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Introduction Nigeria, Ethiopia and Tanzania have some of the highest teenage pregnancy rates and lowest rates of modern contraceptive use among adolescents. The transdisciplinary Adolescents 360 (A360) initiative being rolled out across these three countries uses humancentred design to create context-specific multicomponent interventions with the aim of increasing voluntary modern contraceptive use among girls aged 15–19 years. Methods The primary objective of the outcome evaluation is to assess the impact of A360 on the modern contraceptive prevalence rate (mCPR) among sexually active girls aged 15–19 years. A360 targets different subpopulations of adolescent girls in the three countries. In Northern Nigeria and Ethiopia, the study population is married girls aged 15–19 years. In Southern Nigeria, the study population is unmarried girls aged 15–19 years. In Tanzania, both married and unmarried girls aged 15–19 years will be included in the study. In all settings, we will use a prepopulation and postpopulation-based crosssectional survey design. In Nigeria, the study design will also include a comparison group. A one-stage sampling design will be used in Nigeria and Ethiopia. A two-stage sampling design will be used in Tanzania. Questionnaires will be administered face-to-face by female interviewers aged between 18 and 26 years. Study outcomes will be assessed before the start of A360 implementation in late 2017 and approximately 24 months after implementation in late 2019. Ethics and dissemination Findings of this study will be widely disseminated through workshops, conference presentations, reports, briefings, factsheets and academic publications. [ABSTRACT FROM AUTHOR]

Objectives: Trichomonas vaginalis is the most prevalent curable STI worldwide and has been associated with adverse health outcomes and increased HIV-1 transmission risk. We conducted a cross-sectional analysis among couples to assess how characteristics of both individuals in sexual partnerships are associated with the prevalence of male and female T. vaginalis infection.Methods: African HIV-1 serodiscordant heterosexual couples were concurrently tested for trichomoniasis at enrolment into two clinical trials. T. vaginalis testing was by nucleic acid amplification or culture methods. Using Poisson regression with robust standard errors, we identified characteristics associated with trichomoniasis.Results: Among 7531 couples tested for trichomoniasis, 981 (13%) couples contained at least one infected partner. The prevalence was 11% (n=857) among women and 4% (n=319) among men, and most infected individuals did not experience signs or symptoms of T. vaginalis. Exploring concordance of T. vaginalis status within sexual partnerships, we observed that 61% (195/319) of T. vaginalis-positive men and 23% (195/857) of T. vaginalis-positive women had a concurrently infected partner. In multivariable analysis, having a T. vaginalis-positive partner was the strongest predictor of infection for women (relative risk (RR) 4.70, 95% CI 4.10 to 5.38) and men (RR 10.09, 95% CI 7.92 to 12.85). For women, having outside sex partners, gonorrhoea, and intermediate or high Nugent scores for bacterial vaginosis were associated with increased risk of trichomoniasis, whereas age 45 years and above, being married, having children and injectable contraceptive use were associated with reduced trichomoniasis risk. Additionally, women whose male partners were circumcised, had more education or earned income had lower risk of trichomoniasis.Conclusions: We found that within African HIV-1 serodiscordant heterosexual couples, the prevalence of trichomoniasis was high among partners of T. vaginalis-infected individuals, suggesting that partner services could play an important role identifying additional cases and preventing reinfection. Our results also suggest that male circumcision may reduce the risk of male-to-female T. vaginalis transmission. [ABSTRACT FROM AUTHOR]

Background: Children living in households where there is intimate partner violence (IPV) are at increased risk of maltreatment, which is associated with a range of poor health outcomes. There is considerable interest in whether existing interventions targeting IPV have 'spill over' effects on child maltreatment. UZIKWASA, a civil society organisation in Pangani, has developed a targeted intervention for couples in conflict, combining intensive reflective workshops with ongoing coaching to address IPV. Objective: As part of a larger study looking at the broader impacts of the UZIKWASA intervention package, we explored its impact on children of a sample of participating couples. Methodology: In-depth interviews were conducted with adolescent children (14-17 years) of five couples who participated in the intervention and analysed using a mixed deductive/inductive approach. Results: Adolescents narrated different challenges they encountered in living in households with IPV, which included worries about their parents' relationship. They described how this interfered negatively with their health and well-being. Examples include mental distress (e.g., sadness, irritability), changes in eating and sleeping patterns, mood changes, and lower academic performance. They also talked about the positive impacts of their parents' participation in the UZIKWASA intervention. Less conflict and more positive communication between parents improved the household environment in general, leading to several positive changes. These included increased concentration on school activities resulting in improvement in academic performance, improved mental and emotional stability, learning of new communication skills and household routines including eating and sleeping schedules, and increased trust in parents. Conclusions and recommendations: This analysis reveals the wider benefits of the UZIKWASA couples' programme on children's physical and mental health. There is a need to utilise existing interventions to address the need for integrated violence prevention programmes, including fully understanding the 'spill over' effects of IPV and violence against children programming. [ABSTRACT FROM AUTHOR]

