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Nathanael Sirili,1 Doreen Mloka,2 Lilian Mselle,3 Rodrick Kisenge,4 Erasto Mbugi,5 Dennis Russa,6 Obadia Nyongole,7 Stephen E Mshana,8 Rose Laisser,9 Kien Mteta,10 Levina Msuya,11 Eligius Lyamuya,12 Judith Martin-Holland,13 Gideon Kwesigabo,14 Ephata Kaaya15 1Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 3Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 4Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Department of Biochemistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Department of Anatomy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 7Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 8Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 9Archbishop Anthony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 10Department of Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 11Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 12Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 13Department of Physiological Nursing, University of San Francisco California, San Francisco, CA, USA; 14Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; 15Department of Pathology, Kilimanjaro Christian Medical University College, Moshi, TanzaniaCorrespondence: Nathanael Sirili, Email drnsirili@gmail.comBackground: In 2012, the Muhimbili University of Health and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its programmes. Other health profession training institutions continued with their traditional way of teaching and thus causing variability in the competencies of the graduates. We aimed to analyze the experiences of different stakeholders on the implementation of CBC specifically on biomedical sciences by MUHAS to inform the development of harmonized competency-based curricula in three health professional training institutions in Tanzania.Methods: We adopted an exploratory case study to analyse the implementation of CBC in programmes of Medicine and Nursing involving MUHAS graduates, immediate supervisors at the employment sites, faculty, and continuing students at MUHAS. Kiswahili guides were used to conduct the in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted for analysis.Results: From the 38 IDIs and 15 FGDs, four categories of human resources teaching and learning environment; curriculum content; and support systems emerged. Human resources were attributed to the shortage of an adequate number of faculty and teaching skills variation. The curriculum content category was linked to the redundancy of courses or topics, poor sequencing of some topics or courses, and limited time for teaching some essential courses or topics. Training and practice area mismatch, accommodation to students, teaching space, and library were the sub-categories linked to teaching and learning environment. Lastly, support systems related to teaching methods and opportunities for improving teaching and learning were revealed.Conclusion: The findings of this study highlight the challenges and opportunities for the implementation of CBC. The solutions to the revealed challenges are beyond the training institutions’ capacity. The latter call for multi-stakeholder engagement including those from the public and private sectors in health, higher education and finance for common and sustainable solutions.Keywords: competency-based curricula, biomedical sciences, teaching pedagogy, health training institutions, harmonized training, Tanzania

James Samwel Mundamshimu,1 Kija Malale,1 Benson R Kidenya,1 Daniel W Gunda,1 Logious Bwemelo,1,* Mwakile Mwashiuya,1,* Salhida Shamnte Omar,1,* Neema Mlowe,1,* Magwa Kiyumbi,1 James S Ngocho,2,3 Emmanuel Balandya,4 Bruno Sunguya,4 Stephen E Mshana,1 Kien Mteta,2 John Bartlett,5,6 Eligius Lyamuya,4 Blandina Theophil Mmbaga,2,3 Samuel Kalluvya1 1Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 2Kilimanjaro Christian Medical University College, Moshi, Tanzania; 3Kilimanjaro Clinical Research Institute, Moshi, Tanzania; 4Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Kilimanjaro Christian Medical University College, Mosh, Tanzania; 6Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA*These authors contributed equally to this workCorrespondence: James Samwel Mundamshimu, Tel +255746999249, Email jamessamwel913@yahoo.comBackground: Introduction and expansion of antiretroviral therapy (ART) have turned the tide of HIV pandemic, thus helping people living with HIV (PLHIV) achieve viral suppression. This success may need to be complemented by intensified adherence counseling (IAC) to improve adherence to treatment. However, some PLHIV still face higher than acceptable viral loads despite being on treatment.Purpose: We investigated the factors associated with the failure to suppress HIV viral load after three months of IAC sessions.Patients and Methods: This cross-sectional study analyzed secondary data from PLHIV-attended care and treatment clinics in Mwanza between January 2018 and December 2019 who had unsuppressed VL after being on ART for at least six months. We identified PLHIV in first-line ART with viral load evaluation before receiving IAC and had viral load results done at 90 days after IAC. We conducted descriptive statistics to examine the magnitude of viral suppression. Wilcoxon signed-rank test used to compare the median viral load before and after IAC sessions, and logistic regressions predicted the factors associated with failure.Results: This study included 212 subjects. After intervention, most participants 85.9% (182) had significantly improved adherence compared to baseline. More than half 75.5% (160) of the participants had viral suppression after the intervention. Participants aged 18– 25 years (AOR = 5.6, 95% CI, 1.1– 29.6), unstable client during ART initiation (AOR = 0.3, 95% CI, 0.13– 0.62), and poor adherence to ART (AOR = 4, 95% CI, 1.3– 12.3) remained the main predictors of virological failure after IAC intervention.Conclusion: Even though virological suppression is influenced by ART adherence, the findings in this study have shown co-existence of other factors to be addressed. Unstable during ART initiation is a new factor identified in this study.Keywords: people living with HIV, virological failure, intensified adherence counseling, factors, Tanzania

