2 Irene Kida Minja,3 Haruna Dika,4 Edith AM Tarimo,5 Nathanael Sirili,6 Lillian Teddy Mselle,7 Rodrick Richard Kisenge,8 Philip Sasi,9 Livuka Nsemwa,10 Delfina R Msanga,11 Einoti Yohana Matayan,12 Nicholaus Bartholomeo Ngowi,13 Mainen Julius Moshi,14 John Bartlett,15 Sarah B Macfarlane,16 Ephata Kaaya,17 Patricia S O’Sullivan18 1Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Emergency Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 3Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 4Department of Anatomy, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 5Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Department of Development Studies, Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, Dar es Salaam, Tanzania; 7Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 8Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 9Department of Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 10Department of Nursing and Midwifery, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 11Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 12Department of Ophthalmology, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 13Department of Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 14Department of Biological and Preclinical Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 15Department of Global Health and Medicine, Duke University, Durham, NC, USA; 16Department of Global Health Sciences, University of San Francisco California, San Francisco, CA, USA; 17Department of Pathology, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 18Office of Research and Development in Medical Education, University of San Francisco California, San Francisco, CA, USACorrespondence: Doreen Anna Mloka, Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, P.O. Box 650013, Dar es Salaam, Tanzania, Tel +255712459528, Email mlokadoreen@gmail.comBackground: Effective implementation of new curricula requires faculty to be knowledgeable about curriculum goals and have the appropriate pedagogical skills to implement the curriculum, even more so if the new curriculum is being deployed at multiple institutions. In this paper, we describe the process of creating a common faculty development program to train cross-institutional faculty developers to support the implementation of national harmonized medicine and nursing curricula.Methods: A five-step approach was used, including a cross-institutional needs assessment survey for faculty development needs, the development of a generic faculty development program, the identification and training of cross-institutional faculty educators, and the implementation of cross-institutional faculty capacity-building workshops.Results: A list of common cross-cutting faculty development needs for teaching and learning was identified from the needs assessment survey and used to develop an accredited, cross-institutional faculty development program for competency-based learning and assessment. A total of 24 cross-institutional faculty developers were identified and trained in 8 core learning and assessment workshops. A total of 18 cross-institutional and 71 institutional workshops were conducted, of which 1292 faculty members and 412 residents were trained, and three cross-institutional educational research projects were implemented.Conclusion: The success attained in this study shows that the use of cross-institutional faculty developers is a viable model and sustainable resource that can be used to support the implementation of harmonized national curricula.Keywords: faculty development across institutions
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- 2024
4. HIV prevalence and incidence among FSWs participating in a HIV vaccine preparedness study in Dar es Salaam, Tanzania
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Faini, D., Msafiri, F., Munseri, P., Bakari, M., Joachim, A., Nagu, T., Tarimo, E., Lyamuya, E., Sandstrom, E., Biberfeld, G., Nilsson, C., Hanson, C., and Aboud, S.
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Working women -- Statistics -- Health aspects ,Prostitutes -- Statistics -- Health aspects ,AIDS vaccines -- Statistics ,HIV infection -- Statistics -- Demographic aspects -- Risk factors ,Health - Abstract
Background: PrEPVacc is a phase IIb multicenter HIV vaccine trial planned to be conducted at five sites in four sub-Saharan African countries that aims to evaluate safety and efficacy of two combinations of HIV vaccine regimens; HIV DNA + gp120/alum and HIV DNA, MVA + gp140/MPLA. A PrEPVacc HIV-negative registration cohort study was established to determine HIV prevalence and incidence among female sex workers (FSW) in Dar es Salaam, Tanzania. Methods: Between October and December 2018, a total of 773 FSW aged 18-45 years were screened for eligibility and 700 were enrolled. At screening and at 3-monthly follow-up visits, demographics and risky behavioural assessment and collection of blood samples were done. HIV testing was performed using two sequential rapid diagnostic tests; SD Bioline HIV1/2 and Uni-Gold HIV-1/2. HIV reactive samples were confirmed using Siemens Enzygnost HIV Integral 4 ELISA. Logistic regression was used to estimate odds Ratios for factors associated with HIV prevalence. Time-to-event analysis was performed using Poisson regression to estimate HIV incidence. Women were censored at 12 months of follow-up or earliest date of HIV seroconversion. Date of seroconversion was assumed to be midway between last negative and first positive HIV test results. Results: HIV prevalence at screening was 8% (59/773), associated with older age (p < 0.001), lower education levels (p < 0.001) and being single (either never married or separated/divorced/widowed) (p < 0.001). FSWs who reported being raped or having used drugs, were more likely be HIV-infected than their counterparts (p = 0.01 and p = 0.002, respectively). Attendance at 12 months was 80% (560/700) with women in the cohort contributing a total of 609 person-years-at risk (PYR). Twenty-one FSWs seroconverted with the HIV incidence rate in the cohort of 3.45 per 100 PYRS (95% CI; 2.25 to 5.28/100 PYRS). Conclusions: HIV prevalence and incidence were high among FSW in Dar es Salaam. These findings demonstrate feasibility of recruiting FSW for HIV vaccine prevention trials., OA02.04 D. Faini (1); F. Msafiri (2); P. Munseri (3); M. Bakari (4); A. Joachim (2); T. Nagu (3); E. Tarimo (5); E. Lyamuya (2); E. Sandstrom (6); G. Biberfeld [...]
