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Background: Despite lower rates of the human immunodeficiency virus (HIV) among adolescents in Tanzania, the number of adolescents living with HIV is increasing. Generally, adolescents are lagging in achieving the “Third 95” target that focuses on suppressing the viral load to 95% of those on treatment. This study aimed to describe factors independently associated with viral load non-suppression among HIV-positive ART-experienced adolescents in care and treatment health services facilities supported by Amref Health Africa Tanzania in the Tanga region. Methods: A retrospective review of routinely collected HIV program records was carried out. We extracted data from the CTC2 database that included age, sex, BMI, WHO HIV staging, marital status, ART duration, VLS, regimen, facility level, and Dolutegravir (DTG)-based drug. Descriptive analysis using frequencies was carried out to describe the study participants' sociodemographic and clinical characteristics. Multiple logistic regression was done to adjust for factors associated with viral load non-suppression. Viral load non-suppression was defined as viral load ≥ 1000 copies/ml. Results: 2493 (98%) adolescents were on first-line ART, and 2286 (89.68%) participants were virally suppressed, while 263 (10.32%) had viral load non-suppression (≥ 1000 copies/ml). In addition, 2322 (91.09%) of participants on ART were using DTD-related drugs; of them, 92.76% were virally suppressed. Not using DTG-related drugs (OR: 13.89, 95% CI 6.44 – 16.96) and hospital facility level (OR: 3.53, 95% CI 1.39 – 8.99) were independently associated with increased odds for not achieving viral load suppression. In addition, adolescents aged between 15 – 19 years were more likely associated with viral load suppression (OR: 0.54, 95% CI 0.30 – 0.97). Conclusion: 10.32% of the adolescents on ART did not achieve viral load suppression, not using DTG-related drugs, and the hospital facility level increased the odds of not achieving viral load suppression. The use of DTG-related drugs significantly lowered viral load. HIV intervention strategies should be improved to ensure DTG utilisation in all PLHIV on ART and techniques used by health centres are disseminated to the hospital facility level.

Additional file 2. Supplementary content 2: Assessment of risk of bias for the quantitative studies/ study part. The assessment follows the methods commentary: Risk of Bias in cross-sectional surveys of attitudes and practices (Agarwal et al. 2017).

Additional file 1. Supplementary Content 1: Search terms and hits by database.

In sub-Saharan Africa where sex work is often criminalized and highly stigmatized, female bar workers (FBWs) often serve as informal sex workers. However, little is known about the prevalence of HIV and HIV-related risk factors among FBWs in Dar es Salaam (DSM), Tanzania. Using an adapted Structural HIV Determinants Framework, we identified structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition. We compared the prevalence of these risk factors and the prevalence of HIV among a random sample of 66 FBWs from DSM to an age-standardized, representative sample of female DSM-residents using data from the Tanzanian 2016 Demographic and Health and 2011-2012 AIDS Indicator Surveys. We found that, compared to other women in DSM, FBWs had elevated prevalence of all four groups of risk factors, often substantially so. Key risk factors included gender and economic inequalities (structural); sexual violence and challenges negotiating condom use (interpersonal); depression, post-traumatic stress disorder, and low social support (psychosocial); and history of unprotected sex, multiple sex partners, and frequent high alcohol consumption (behavioral). However, the HIV prevalence did not differ between FBWs (7.1%, 95% CI 3.7-13.3%) and survey respondents (7.7%, 95% CI: 5.3-11.1%), perhaps due to FBWs’ higher – but still sub-optimal – engagement with HIV prevention strategies including condom use and HIV testing. FBWs’ elevated exposure to structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition but low HIV prevalence suggests that economic, psychosocial, and biomedical interventions to prevent HIV acquisition among FBWs in DSM are warranted.