Emmanuel Balandya,1 Bruno Sunguya,2 Benson Kidenya,3 Tumaini Nyamhanga,4 Irene K Minja,5 Michael Mahande,6 Blandina T Mmbaga,7 Stephen E Mshana,8 Kien Mteta,9 John Bartlett,10 Eligius Lyamuya11 1Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 2Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 3Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 4Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 5Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 6Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 7Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 8Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 9Department of Urology, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 10Duke Global Health Institute, Duke University, Durham, NC, USA; 11Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, TanzaniaCorrespondence: Emmanuel Balandya, Department of Physiology, Muhimbili University of Health and Allied Sciences, P.O. Box. 65001, Dar-es-salaam, Tanzania, Tel +255-768-431600, Fax +255-22-2150465, Email ebalandya@muhas.ac.tzBackground: Mentorship is pivotal for sustainability of a successful research culture at higher learning institutions. Various models have been proposed for provision of research mentorship in health sciences but are challenged by utilizing predominantly hierarchical mentoring, as well as being centred on one discipline or one institution. This paper describes the approach and successes of an inclusive mentorship model employed in a resource-limited setting in sub-Saharan Africa.Methods: Through the NIH-funded Transforming Health Professions Education in Tanzania (THET) project, a consortium of three prominent health sciences higher learning institutions in Tanzania (MUHAS, CUHAS and KCMUCo) and two collaborating US institutions (UCSF and Duke University) was formed. Within THET, the Community of Young Research Peers (CYRP) was constituted, comprised two cohorts of undergraduate students and young faculty (fellows), and senior scientists. Besides mentorship and research training, fellows received funded research awards and in turn mentored undergraduate students.Results: By the first quarter of project year four, the number of fellows and mentored undergraduate students had increased from 12 to 24 and from 41 to 67, respectively. Fellows in the second cohort (junior fellows) included medical doctors, nurses, dentist, biomedical scientist, sociologist and education psychologist. In fostering peer-to-peer mentoring, the cross-institutional pairs of fellows from the first cohort (senior fellows) were assigned to reciprocal pairs of junior fellow mentees and took a leading role in research training. Furthermore, the senior fellows had made significant strides, including eight enrolled in PhD programmes, eight publications from mentored research projects, and six small to medium-size research grants won.Conclusion: The unifying model of research mentorship employed by the CYRP has been demonstrated as an effective model for joint research mentorship of the diverse group of young investigators from collaborating higher learning institutions in Tanzania. This model is recommended for scale-up, particularly in sub-Saharan Africa.Keywords: health research, cross-institutional, inter-disciplinary, young faculty, mentorship, undergraduate

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 [...]

As international collaborative health research activities increase, building research ethics committees (REC) infrastructure and capacity in low- and middle-income countries for efficient and thorough review of research protocols becomes more critical, especially in sub-Saharan Africa. International investigators may face multiple challenges when conducting research in these settings, an important one being the length of time involved in securing REC review and approval. We discuss an approach to the problem that involved organisation of 'rapid review' REC sub-committees who met via video-conference for collaborative review of research protocols. [ABSTRACT FROM AUTHOR]

Raphael Z Sangeda,1,2 Fausta Mosha,3 Said Aboud,4 Appolinary Kamuhabwa,5 Guerino Chalamilla,6,† Jurgen Vercauteren,2 Eric Van Wijngaerden,7 Eligius F Lyamuya,4 Anne-Mieke Vandamme2,8 1Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, KU Leuven – University of Leuven, Leuven, Belgium; 3Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania; 4Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Management and Development for Health (MDH), Dar es Salaam, Tanzania; 7Department of General Internal Medicine, University Hospitals, KU Leuven – University of Leuven, Belgium; 8Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal †Dr Guerino Chalamilla passed away in November 2015 Background: Measurement of adherence to antiretroviral therapy (ART) can serve as a proxy for virologic failure in resource-limited settings. The aim of this study was to determine the factors underlying nonadherence measured by three methods. Patients and methods: This is a prospective longitudinal cohort of 220 patients on ART at Amana Hospital in Dar es Salaam, Tanzania. We measured adherence using a structured questionnaire combining a visual analog scale (VAS) and Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ), pharmacy refill, and appointment keeping during four periods over 1 year. Overall adherence was calculated as the mean adherence for all time points over the 1 year of follow-up. At each time point, adherence was defined as achieving a validated cutoff for adherence previously defined for each method. Results: The proportion of overall adherence was 86.4% by VAS, 69% by SHCS-AQ, 79.8% by appointment keeping, and 51.8% by pharmacy refill. Forgetfulness was the major reported reason for patients to skip their medications. In multivariate analysis, significant predictors to good adherence were older age, less alcohol consumption, more advanced World Health Organization clinical staging, and having a lower body mass index with odds ratio (CI): 3.11 (1.55–6.93), 0.24 (0.09–0.62), 1.78 (1.14–2.84), and 0.93 (0.88–0.98), respectively. Conclusion: We found relatively good adherence to ART in this setting. Barriers to adherence include young age and perception of well-being. Keywords: self-report, appointment keeping, pharmacy refill, adherence barriers, resource-limited settings, AIDS