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- 2021
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5. Timing of etonogestrel-releasing implants and growth of breastfed infants: a randomized controlled trial
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Prakash A, Tarimo E, Bolton Ka, Laws R, Ali A, J. I. B. Adinma, Carolina Sales Vieira, Campbell Kj, Minja A, Hibberd Pl, Hansen Ni, Rafiq My, Steyn N, Decloedt Eh, Kylie D. Hesketh, Keetile M, Arlington L, Sariah A, Devries K, Makuchilo M, Urassa D, Abdulla S, Patel Ab, Rui Alberto Ferriani, Bowelo M, Kremer P, Juma Oa, Silvana Maria Quintana, Lindskog Ee, Umeh Mn, Lees S, Rugemalila J, Siril H, Moleen Zunza, Shekalaghe S, Somba M, Wheatley H, Miao Wang, Mgnonia S, de Melo Pereira Carmo Ls, Enumah Zo, Umeononihu Os, and Giordana Campos Braga
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Adult ,medicine.medical_specialty ,Population ,RECÉM-NASCIDO ,Breastfeeding ,Drug Administration Schedule ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Statistical significance ,Contraceptive Agents, Female ,Humans ,Lactation ,Medicine ,030212 general & internal medicine ,education ,Etonogestrel ,Drug Implants ,education.field_of_study ,Desogestrel ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Postpartum Period ,Infant, Newborn ,Obstetrics and Gynecology ,Confidence interval ,Breast Feeding ,Treatment Outcome ,Sexual abuse ,Female ,business ,Brazil ,Postpartum period ,Cohort study ,medicine.drug - Abstract
OBJECTIVE: To evaluate the growth of breastfed infants whose mothers had inserted an etonogestrel-releasing implant in the immediate postpartum period. METHODS: An open randomized controlled and parallel trial of postpartum women who were block-randomized to early (up to 48 hours postpartum before discharge) or conventional (at 6 weeks postpartum) insertion of an etonogestrel implant. The primary outcome was average infant weight at 12 months (360 days) and a difference of equal to or greater than 10% between groups was considered clinically significant. The secondary outcomes were infants height and head and arm circumferences. These variables were measured at baseline and at 14 40 90 180 270 and 360 days postpartum. The mixed-effects linear regression model was used to evaluate the outcomes with a power of 80% and a significance level of 1% for the primary outcome and 0.3% for secondary outcomes as a result of correction for multiple hypothesis testing. RESULTS: From June to August 2015 a total of 100 women were randomized: 50 to early and 50 to conventional postpartum etonogestrel insertion. Sociodemographic characteristics were similar between the groups except for educational attainment. The conventional insertion group included a higher proportion of women with 8 or more years of formal education than the early insertion group (88% [44/50] compared with 70% [35/50] P=.02). There was no difference in infant weight at 360 days between the groups (early [mean±standard deviation] 10.1±1.2 kg compared with conventional 9.8±1.3 kg mean difference estimate 0.3 kg 95% confidence interval 0-0.7 kg). Growth curves height and head and arm circumferences did not differ between the groups. CONCLUSION: There is no difference in growth at 12 months among breastfed infants whose mothers underwent early compared with conventional postpartum insertion of the etonogestrel implant. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT02469454
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- 2017
6. Filling the Gap for Healthcare Professionals Leadership Training in Africa: The Afya Bora Consortium Fellowship
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Krakowiak, D., primary, Mashalla, Y., additional, O'Malley, G., additional, Seloilwe, E., additional, Ekane, G., additional, Atanga, S., additional, Gachuno, O., additional, Odero, T.M., additional, Urassa, D., additional, Tarimo, E., additional, Nakanjako, D., additional, Sewankambo, N., additional, Manabe, Y., additional, Ousman, K., additional, Chapman, S., additional, Dicker, R., additional, Polomano, R., additional, Wiebe, D., additional, Voss, J., additional, Hosey, K.N., additional, Wasserheit, J.N., additional, and Farquhar, C., additional
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- 2017
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7. Leadership training to build sustainable workforces and improve health in Africa
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Newman, L.P., primary, Mashalla, Y., additional, O’Malley, G., additional, Seloilwe, E., additional, Gachuno, O., additional, Odero, T., additional, Urassa, D., additional, Tarimo, E., additional, Nakanjako, D., additional, Sewankambo, N., additional, Manabe, Y., additional, Ousman, K.B., additional, Chapman, S.A., additional, Polomano, R.C., additional, Wiebe, D.J., additional, Voss, J., additional, Wasserheit, J.N., additional, and Farquhar, C., additional
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- 2016
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8. Motivations to participate in a Phase I/II HIV vaccine trial: A descriptive study from Dar es Salaam, Tanzania
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Tarimo, E. A. M., primary, Bakari, M., additional, Kakoko, D. C. V., additional, Kohi, T. W., additional, Mhalu, F., additional, Sandstrom, E., additional, and Kulane, A., additional
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- 2016
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9. The Afya Bora Fellowship in Global Health Leadership: dual mentorship to strengthen the next generation of African health leaders
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Farquhar, C., primary, Newman, L.P., additional, Mashalla, Y., additional, O'Malley, G., additional, Seloilwe, E., additional, Gachuno, O., additional, Odero, T., additional, Urassa, D., additional, Tarimo, E., additional, Nakanjako, D., additional, Sewankambo, N., additional, Manabe, Y., additional, Ousman, K.B., additional, Chapman, S.A., additional, Muecke, M., additional, Wiebe, D.J., additional, Voss, J., additional, and Wasserheit, J.N., additional
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- 2015
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10. Digest: Are female miniature geckos larger than males?
