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IntroductionPoor menstrual health negatively impacts psychosocial and physical health, and subsequently leads to poor school outcomes, but the effort to improve adolescent girls’ menstrual health in Tanzania remains fragmented. This study aimed to develop and pilot a scalable, comprehensive menstrual, sexual and reproductive health (MSRH) intervention within Tanzanian government structures to improve MSRH practices and perceptions and the overall school climate to ensure the psychosocial well-being and optimal school participation and performance among secondary schoolgirls.Methods and analysisThis study will be conducted in three phases. Phase I will be a formative research to iteratively refine an existing puberty and menstrual health intervention, and to collaboratively design strategies to embed the intervention into government structures thereby promoting scalability. In Phase II, we will pilot and evaluate the refined intervention and implementation strategies using a mixed-methods design to assess (1) feasibility, acceptability and sustainability; and (2) effect on MSRH practices and perceptions and the overall school climate. In Phase III, we will synthesise the research findings in collaboration with the national, regional and district government and non-government stakeholders.Ethics and disseminationThis pilot study will provide evidence-based recommendations for a comprehensive, complex menstrual and puberty intervention within secondary schools in Tanzania that can be further tested for broader effectiveness across a larger population. Papers, policy briefs and both regional/international conference presentations are planned to reach academic and non-academic groups. Protocol, tools and consent have been reviewed and approved by the independent Tanzanian national ethics committee (NIMR/HQ/R.8a/Vol.IX/3647) and the LSHTM Observational/Interventions Research Ethics Committee (LSHTM Ethics Ref: 22854). The project will involve adolescents, and procedures will be followed to ensure that we obtain permission and consent of parents and guardians and assent from all adolescents below 18 years of age that will be enrolled in the study.

IntroductionPoor adolescent mental health is a barrier to achieving several sustainable development goals in Tanzania, where adolescent mental health infrastructure is weak. This is compounded by a lack of community and policy maker awareness or understanding of its burden, causes and solutions. Research addressing these knowledge gaps is urgently needed. However, capacity for adolescent mental health research in Tanzania remains limited. The existence of a National Institute for Medical Research (NIMR), with a nationwide mandate for research conduct and oversight, presents an opportunity to catalyse activity in this neglected area. Rigorous research priority setting, which includes key stakeholders, can promote efficient use of limited resources and improve both quality and uptake of research by ensuring that it meets the needs of target populations and policy makers. We present a protocol for such a research priority setting study and how it informs the design of an interinstitutional adolescent mental health research capacity strengthening strategy in Tanzania.Methods and analysisFrom May 2021, this 6 month mixed-methods study will adapt and merge the James Lind Alliance approach and validated capacity strengthening methodologies to identify priorities for research and research capacity strengthening in adolescent mental health in Tanzania. Specifically, it will use online questionnaires, face-to-face interviews, focus groups, scoping reviews and a consensus meeting to consult expert and adolescent stakeholders. Key evidence-informed priorities will be collaboratively ranked and documented and an integrated strategy to address capacity gaps will be designed to align with the nationwide infrastructure and overall strategy of NIMR.Ethics and disseminationNational and institutional review board approvals were sought and granted from the National Health Research Ethics Committee of the NIMR Medical Research Coordinating Committee (Tanzania) and the Liverpool School of Tropical Medicine (United Kingdom). Results will be disseminated through a national workshop involving all stakeholders, through ongoing collaborations and published commentaries, reviews, policy briefs, webinars and social media.

The expansion in the provision of life-saving antiretroviral therapy (ART) in sub-Saharan Africa over the past 15 years has been an unprecedented achievement for public health. By the end of 2015, an estimated 10.3 million persons living with HIV (PLHIV) were receiving ART in southern and eastern Africa, the most affected region in the world. Just over half of all PLHIV in the region are now receiving ART, more than double the number just 3 years earlier.1 ART scale-up has dramatically reduced HIV-related mortality and morbidity, bringing countless social and economic benefits to communities that had been hard hit by the epidemic. The network for Analysing Longitudinal Population data on HIV/AIDS (ALPHA), a collaboration among 10 health and demographic surveillance system (HDSS) sites in east and southern Africa, has been investigating declines in adult mortality and their causes in seven countries (www.lshtm.ac.uk/alpha).2 Recent analyses from seven sites indicate a substantial impact of HIV treatment programmes on adult mortality following the expansion of ART, with declines ranging from 58% to 84%.3 Despite this progress, there remains a substantial deficit in overall life expectancy among adults living with HIV, with their survival between 5 and 10 years less than among uninfected adults.4 These ‘excess’ deaths among PLHIV are occurring due to late diagnosis, poor linkage to care and treatment, and ART interruptions.5 By the end of 2015, an estimated 44% of PLHIV in southern and eastern Africa remained undiagnosed,6 and rates of linkage to care after diagnosis range widely from 17% to 78%, while ART initiation among those eligible for treatment ranges from 14% to 95%.7 A number of studies have documented reasons for delays in testing, and initiating and adhering to treatment including beliefs that treatment is for people who are sick, fear of side …