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Introduction: Epidemiological evidence suggests that Onchocerca volvulus is associated with epilepsy, although the exact pathophysiological mechanism is unknown. Mahenge is an endemic focus of onchocerciasis, with the longest-running ivermectin treatment intervention in Tanzania. We assessed the prevalence of onchocerciasis and epilepsy after 25 years of control using ivermectin. Methods: This was a population-based cross-sectional study in 34 villages in Mahenge in 2021. Community health workers conducted door-to-door household surveys to enumerate the population and screen for individuals suspected of epilepsy using a standardised questionnaire. Trained physicians confirmed epilepsy. Children aged 6–11 years were screened for onchocerciasis antibodies using the Ov16 rapid test. Villages were stratified into three altitude levels (low [<400], medium [400–950], and high [>950 meters above sea level]) as a proxy for rapids, which black flies favour for breeding sites. Incidence of epilepsy was estimated as a ratio of new cases in the year preceding the survey per 100,000 population. Results: 56,604 individuals (median age 20.2 years, 51.1% females) were surveyed. Onchocerciasis prevalence in children was 11.8% and was highest in villages at medium (21.7%) and lowest in low altitudes (3.2%), p<0.001. Self-reported use of ivermectin was 88.4%. Epilepsy prevalence was 21.1 (95%CI: 19.9–22.3) cases per 1000 persons and was highest in medium (29.5%) and lowest in the lowlands (12.7%). The odds ratio (OR) of having epilepsy was significantly higher in females (OR = 1.22, 95%CI: 1.08–1.38), middle altitudes (OR = 2.34 [95%CI: 2.04–2.68]), and in individuals positive for OV16 (OR = 1.98 [95%CI:1.57–2.50]). The incidence of epilepsy a year before the survey was 117 (95%CI: 99.7–160.4) cases per 100,000 person-years. Conclusion: Despite ivermectin use for 25 years, the prevalence of onchocerciasis and epilepsy remains high. It is crucial to strengthen bi-annual ivermectin treatment and initiate interventions targeting vectors to control onchocerciasis and epilepsy in the area. Author summary: Onchocerciasis is endemic in Mahenge, with epidemiological evidence that the parasite (Onchocerca volvulus) may be associated with epilepsy. The high burden of the disease in Mahenge led to the introduction of Community Directed Treatment with Ivermectin (CDTI) in 1997. Despite the long history of CDTI implementation in Mahenge, the persistent transmission of the parasite is still reported. A population-based cross-sectional study was conducted to establish the current prevalence of onchocerciasis and epilepsy 25 years after the start of the CDTI programme. The prevalence of epilepsy was 21.1 (95%CI: 19.9–22.3) cases per 1000 people. The incidence of epilepsy one year preceding the survey was 117 (95%CI: 99.7–160.4) per 100,000 person-years. Despite high self-reported coverage of ivermectin (88%), active onchocerciasis transmission was observed among children aged 6–11 years, and more than half of the individuals with epilepsy (54.1%) were serologically positive for onchocerciasis. The predictors for epilepsy were sex (female), age ≥ 10 years, being a resident of Mahenge for ≥20 years, especially in villages located at a medium altitude, and being onchocerciasis positive. Strengthening of processes to ensure bi-annual ivermectin treatment is recommended. [ABSTRACT FROM AUTHOR]

Background: NIMR Tanga laboratory was capacitated with installation of PCR machine by the Ministry of Health in December 2019 for quantifying HIV-1 viral load and HIV-1 early diagnosis for clients of Tanga region. Before samples from Tanga region were sent to KCMC Molecular Laboratory for analysis. The exercise of sending samples to KCMC was time consuming, costly, and resulted to long turnaround time (TAT) of about one month. Long TAT can lead to delay in treatment initiation, poor patient management and even death of PLWHIV. Objective: To reduce TAT of PCR quantification of HIV-1 viral load and early infant diagnosis of HIV-1 among PLWHIV from 8 districts of Tanga region. Methodology: Plasma and dried blood spots samples from 8 districts of Tanga region were sent to NIMR Tanga laboratory for Polymerase chain reaction (PCR) using Cobas Ampliprep/TaqMan platform. After analysis results were sent to the respective health facilities through electronic sample referral system (eSRS) and later hard copies were returned to the facilities. Results: Results shows in 2020 and 2021 a total 23,991 plasma samples for HIV-1 viral load were analysed whereas for HIV-1 early infant diagnosis a total of 838 dried blood spots samples has been analysed both by PCR. Laboratory TAT was reduced to 5 days while TAT at facility level at a maximum 14 days. Conclusion: The Laboratory Turnaround time for HIV-1 viral load and early infant diagnosis of HIV-1 testing has been reduced to 5 days and 14 days at health facility levels in Tanga. [ABSTRACT FROM AUTHOR]