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Tarimo E
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What shapes the differences in body size between males and females in miniature species? One potential key factor is reproduction, which could constrain body size evolution because females of miniature species need to remain large enough to lay viable eggs. Glynne & Adams (2024) tested this hypothesis in two gecko families, the Sphaerodactylidae and Phyllodactylidae. Their findings support this hypothesis, indicating that female-biased size differences in miniature species are shaped by selection for reproductive success., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Society for the Study of Evolution (SSE). All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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11. The process of harmonizing competency-based curricula for medicine and nursing degree programmes: A Multi-institutional and multi-professional experience from Tanzania.
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Mloka D, Tarimo E, Mselle L, Mshana S, Sirili N, Rogathi J, Msuya L, Rugarabamu P, Mteta A, Moshi M, Kwesigabo G, Lyamuya E, Bartlett J, Martin-Holland J, O'Sullivan P, Macfarlane S, and Kaaya E
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- Humans, United States, Tanzania, Health Occupations, Health Facilities, Curriculum, Medicine
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In many low- and middle-income countries, there seems to be a mismatch between graduate skills and healthcare industry requirements due to variability in curricula. With the current increased global demand for competent health profession graduates, harmonizing competency-based curricula (CBC) is necessary to address this mismatch. This paper describes how three health professions training universities in Tanzania and their two long-standing United States partners embarked on developing harmonized CBC for undergraduate medicine and nursing degrees. The main goal of the activity was to develop templates to harmonize curricula that would support graduates to acquire mandatory national Graduate Minimum Essential Competencies (GMEC) irrespective of the institution of their training. The paper describes the processes of engaging multiple institutions, the professions of medicine and nursing and various stakeholders to develop mandatory curricula generic competencies, creating milestones for assessing competencies, training faculty at each of the three partnering institutions in curriculum delivery and assessments, resulting in the adoption of the curricula by the University leadership at each institution. Ultimately the Tanzania Commission for Universities (TCU) a regulatory body required all schools of medicine and nursing in the country to adopt the curricula, thus creating a harmonized national standard for teaching medicine and nursing beginning October 2022.
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- 2023
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12. Eliminating mother-to-child transmission of HIV in Tanzania calls for efforts to address factors associated with a low confirmatory test.
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Morris BM, Nyamhagata M, Tarimo E, and Sunguya B
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Option B+ approach for prevention of mother-to-child transmission (PMTCT) has demonstrated the potential to eliminate pediatric HIV infections. Its success depends on early infant diagnosis (EID) of HIV among the exposed infants within the first 6 weeks, and a subsequent confirmatory HIV test within 18 months. However, most mothers enrolling in option B+ in Tanzania do not come for such confirmatory tests. We examined factors associated with the turning-up of mother-baby pairs on the PMTCT program for a confirmatory HIV testing 18 months post-delivery in Tanzania. This study utilized longitudinal data collected between 2015 and 2017, from 751 mother-baby pairs enrolled in the PMTCT-option B+ approach in 79 health facilities from the 12 regions of Tanzania-mainland. Only 44.2% of 751 mother-baby records observed received the HIV confirmatory test by the 18th month. Mothers aged 25 years or above (adults' mothers) were 1.44 more likely to turn up for confirmatory HIV testing than young mothers; mothers with partners tested for HIV were 1.74 more likely to have confirmatory HIV testing compared with partners not tested for HIV. Newly diagnosed HIV-positive mothers were 28% less likely to bring their babies for a confirmatory HIV-testing compared to known HIV-positive mothers. Mothers with treatment supporters were 1.58 more likely to receive confirmatory HIV-testing compared to mothers without one. Mother-baby pairs who collected DBS-PCR-1 were 3.61 more likely to have confirmatory HIV-testing than those who didn't collect DBS-PCR-1. In conclusion, the confirmatory HIV testing within 18 months among mother-baby pairs enrolled in the Option B+ approach is still low in Tanzania. This is associated with low maternal age, having a male partner not tested for HIV, lack of experience with HIV services, lack of treatment supporters, and failure to take the DBS-PCR-1 HIV test within the first two months post-delivery., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Morris et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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13. Prevalence and determinants of non-communicable diseases including depression among HIV patients on antiretroviral therapy in Dar es Salaam, Tanzania.