Background: Child abuse is a global problem with devastating health consequences. It is also one of the risk factors for the perpetration and experience of Intimate Partner Violence (IPV). There is paucity of insights on childhood abuse from men and women in low-income countries such as Tanzania. Yet such information is crucial for developing appropriate interventions. Objectives: To explore the lived experiences of childhood violence of men and women in Mwanza. To examine narratives of their children's experiences of violence within the family context, and those of other children in the community, and their health effects. Methods: We conducted in-depth interviews with purposively sampled 18 women and 30 men in different localities of Mwanza city. Participant's age range was 22 to 61 years. Same sex researchers conducted the interviews using semi-structured interview guides. The data was coded using NVivo software and analyzed through a multistage inductive process. Results: Participants recounted about their own experiences of childhood violence while growing up. The violence came from their parents, relatives, or opposite sex adults. Women reported sexual abuse from older men leading to some dropping out of school, becoming pregnant and early childhood marriages. They also reported that their male partners abused their children. Main causes of childhood violence were parent's infidelity and alcohol abuse, family's economic difficulties, early engagement in sexual acts, negative social norms about children's upbringing and discipline, youth drug abuse and negative impact of internet and social networks. These resulted into four main forms of violence: physical, psychological, economic, and sexual abuse. Conclusions: Interventions addressing childhood violence and IPV must address both personal and structural factors propelling violence. There is a need to explore the deep-rooted connections between violence experience and perpetration in the life course of children. [ABSTRACT FROM AUTHOR]

Background: High blood pressure (BP) among children and adolescents is increasingly becoming common. However, prevalence estimates vary widely partly due to variations in study setting (rural/urban), method of BP measurement and definition of high BP. Few studies have used unattended automated office BP measurements (AOBP) and to the best of our knowledge no study in Africa has used 24-Hour ambulatory BP measurement (24-Hour ABPM) for confirming high BP among adolescents. Objectives: To estimate prevalence of high BP using unattended automated office BP (on two separate occasions) and 24-hour ABPM for confirmation of sustained high BP and ruling out white coat hypertension. Methods: From April to September 2018, we enrolled 500 adolescents aged between 11 and 15 years from 3 public secondary schools in Mwanza city. Using standard procedures, we obtained 3 unattended AOBP readings on the first occasion. On the second occasion -- within 2 weeks - 3 unattended AOBP were obtained from participants who had high BP on the first occasion. Within a month, 24-Hour ABPM was done on participants with persistently high BP on the second occasion. Results: The median age (Interquartile range) of participants was 14.0 (13.0 -- 15.0) years and 56.6% of participants were females. Most participants (91.2%) had their BP measured for the first-time following participation in this study. Based on three BP measures taken during the first occasion, prevalence of high BP was 36.6% (183) and 25.6% (128) using first BP measure and average of last two BP measures, respectively. On the second occasion, 10.2% (51) had persistently high BP using average of last two readings. 2.6% (13) had sustained high BP using 24-Hour ambulatory BP measurement. Conclusion: White coat hypertension is common among adolescents in Tanzania. School based screening for high BP is feasible and could be used for cardiovascular health promotion. [ABSTRACT FROM AUTHOR]

We evaluated the efficacy of a brief motivational intervention (MI) counseling in reducing alcohol consumption among persons living with HIV/AIDS in Kampala, Uganda. Persons living with HIV/AIDS with Alcohol Use Disorders Identification Tool (AUDIT) score ≥3 points were randomized to either standardized positive prevention counseling alone or in combination with alcohol brief MI counseling. The mean change in AUDIT-C scores over 6 months was compared by treatment arm. The mean (standard deviation [SD]) AUDIT-C scores were 6.3 (2.3) and 6.8 (2.3) for control and MI arms ( P = .1) at baseline, respectively, and change in mean AUDIT-C score was not statistically different between arms over the 6 months ( P = .8). However, there was a statistically significant decrease in mean AUDIT-C score (-1.10; 95% confidence interval: -2.19 to -0.02, P = .046) among women in the MI arm. There was a nondifferential reduction in alcohol consumption overall, but MI appeared effective among women only. Studies with more than 1 counseling session and evaluation of gender differences in treatment response are needed. [ABSTRACT FROM AUTHOR]