OBJECTIVE The objective of this study was to assess the effectiveness of a routine multivitamin supplementation program for adults living with HIV in Tanzania. DESIGN We conducted a retrospective cohort study of 67 707 adults enrolled in the Dar es Salaam HIV care and treatment program during 2004-2012. METHODS The Dar es Salaam HIV care and treatment program intended to provide all adult patients with multivitamin supplements (vitamins B-complex, C, and E) free of charge; however, intermittent stockouts and other implementation issues did not afford universal coverage. We use Cox proportional hazard models to assess the time-varying association of multivitamin supplementation with mortality and clinical outcomes. RESULTS The study cohort contributed 41 540 and 129 315 person-years of follow-up time to the antiretroviral therapy (ART)-naive and ART-experienced analyses, respectively. Among 48 207 ART-naive adults, provision of multivitamins reduced the risk of mortality [adjusted hazard ratio (aHR): 0.69; 95% confidence interval (CI): 0.59-0.81], incident tuberculosis (TB) (aHR: 0.83; 0.76-0.91), and meeting ART eligibility criteria (aHR: 0.78; 95% CI: 0.73-0.83) after adjustment for time-varying confounding. Among 46 977 ART-experienced patients, multivitamins reduced mortality (hazard ratio: 0.86; 95% CI: 0.80-0.92), incident TB (aHR: 0.78; 95% CI: 0.73-0.84), and immunologic failure (aHR: 0.70; 95% CI: 0.67-0.73). The survival benefits associated with provision multivitamins appeared to be greatest during the first year of ART and declined over time (P value

Background: Overweight and obesity are increasingly prevalent among HIV-infected populations. We describe their prevalence and associated risk factors among HIV-infected adults in Dar es Salaam, Tanzania. Methods: A cross-sectional study was conducted to determine the proportion of patients who were overweight or obese at enrollment to care and treatment centres from 2004 to 2011. Multivariate relative risk regression models were fit to identify risk factors. Results: A total of 53 825 patients were included in the analysis. In all, 16% of women and 8% of men were overweight, while 7% and 2% were obese, respectively. In multivariate analyses, older age, higher CD4 count, higher hemoglobin levels, female sex, and being married were associated with obesity and overweight. World Health Organization HIV disease stage, tuberculosis history, and previous antiretroviral therapy were inversely associated with obesity and overweight. Conclusion: Overweight and obesity were highly prevalent among HIV-infected patients. Screening for overweight and obesity and focused interventions should be integrated into HIV care.

Objective:To describe the incidence of and risk factors for overweight and obesity following antiretroviral therapy (ART) initiation.Methods:We used Cox proportional hazards models to investigate risk factors for incident overweight and obesity in 79 074 individuals aged 15 years or older who initiated ART in Dar es Salaam, Tanzania.Results:Twenty-five percent of the patients became overweight and 10% became obese. The incidence rate of obesity was 3.2 per 100 person-years (95% confidence interval [CI]: 3.1-3.3) in patients who were of normal weight before starting ART and 22.6 per 100 person-years (95% CI: 21.9-23.3) in those who were overweight. Lower CD4 count was associated with a higher risk of overweight and obesity ( P value for trend < .0001).Conclusion:There is a high burden of overweight and obesity after starting ART, leading to proportions of these 2 conditions that are similar to those in the general population.

We examined the incidence of herpes zoster (HZ) before and after the initiation of antiretroviral therapy (ART), and risk factors for HZ among human immunodeficiency virus (HIV)-infected individuals in Tanzania. A cohort study was conducted among HIV-positive individuals enrolled in HIV care and treatment clinics in Dar es Salaam, Tanzania. A Cox proportional hazard model was used to examine the effect of ART on the risk of HZ after adjusting for sociodemographics and time-varying clinical and nutritional factors. Among 72,670 HIV-positive individuals, 2,312 incident cases of HZ (3.2%) occurred during the median follow-up of 15 months (interquartile range: 3–35). The incidence rate of HZ significantly declined from 48.9 (95% confidence interval [CI] = 46.7–51.0) per 1,000 person-years before ART to 3.7 (95% CI = 3.3–4.1) per 1,000 person-years after the initiation of ART (P < 0.001). The risk of HZ declined with longer duration on ART. Low CD4 cell count, older age, female sex, district of Dar es Salaam, and year of enrollment were independently associated with the risk of HZ in the multivariate analysis. Low body mass index and anemia were not associated with the risk of HZ. The risk of HZ substantially declined after ART initiation in this large cohort of HIV-infected individuals. Earlier initiation of ART could reduce the risk of HZ and other opportunistic infections among HIV-infected individuals in sub-Saharan Africa.