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Mutagonda RF, Siril H, Kaaya S, Amborose T, Haruna T, Mhalu A, Urassa D, Mtisi E, Moshiro C, Tarimo E, Mahiti GR, Minja A, Somba M, August F, and Mugusi F
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- Adult, Aged, Cross-Sectional Studies, Depression epidemiology, Depression etiology, Female, Humans, Male, Middle Aged, Prevalence, Tanzania epidemiology, HIV Infections complications, HIV Infections drug therapy, HIV Infections epidemiology, Noncommunicable Diseases epidemiology
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Objective: People living with HIV/AIDS (PLHA) are experiencing growing co-morbidities due to an increase in life expectancy and the use of long-term antiretroviral therapy (ART). The lack of integrated non-communicable diseases (NCDs) screening and management at the HIV care and treatment centres (CTCs) make it difficult to determine the trends of NCD co-morbidity among patients with HIV. This study aimed to assess the burden and determinants of common NCDs, including depression among patients with HIV., Methods: Analytical cross-sectional study of 1318 HIV patients enrolled using systematic random sampling conducted from April to November 2020. Five large CTCs in district referral hospitals were selected representing the five districts of Dar es Salaam including Mwananyamala, Temeke, and Amana regional referral hospitals and Sinza and Vijibweni hospitals. The study population consisted of adult PLHA aged 18 years and above. The primary outcome measure was the prevalence of NCDs among HIV patients. Observation of actual NCD medications or their purchase receipts or booked NCD clinic appointments that PLHA had during the study period was used to verify the reported presence of NCDs. The secondary outcome measure was the prevalence of probable depression among PLHA. The locally validated Swahili Patient Health Questionnaire (PHQ-9) was used to screen for depressive symptom severity. A logistic regression model was used to identify factors associated with common NCDs and those associated with probable depression. Potential risk factors that were statistically significant at a P-value of 0.2 or less in univariable analysis were included as potential confounders in multivariable models., Results: The median age of participants was 42 (IQR 35-49) years, with 32.7% in the 36-45 years age group. The majority of patients were women (69%). Most (80.5%) had achieved HIV viral (VL) suppression (a serum HIV VL of <1000 copies/ml). Overall, 14.3% of self-reported an NCD with evidence of their current medication for the NCD from receipts for medication purchased and appointments from NCD clinics they attended. In the multivariable analyses, higher odds of NCDs were in older patients (>45 years) and those with a weight above 75 kg (P < 0.05). Male patients had 51% reduced odds of NCDs (aOR 0.49; 95% CI: 0.32-0.74) than females (P < 0.001). Probable depression prevalence was 11.8%, and depressed patients had more than twice the odds of having NCDs than those without depression (aOR 2.26; 95% CI: 1.45-3.51; P < 0.001)., Conclusion: This study determined co-existing previously diagnosed NCDs among PLHA accessing care and high levels of depressive symptom severity. We recommend additional research on the feasibility, acceptability, and cost implications of screening and treating NCDs on HIV care platforms to provide evidence for Tanzania's integrated HIV/NCD care model., (© 2022 John Wiley & Sons Ltd.)
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- 2022
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14. Factors hindering integration of care for non-communicable diseases within HIV care services in Dar es Salaam, Tanzania: The perspectives of health workers and people living with HIV.
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Haruna T, Somba M, Siril H, Mahiti G, August F, Minja A, Urassa D, Tarimo E, and Mugusi F
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- Adult, Aged, Female, Humans, Male, Middle Aged, Tanzania epidemiology, Acquired Immunodeficiency Syndrome epidemiology, Acquired Immunodeficiency Syndrome therapy, HIV-1, Health Personnel, Noncommunicable Diseases epidemiology, Noncommunicable Diseases therapy
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Background: Global mortality attributable to non-communicable diseases (NCDs) occurs in more than 36 million people annually with 80% of these deaths occurring in resource limited countries. Among people living with HIV and AIDS (PLHA) studies have reported higher prevalence's of NCDs compared to the general population but most studies do report a narrow range of NCDs commonly hypertension, diabetes and neoplasms and not all. In addition, there is limited reporting, integration of systematic screening and treatment for all NCDs among PLHA attending care, suggesting the NCD burden among PLHA is likely an underestimate. Little is known about factors facilitating or hindering integration of the care and treatment of NCDs within HIV care and treatment clinics (CTCs) in Tanzania., Objective: To explore the perceptions of PLHA and health workers on factors facilitate or hinder the recognition and integration of care for NCDs within CTCs in Dar es Salaam., Methods: Inductive content analysis of transcripts from 41 in-depth interviews were conducted with 5 CTC managers (CTC Managers), 9 healthcare providers (DHCP) and 27 people living with HIV (PLHA) attending CTCs and with co-morbid NCDs., Results: Four themes emerged; the current situation of services available for care and treatment of NCDs among PLHA in CTCs, experiences of PLHA with co-morbid NCDs with access to care and treatment services for NCDs, facilitators of integrating care and treatment of NCDs within CTCs and perceived barriers for accessing and integration of care and treatment of NCDs within CTCs., Conclusions: There was a positive attitude among PLHA and healthcare workers towards integration of NCD services within CTC services. This was enhanced by perceived benefits inherent to the services. Factors hindering integration of NCD care and services included; limited and inconsistent supplies such as screening equipment, medications; insufficient awareness of NCDs within PLHA; lack of adequate training of healthcare workers on management of NCD and treatment costs and payment systems., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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15. Gaps, Challenges, and Opportunities for Global Health Leadership Training.