Copyright of Health Policy & Planning is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study was performed to analyze the associations between cervical human papillomavirus (HPV) infection and human immunodeficiency virus (HIV) acquisition, using cervical samples from previous studies in Tanzania and Uganda.Methods: A total of 161 adult women who acquired HIV infection during follow-up and 464 individually matched HIV-seronegative controls were selected from 5 cohorts of women working in bars and recreational facilities. Stored cervical samples were tested for 37 HPV genotypes, using a polymerase chain reaction assay (Roche Linear Array genotyping assay). Multivariate matched analysis using conditional logistic regression was performed to evaluate HPV infection, persistence, and clearance as predictors of HIV acquisition.Results: HIV seroconverters were significantly more likely than controls to frequently drink alcohol and to be infected with Chlamydia trachomatis, Neisseria gonorrhoeae, or herpes simplex virus type 2. There was no evidence of an association between HIV acquisition and any detectable HPV at the visit prior to HIV seroconversion (adjusted odds ratio, 1.02; 95% confidence interval, .66-1.57) or between HIV acquisition and persistent HPV infection (defined as 2 positive HPV genotype-specific test results at least 6 months apart), cleared HPV infection (defined as a positive HPV test result followed by negative HPV genotype-specific test result), or newly acquired HPV infection, compared with HPV-negative women.Conclusions: There was no evidence of association between HPV infection status and subsequent HIV acquisition. These results stand in contrast to other observational studies. [ABSTRACT FROM AUTHOR]

Purpose Acquisition of human papillomavirus (HPV) in women occurs predominantly through vaginal sex. However, HPV has been detected in girls reporting no previous sex. We aimed to determine incidence and risk factors for HPV acquisition in girls who report no previous sex in Tanzania, a country with high HPV prevalence and cervical cancer incidence. Methods We followed 503 adolescent girls aged 15–16 years in Mwanza, Tanzania, with face-to-face interviews and self-administered vaginal swabs every 3 months for 18 months; 397 girls reported no sex before enrollment or during follow-up; of whom, 120 were randomly selected. Samples from enrollment, 6-, 12-, and 18-month visits were tested for 37 HPV genotypes. Incidence, clearance, point prevalence, and duration of any HPV and genotype-specific infections were calculated and associated factors were evaluated. Results Of 120 girls who reported no previous sex, 119 were included, contributing 438 samples. HPV was detected in 51 (11.6%) samples. The overall incidence of new HPV infections was 29.4/100 person-years (95% confidence interval: 15.9–54.2). The point prevalence of vaccine types HPV-6,-11,-16, and -18 was .9%, .9%, 2.0%, and 0%, respectively. Spending a night away from home and using the Internet were associated with incident HPV, and reporting having seen a pornographic movie was inversely associated with HPV incidence. Conclusions Incident HPV infections were detected frequently in adolescent girls who reported no previous sex over 18 months. This is likely to reflect under-reporting of sex. A low-point prevalence of HPV genotypes in licensed vaccines was seen, indicating that vaccination of these girls might still be effective. [ABSTRACT FROM AUTHOR]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Human immunodeficiency virus (HIV)-infected persons have higher rates of herpes zoster than HIV-uninfected individuals. We assessed whether twice daily treatment with 400 mg of oral acyclovir reduces the incidence of herpes zoster in a randomized, double-blind, placebo-controlled trial among 3408 persons coinfected with HIV and herpes simplex virus type 2. During 5175 person-years of follow-up, 26 cases of herpes zoster occurred among those assigned acyclovir, compared with 69 cases among those assigned placebo (rates, 1.00 and 2.68/100 person-years, respectively), a relative decrease of 62% (hazard ratio, 0.38; 95% confidence interval, .24-.67; P < .001). Daily acyclovir prophylaxis significantly reduced herpes zoster incidence among HIV-infected persons. [ABSTRACT FROM AUTHOR]

Background. The efficacy of condoms for protection against transmission of herpes simplex virus type 2 (HSV-2) has been examined in a variety of populations with different effect measures. Often the efficacy has been assessed as change in hazard of transmission with consistent vs inconsistent use, independent of the number of acts. Condom efficacy has not previously measured on a per-act basis. Methods. We examined the per-act HSV-2 transmission rates with and without condom use among 911 African HSV-2 and human immunodeficiency virus type 1 (HIV-1) serodiscordant couples followed for an average of 18 months in an HIV prevention study. Infectivity models were used to associate the log10 probability of HSV-2 transmission over monthly risk periods with reported numbers of protected and unprotected sex acts. Condom efficacy was computed as the proportionate reduction in transmission risk for protected relative to unprotected sex acts. Results. Transmission of HSV-2 occurred in 68 couples, including 17 with susceptible women and 51 with susceptible men. The highest rate of transmission was from men to women: 28.5 transmissions per 1000 unprotected sex acts. We found that condoms were differentially protective against HSV-2 transmission by sex; condom use reduced per-act risk of transmission from men to women by 96% (P < .001) and marginally from women to men by 65% (P = .060). Conclusions. Condoms are recommended as an effective preventive method for heterosexual transmission of HSV-2. [ABSTRACT FROM AUTHOR]