BackgroundMale partner participation improves uptake, retention and outcomes of prevention of mother-to-child transmission of HIV (PMTCT) services. However, in patriarchal settings few men accompany their partners to antenatal care (ANC) and PMTCT services. We explored whether community leaders can improve male partner participation in ANC and PMTCT.MethodsWe integrated initiatives to increase male partner participation in routine ANC care in six health facilities (attending about 4,500 new pregnant women per quarter) in Dar es Salaam, Tanzania in 2015/16. These initiatives were adapted from a best performing health facility, on male partner participation in ANC and PMTCT, referred to as the "best practice site". At the six purposively selected intervention sites, we sensitized and garnered commitment from healthcare providers to provide couple friendly services. We then worked with the providers to sensitize and engage community leaders to integrate and promote male partner participation initiatives in their routine community activities. We assessed change in male partner participation in ANC and PMTCT using the proportion of women testing for HIV together with their partners (i.e. couple HIV testing) by quarter. We used 203 ANC facilities (attending about 31,000 new pregnant women per quarter) in the same area as control sites.ResultsAfter one year, couple HIV testing in the six intervention sites had tripled from 11.9% at baseline to 36.0% (pConclusionEffective engagement and functional partnerships between healthcare providers and community leaders can contribute to improve male partner participation in ANC and PMTCT services. PMTCT programs should capitalize on community leaders, in addressing low male partner participation in ANC and PMTCT, in order to improve effective uptake, retention and outcomes of HIV prevention and treatment services among pregnant and breastfeeding women, their partners, infants and families.

OBJECTIVE: To identify risk factors for loss to follow-up (LTFU) in an HIV-infected pediatric population in Dar es Salaam Tanzania between 2004 and 2011. DESIGN: Longitudinal analysis of 6236 HIV-infected children. METHODS: We conducted a prospective cohort study of 6236 pediatric patients enrolled in care and treatment in Dar es Salaam from October 2004 to September 2011. LTFU was defined as missing a clinic visit for >90 days for patients on ART and for >180 days for patients in care and monitoring. The relationship of baseline and time-varying characteristics to the risk of LTFU was examined using a Cox proportional hazards model. RESULTS: A total of 2130 children (34%) were LTFU over a median follow-up of 16.7 months (interquartile range 3.4-36.9). Factors independently associated with a higher risk of LTFU were age

ObjectiveFemale bar workers (FBW) in East Africa often conduct sex work to supplement their incomes, and may be vulnerable to HIV acquisition. Pre-exposure prophylaxis (PrEP) offers protection against HIV acquisition. However, there is little research on FBW’s sexual health. Our objective was to determine HIV risk behaviours and interest in PrEP among FBW in the largest city in East Africa.DesignCross-sectional survey covering respondents’ work and personal lives, including social and behavioural risk factors for HIV. The survey aimed to determine the feasibility of working with FBW and HIV prevalence estimates. Those who did not report being HIV positive were asked about their knowledge of and interest in PrEP. All women were offered free on-site HIV testing and counselling (HTC).SettingEight randomly selected workplaces, that is, bars, in Kinondoni district, Dar es Salaam (DSM).Participants66 FBW (≥18 years) selected at random from all women working in selected bars on the day of visit.ResultsHalf of respondents reported having had sex for money: 20% with bar clients only, 15% with other men only and 15% with both. Almost all (98%) reported ≥1 non-commercial partners in the past 12 months; only 30% reported using condoms with these partners. 85% of respondents had ever been pregnant; 44% had had an unintended pregnancy. Only 5% of respondents had ever heard of PrEP. However, 54% were somewhat/very interested in daily-pill PrEP and 79% were somewhat/very interested in long-acting injectable PrEP. When asked to rank modalities, long-acting injectable PrEP was the most preferred. Seven per cent of the 56 respondents who completed HTC tested HIV positive.ConclusionsFBW in DSM have elevated risk factors for HIV acquisition, and PrEP appears highly acceptable. Studies developing PrEP delivery models and assessing PrEP initiation and adherence in FBW appear warranted.

Objectives In a large cohort of HIV-infected Tanzanians, we assessed: (i) rates of first-line treatment failure and switches to second-line ART; (ii) the effect of switching to second-line ART on death and loss to follow-up; and (iii) treatment outcomes on second-line ART by regimen. Methods HIV-1-infected adults (≥15 years) initiated on first-line ART between November 2004 and September 2012, and who remained on initial therapy for at least 24 weeks before switching, were studied. Survival analyses were conducted to examine the effect of second-line ART on mortality and loss to follow-up in: (i) the whole cohort; (ii) all patients eligible for second-line ART by immunological failure (IF) and/or virological failure (VF) criteria; and (iii) patients eligible by VF criteria. Results In total, 47 296 HIV-infected patients [mean age 37.5 (SD 9.5) years, CD4 175 (SD 158) cells/mm 3 , 71% female] were included in the analyses. Of these, 1760 (3.7%) patients switched to second-line ART (incidence rate = 1.7/100 person-years). Higher rates of mortality were observed in switchers versus non-switchers in all patients and patients with ART failure using IF/VF criteria. Switching only protected against mortality in patients with ART failure defined virologically and with the highest level of adherence [switching versus non-switching; >95% adherence; adjusted HR = 0.50 (95% CI = 0.26-0.93); P = 0.03]. Conclusions Switching patients to second-line ART may only be beneficial in a select group of patients who are virologically monitored and demonstrate good adherence. Our data emphasize the need for routine viral load monitoring and aggressive adherence interventions in HIV programmes in sub-Saharan Africa.