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Voss J, Yasobant S, Akridge A, Tarimo E, Seloilwe E, Hausner D, and Mashalla Y
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- Fellowships and Scholarships, Humans, Capacity Building, Global Health, Health Personnel education, Leadership
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Background: Global Health Leadership (GHL) programs are essential for training emerging health care professionals to be effective leaders. Synthesizing knowledge acquired through experience implementing GHL programs can inform future recommendations for GHL., Objective: To describe the lessons learned, highlighting gaps, challenges and opportunities, during implementation of two GHL capacity building programs, namely the Afya Bora Consortium Fellowship in Global Health Leadership and the Sustaining Technical and Analytic Resources (STAR) fellowship and internship program for global health professionals., Methods: A mixed methods case-comparison study was conducted, using qualitative data (expert opinion) collected from the Program Directors in order to understand the experiences of the two GHL programs. A structured response guide was used to assess the overall experience in GHL program implementation, operational challenges and reported gaps. Afya Bora and STAR have been implemented for 8 and 2.5 years respectively. Thus, the analysis reflects a snapshot of the two programs at different stages., Findings: The results reflect knowledge gained through extensive experience in implementing the two GHL programs. Afya Bora has trained 188 multi-disciplinary fellows, and 100% of the African fellows are engaged in leadership positions in government departments and non-governmental organizations (NGOs) in their countries. STAR has placed 147 participants (89 fellows and 58 interns) in more than 25 countries globally. Both programs were successful in strengthening south-south and north-south collaborations for a common goal of improving global health. Implementation of both fellowships identified room for improvement in operational procedures and financing of the programs, and highlighted knowledge and skills gaps, as well as challenges in sustainability of the training programs., Conclusions: Afya Bora and STAR have had significant impact and have contributed to changing the leadership landscape in global health. Future GHL programs should address sustainability in terms of financing, delivery modalities and domestic integration of knowledge., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2021 The Author(s).)
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- 2021
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16. Views from Multidisciplinary Oncology Clinicians on Strengthening Cancer Care Delivery Systems in Tanzania.
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Nyagabona SK, Luhar R, Ndumbalo J, Mvungi N, Ngoma M, Meena S, Siu S, Said M, Mwaiselage J, Tarimo E, Buckle G, Selekwa M, Mushi B, Mmbaga EJ, Van Loon K, and DeBoer RJ
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- Aged, Child, Focus Groups, Hospitals, Humans, Tanzania, Delivery of Health Care, Neoplasms therapy
- Abstract
Background: In response to the increasing burden of cancer in Tanzania, the Ministry of Health, Community Development, Gender, Elderly and Children launched National Cancer Treatment Guidelines (TNCTG) in February 2020. The guidelines aimed to improve and standardize oncology care in the country. At Ocean Road Cancer Institute (ORCI), we developed a theory-informed implementation strategy to promote guideline-concordant care. As part of the situation analysis for implementation strategy development, we conducted focus group discussions to evaluate clinical systems and contextual factors that influence guideline-based practice prior to the launch of the TNCTG., Materials and Methods: In June 2019, three focus group discussions were conducted with a total of 21 oncology clinicians at ORCI, stratified by profession. A discussion guide was used to stimulate dialogue about facilitators and barriers to delivery of guideline-concordant care. Discussions were audio recorded, transcribed, translated, and analyzed using thematic framework analysis., Results: Participants identified factors both within the inner context of ORCI clinical systems and outside of ORCI. Themes within the clinical systems included capacity and infrastructure, information technology, communication, efficiency, and quality of services provided. Contextual factors external to ORCI included interinstitutional coordination, oncology capacity in peripheral hospitals, public awareness and beliefs, and financial barriers. Participants provided pragmatic suggestions for strengthening cancer care delivery in Tanzania., Conclusion: Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect uptake of the TNCTG. Our findings were used to inform a broader guideline implementation strategy, in an effort to improve uptake of the TNCTGs at ORCI., Implications for Practice: This study provides an assessment of cancer care delivery systems in a low resource setting from the unique perspectives of local multidisciplinary oncology clinicians. Situational analysis of contextual factors that are likely to influence guideline implementation outcomes is the first step of developing an implementation strategy for cancer treatment guidelines. Many of the barriers identified in this study represent actionable targets that will inform the next phases of our implementation strategy for guideline-concordant cancer care in Tanzania and comparable settings., (© 2021 The Authors. The Oncologist published by Wiley Periodicals LLC on behalf of AlphaMed Press.)
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- 2021
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17. Safe birth matters: facilitators and barriers to uptake of the WHO safe childbirth checklist tool in a Tanzania Regional Hospital.
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Thomas J, Voss J, and Tarimo E
- Subjects
- Adult, Female, Humans, Infant, Newborn, Parturition, Patient Safety, Pregnancy, Quality of Health Care, Retrospective Studies, Tanzania, World Health Organization, Checklist statistics & numerical data, Delivery, Obstetric standards, Guideline Adherence, Guidelines as Topic
- Abstract
Background: The World Health Organization (WHO) developed the Safe Birth Checklist (SCC) to facilitate best practices in safe birthing practices. The SCC is utilizing existing evidence-based WHO guidelines and recommendations which has combined those into a single and practical bedside tool. The SCC is the first checklist-based intervention to target the prevention of maternal and neonatal deaths., Objective: The objective of this project was to pilot-test the World Health Organization Safe Childbirth Checklist with Maternity Regional Hospital in, Tanzania., Study Design and Methods: Retrospective analysis on 35 charts were completed to identify presence or absence of documentation aligned with evidenced based checklist items. Staff training, end user observations and focus group discussions were utilized to elicit feedback about the tool and the process. Descriptive statistics and manual content analysis were used to analyze the rate of uptake and ownership over the checklist. The Checklist is broken down into four sections or time points (that are considered natural pause points in the care of laboring women). The four different pause points are admission, delivery, post-partum, and discharge., Results: We trained 26 participants out of 32 staff how to use the SCC. Delivery time point had the lowest at SCC completion rate at 39% compared to discharge having the highest completion rate at 93%. There was variation in completion rate of the checklist items at each time point. Checklist items at the beginning of each time point were completed between 94% and 100% of the time with the latter checklist list items completed between 29% and 57% of the time., Conclusion: This project was able to identify facilitators and potential barriers to the successful uptake of the Safe Childbirth Checklist in Shinyanga Regional Hospital. Based on these findings, the MOH have opportunities to utilize those findings in the scale-up of the implementation of the checklist and future evaluation activities., (© 2021 Thomas J et al.)
- Published
- 2021
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18. AFYA BORA CONSORTIUM FELLOWSHIP: a journey of success in Global Health Leadership Training.
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Gachuno O, Odero T, Seloilwe E, Urassa D, Tarimo E, Nakanjako D, Sewankambo N, Atanga NS, Halle-Ekane EG, Manabe Y, Hosey KN, Chapman SA, Wiebe DJ, Voss J, O'Malley G, Mashalla Y, Ndegwa M, Omogi J, Farquhar C, and Wasserheit JN
- Subjects
- Humans, Program Evaluation, Fellowships and Scholarships, Global Health, Leadership
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- 2021
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19. Why did I stop? And why did I restart? Perspectives of women lost to follow-up in option B+ HIV care in Dar es Salaam, Tanzania.
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Sariah A, Rugemalila J, Protas J, Aris E, Siril H, Tarimo E, and Urassa D
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- Adult, Breast Feeding, Female, HIV Infections psychology, HIV Infections transmission, Humans, Infant, Infectious Disease Transmission, Vertical prevention & control, Motivation, Pregnancy, Qualitative Research, Tanzania, Young Adult, HIV Infections drug therapy, Lost to Follow-Up, Patient Acceptance of Health Care psychology
- Abstract
Background: Despite an increased uptake of option B+ treatment among HIV- positive pregnant and breastfeeding women, retaining these women in care is still a major challenge. Previous studies have identified factors associated with loss to follow-up (LTFU) in HIV care, however, the perspectives from HIV-positive pregnant and breastfeeding women regarding their LTFU in option B+ needs further exploration. We explored reasons for LTFU and motivation to resume treatment among HIV-positive women initiated in option B+ in an Urban setting., Methods: A descriptive qualitative study was conducted at three public care and treatment clinics (CTC) (Buguruni health center, Sinza hospital, and Mbagala Rangitatu health center) in Dar es Salaam, Tanzania between February and May 2017. In-depth interviews were conducted with 30 HIV-positive pregnant and breastfeeding women who were lost to follow up in the option B+ regimen. Analysis of data followed content analysis that was performed using NVivo 10 computer-assisted qualitative data analysis software., Results: Eleven women were lost to follow-up and did not resume Option B+, while 19 had resumed treatment. The study indicated a struggle with long term disease amongst HIV-positive pregnant and breastfeeding women initiated in option B+ treatment. The reported reasons contributing to LTFU among these women appeared in three categories. The contribution of LTFU in the first category namely health-related factors included medication side effects and lack of disease symptoms. The second category highlighted the contribution of psychological factors such as loss of hope, fear of medication side effects and HIV-related stigma. The third category underscored the influence of socio-economic statuses such as financial constraints, lack of partner support, family conflicts, non-disclosure of HIV-positive status, and religious beliefs. Motivators to resume treatment after LTFU included support from health care providers and family members, a desire to protect the unborn child from HIV-infection and a need to maintain a healthy status., Conclusion: The study has highlighted the reasons for LTFU and motivation to resume treatment among women initiated in Option B+. Our results provide further evidence on the need for future interventions to focus on these factors in order to improve retention in life-long treatment.