Introduction Global scale up of anti‐retroviral therapy (ART) has led to expansion of HIV treatment and prevention across sub‐Saharan Africa. However, age and gender‐specific disparities persist leading to failures in fulfillment of Sustainability Development Goals, including SDG3 (achieving healthy lives and wellbeing for all, at all ages) and SDG5 (gender equality). We assessed ART initiation and adherence, loss to follow‐up, all‐cause death and early death, according to SDG3 and SDG5 indicators among a cohort of HIV‐infected children and adolescents enrolled in care in Dar‐es‐Salaam, Tanzania Methods SDG3 indicators included young (

Background Few studies have described time-based trends of clinical and demographic characteristics of children enrolling in HIV and AIDS care and treatment services. We present findings of a study that explored time-based trends of baseline characteristics among children enrolling into 26 public HIV care facilities in Dar es Salaam, Tanzania. Methods Children enrolled between October 2004 and September 2011 was included in these analyses. The year of enrollment was used as the primary predictor of interest, and log linear and linear regressions model were used to analyze dichotomous and continuous variables respectively. P-values under 0.05 were considered significant. Results Among the 6,579 children enrolled, the proportion with advanced disease at enrollment increased from 35% to 58%, mean age increasing from 5.0 to 6.2 years (p

Background: Adherence rates of ≥95% to antiretroviral therapy (ART) are necessary to maintain viral suppression in HIV-infected individuals. We identified predictors of nonadherence to scheduled antiretroviral drug pickup appointments in a large HIV care and treatment program in Tanzania. Methods: We performed a prospective cohort study of 44, 204 HIV-infected adults on ART between November 2004 and September 2012. Multivariate generalized estimating equation for repeated binary data was used to estimate the relative risk and 95% confidence intervals of nonadherence. Results: Nonadherence was significantly greater among patients with high CD4 counts, high body mass indices, males, younger patients, patients with longer durations on ART, and those with perceived low social support. Conclusions: Targeted interventions should be developed to improve ART adherence among healthier, younger, and more experienced patients who are on ART for longer durations within HIV care and treatment programs. Social support for patients on ART should be emphasized.

OBJECTIVE: To investigate risk factors for maternal mortality among HIV-infected women in Tanzania. DESIGN: Prospective cohort study. SETTING: HIV care and treatment clinics in Dar es Salaam Tanzania. POPULATION: HIV-infected pregnant women. METHODS: Data were collected for all patients enrolled in an HIV/AIDS care and treatment program. Between November 2004 and September 2011 there were 18 917 women pregnant at least once during the follow-up. Thirteen percent of these women had more than one pregnancy with 21 645 pregnancies occurring. Logistic regression was used to explore the predictors of maternal death among these women. MAIN OUTCOME MEASURES: Maternal mortality. RESULTS: During the study period 363 maternal deaths occurred giving a maternal mortality ratio of 1729 [95% confidence interval (CI) 1553-1905] per 100 000 live births. Being wasted [odds ratio (OR) 3.38 95% CI 2.58-4.45] or anemic (OR 2.26 95% CI 1.70-3.00) was associated with a higher risk of maternal mortality. Women who were initiated on antiretroviral therapy before their pregnancy had a 55% decreased risk of maternal mortality (95% CI 0.29-0.70) compared with women who were not. The risk of maternal mortality decreased with the length of time on antiretroviral therapy during pregnancy by 8% for each additional month (OR 0.92 95% CI 0.88-0.96). CONCLUSIONS: Maternal mortality was high among HIV-infected women. Initiating women on antiretroviral therapy as early as possible and providing nutritional interventions during pregnancy should be considered as means to reduce the maternal mortality among these women. (c) 2014 Nordic Federation of Societies of Obstetrics and Gynecology.