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- 2019
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20. High magnitude of under nutrition among HIV infected adults who have not started ART in Tanzania--a call to include nutrition care and treatment in the test and treat model.
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Sunguya BF, Ulenga NK, Siril H, Puryear S, Aris E, Mtisi E, Tarimo E, Urassa DP, Fawzi W, and Mugusi F
- Abstract
Background: Undernutrition among people living with HIV (PLWHIV) can be ameliorated if nutrition specific and sensitive interventions are integrated into their HIV care and treatment centers (CTC). Integrated care is lacking despite expansion of antiretroviral therapy (ART) coverage, representing a substantial missed opportunity. This research aims to examine nutritional status and associated risk factors among HIV-positive adults prior to ART initiation in Tanzania in order to characterize existing gaps and inform early integration of nutrition care into CTC., Methods: We analyzed data from 3993 pre-ART adults living with HIV enrolled in CTCs within the Trial of Vitamin (TOV3) and progression of HIV/AIDS study in Dar es salaam, Tanzania. The primary outcome for this analysis was undernutrition, measured as body mass index (BMI) below 18.5 kg/m
2 . We conducted descriptive analyses of baseline characteristics and utilized multiple logistic regression to determine independent factors associated with pre-ART undernutrition., Results: Undernutrition was prevalent in about 27.7% of pre-ART adults, with a significantly higher magnitude among males compared to females (30% vs. 26.6%, p < 0.025). Severe undernutrition (BMI < 16.0 kg/m2 ) was prevalent in one in four persons, with a trend toward higher magnitudes among females (26.2% vs. 21.1% p = 0.123). Undernutrition was also more prevalent among younger adults ( p < 0.001), those with lower wealth quintiles ( p = 0.003), and those with advanced HIV clinical stage ( p < 0.001). Pre-ART adults presented with poor feeding practices, hallmarked by low dietary diversity scores and infrequent consumption of proteins, vegetables, and fruits. After adjusting for confounders and important co-variates, pre-ART undernutrition was associated with younger age, low wealth indices, advanced clinical stage, and low dietary diversity., Conclusions: One in every four pre-ART PLWHIV presented with undernutrition in Dar es salaam, Tanzania. Risk factors for undernourishment included younger age, lower household income, advanced HIV clinical stage, and lower dietary diversity score. Knowledge of the prevalence and prevailing risk factors for undernutrition among pre-ART PLWHIV should guide targeted, early integration of nutrition interventions into routine HIV care and treatment in high-prevalence, low-income settings such as Tanzania., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2017.)- Published
- 2017
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21. "Experiences with disclosure of HIV-positive status to the infected child": Perspectives of healthcare providers in Dar es Salaam, Tanzania.
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Sariah A, Rugemalila J, Somba M, Minja A, Makuchilo M, Tarimo E, Urassa D, and Siril H
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- Adolescent, Adult, Child, Child, Preschool, Emotions, Fear, Female, Humans, Male, Parents psychology, Psychology, Child, Qualitative Research, Social Stigma, Tanzania, Age Factors, Attitude of Health Personnel, HIV Infections psychology, Health Personnel psychology, Truth Disclosure
- Abstract
Background: The specific age to which an HIV infected child can be disclosed to is stipulated to begin between ages 4 and 6 years. It has also been documented that before disclosure of HIV positive status to the infected child. Health care providers should consider children's cognitive-developmental ability. However, observation and situation analysis show that, health care providers still feel uncomfortable disclosing the HIV positive status to the infected child. The aim of the study was to explore healthcare providers' experiences in disclosure of HIV-positive status to the infected child., Methods: A qualitative study involving 20 health care providers who attend HIV-positive children was conducted in September, 2014 in Dar es Salaam, Tanzania. Participants were selected from ten HIV care and treatment clinics (CTC) by purposive sampling. An interview guide, translated into participants' national language (Kiswahili) was used during in-depth interviews. Sampling followed the principle of data saturation. The interviews focused on perspectives of health-care providers regarding their experience with paediatric HIV disclosure. Data from in-depth interviews were transcribed into text; data analysis followed qualitative content analysis., Results: The results show how complex the process of disclosure to children living with HIV can be to healthcare providers. Confusion was noted among healthcare providers about their role and responsibility in the process of disclosing to the HIV infected child. This was reported to be largely due to unclear guidelines and lack of standardized training in paediatric HIV disclosure. Furthermore, healthcare providers were concerned about parental hesitancy to disclose early to the child due to lack of disclosure skills and fear of stigma. In order to improve the disclosure process in HIV infected children, healthcare providers recommended further standardized training on paediatric HIV disclosure with more emphasis on practical skills and inclusion of disclosure content that is age appropriate for children with HIV., Discussion: The disclosure process was found to be a complex process. Perspectives regarding disclosure in children infected with HIV varied among healthcare providers in terms of their role in the process, clear national guidelines and appropriate standardized training for paediatric disclosure. Consistent with other studies, healthcare providers reported difficulties during disclosure because parents /guardians largely fear blame, social stigma, child's negative emotional reaction when disclosed to and have concerns about the child being too young and immature to understand the HIV condition., Conclusions: In order to prevent inconsistencies during the disclosure process, it is important to have in place clear guidelines and standardized paediatric HIV disclosure training for healthcare providers. This would help improve their skills in paediatric disclosure, leading to positive health outcomes for children infected with HIV.
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- 2016
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22. Training tomorrow's leaders in global health: impact of the Afya Bora Consortium Fellowship on the careers of its alumni.
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Monroe-Wise A, Mashalla Y, O'Malley G, Nathanson N, Seloilwe E, Gachuno O, Odero T, Nakanjako D, Sewankambo N, Tarimo E, Urassa D, Manabe YC, Chapman S, Voss JG, Wasserheit J, and Farquhar C
- Subjects
- Africa, Career Mobility, Humans, Fellowships and Scholarships, Global Health education, Health Personnel education, Leadership
- Abstract
Background: Effective leadership is a cornerstone of successful healthcare delivery in resource limited settings throughout the world. However, few programs in Africa prepare healthcare professionals with the leadership skills vital to the success of the healthcare systems in which they work. One such program, the Afya Bora Consortium Fellowship in Global Health Leadership, has been training health professionals since 2011. The purpose of this study was to assess what career changes, if any, the Afya Bora Fellowship's alumni have experienced since completing the fellowship, and to describe those changes., Methods: The Afya Bora Fellowship is a multidisciplinary, one-year training program that teaches health professionals leadership skills through didactic and experiential learning in four African countries. Between January 2011 and June 2013 the consortium trained 42 nurses and doctors. In November 2013, an electronic survey was sent to all alumni to assess their performance in the workplace post-fellowship., Results: Thirty-one (74 %) of 42 alumni completed surveys. Twenty-one (68 %) reported changes to their position at work; of those, sixteen (76 %) believed the change was due to participation in the fellowship. All alumni reported improved performance at work, and cited the application of a wide range of fellowship skills, including leadership, research, communication, and mentoring. Twenty-six (84 %) alumni spearheaded improvements in their workplaces and almost all (97 %) remained in contact with colleagues from the fellowship. Among the respondents there were five publications, nine manuscripts in preparation, and three international conference presentations., Conclusions: Afya Bora alumni overwhelmingly reported that the one year fellowship positively influenced both their work and career trajectory. Training health professionals in leadership skills through didactic modules with the opportunity to apply learned skills at attachment sites in the Afya Bora Fellowship has an impact on performance in the workplace and the potential to improve long-term institutional capacity.
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- 2016
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23. Interprofessional Fellowship Training for Emerging Global Health Leaders in Africa to Improve HIV Prevention and Care: The Afya Bora Consortium.
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Ousman K, Polomano RC, Seloilwe E, Odero T, Tarimo E, Mashalla YJ, Voss JG, O'Malley G, Chapman SA, Gachuno O, Manabe Y, Nakanjako D, Sewankambo N, Urassa D, Wasserheit JN, Wiebe DJ, Green W, and Farquhar C
- Subjects
- Africa South of the Sahara, Delivery of Health Care, Humans, Nurses, Physicians, Program Evaluation, Public Health, United States, Workforce, Cooperative Behavior, Fellowships and Scholarships, Global Health, HIV Infections prevention & control, HIV Infections therapy, Health Personnel education, International Cooperation, Leadership
- Abstract
HIV continues to challenge health systems, especially in low- and middle-income countries in Sub-Saharan Africa. A qualified workforce of transformational leaders is required to strengthen health systems and introduce policy reforms to address the barriers to HIV testing, treatment, and other HIV services. The 1-year Afya Bora Consortium Fellowship in Global Health capitalizes on academic partnerships between African and U.S. universities to provide interprofessional leadership training through classroom, online, and service-oriented learning in 5 countries in Africa. This fellowship program prepares health professionals to design, implement, scale-up, evaluate, and lead health programs that are population-based and focused on prevention and control of HIV and other public health issues of greatest importance to African communities and health service settings. Afya Bora nurse fellows acquire leadership attributes and competencies that are continuously and systematically tested during the entire program. This multinational training platform promotes interprofessional networks and career opportunities for nurses., (Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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