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HIV Seropositivity: HELP
Articles from Tanzania
Based on 41 articles published since 2008
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These are the 41 published articles about HIV Seropositivity that originated from Tanzania during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Association of opioid agonist therapy with the initiation of antiretroviral therapy - a systematic review. 2016

Mlunde, Linda Beatrice / Sunguya, Bruno Fokas / Mbwambo, Jessie Kazeni Kilonzo / Ubuguyu, Omary Said / Yasuoka, Junko / Jimba, Masamine. ·Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. Electronic address: lindasozy@gmail.com. · Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania. Electronic address: sunguya@gmail.com. · Department of Psychiatry and Mental Health, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania. Electronic address: jmbwambo@gmail.com. · Department of Psychiatry and Mental Health, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania. Electronic address: oubuguyu@yahoo.com. · Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. Electronic address: jyasuoka@post.harvard.edu. · Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. Electronic address: mjimba@m.u-tokyo.ac.jp. ·Int J Infect Dis · Pubmed #27044520.

ABSTRACT: OBJECTIVES: People who inject drugs are at high risk of HIV infection but often face barriers in accessing medical care including access to antiretroviral therapy (ART). Evidence is available about the effectiveness of opioid agonist therapy on drug dependency and risk behaviors. However, it remains scattered regarding access to ART among HIV-positive people who inject drugs. We conducted a systematic review to examine the association of opioid agonist therapy with ART initiation among HIV-positive people who inject drugs. METHODS: We searched the literature for evidence from seven databases. We conducted a narrative synthesis and meta-analysis to examine the association of opioid agonist therapy with ART initiation. RESULTS: Five out of 2,901 identified studies met the inclusion criteria. Three out of five studies reported that, HIV-positive people receiving opioid agonist therapy initiated ART more than those not receiving opioid agonist therapy. In meta-analysis, opioid agonist therapy was associated with ART initiation among HIV positive people who inject drugs (pooled odds ratio: 1.68; 95% confidence interval: 1.03-2.73). CONCLUSIONS: Opioid agonist therapy is positively associated with ART initiation among HIV-positive people who inject drugs. It is important to scale up opioid agonist therapy among people who inject drugs to improve their ART initiation.

2 Clinical Trial Safety and Efficacy of a Dapivirine Vaginal Ring for HIV Prevention in Women. 2016

Nel, Annalene / van Niekerk, Neliëtte / Kapiga, Saidi / Bekker, Linda-Gail / Gama, Cynthia / Gill, Katherine / Kamali, Anatoli / Kotze, Philip / Louw, Cheryl / Mabude, Zonke / Miti, Nokuthula / Kusemererwa, Sylvia / Tempelman, Hugo / Carstens, Hannelie / Devlin, Brid / Isaacs, Michelle / Malherbe, Mariëtte / Mans, Winel / Nuttall, Jeremy / Russell, Marisa / Ntshele, Smangaliso / Smit, Marlie / Solai, Leonard / Spence, Patrick / Steytler, John / Windle, Kathleen / Borremans, Maarten / Resseler, Sophie / Van Roey, Jens / Parys, Wim / Vangeneugden, Tony / Van Baelen, Ben / Rosenberg, Zeda / Anonymous3890890. ·From International Partnership for Microbicides, Silver Spring, MD (A.N., N.N., H.C., B.D., M.I., M.M., W.M., J.N., M.R., S.N., M.S., L.S., P.S., J.S., K.W., Z.R.) · London School of Hygiene and Tropical Medicine, London (S. Kapiga) · Mwanza Intervention Trials Unit, Mwanza, Tanzania (S. Kapiga) · Desmond Tutu HIV Centre, University of Cape Town, Cape Town (L.-G.B., K.G.), Maternal, Adolescent, and Child Health Research, Edendale (C.G., Z.M.), Qhakaza Mbokodo Research Clinic, Ladysmith (P.K.), Prevention for HIV and AIDS Project, Pinetown (N.M.), Madibeng Centre for Research, Brits, the Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria (C.L.), and Ndlovu Care Group, Elandsdoorn (H.T.) - all in South Africa · Medical Research Council-Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda (A.K., S. Kusemererwa) · and SGS Life Science Services-Biometrics, Mechelen (M.B., S.R.), and Janssen Research and Development, Beerse (J.V.R., W.P., T.V., B.V.B.) - both in Belgium. ·N Engl J Med · Pubmed #27959766.

ABSTRACT: BACKGROUND: The incidence of human immunodeficiency virus (HIV) infection remains high among women in sub-Saharan Africa. We evaluated the safety and efficacy of extended use of a vaginal ring containing dapivirine for the prevention of HIV infection in 1959 healthy, sexually active women, 18 to 45 years of age, from seven communities in South Africa and Uganda. METHODS: In this randomized, double-blind, placebo-controlled, phase 3 trial, we randomly assigned participants in a 2:1 ratio to receive vaginal rings containing either 25 mg of dapivirine or placebo. Participants inserted the rings themselves every 4 weeks for up to 24 months. The primary efficacy end point was the rate of HIV type 1 (HIV-1) seroconversion. RESULTS: A total of 77 participants in the dapivirine group underwent HIV-1 seroconversion during 1888 person-years of follow-up (4.1 seroconversions per 100 person-years), as compared with 56 in the placebo group who underwent HIV-1 seroconversion during 917 person-years of follow-up (6.1 seroconversions per 100 person-years). The incidence of HIV-1 infection was 31% lower in the dapivirine group than in the placebo group (hazard ratio, 0.69; 95% confidence interval [CI], 0.49 to 0.99; P=0.04). There was no significant difference in efficacy of the dapivirine ring among women older than 21 years of age (hazard ratio for infection, 0.63; 95% CI, 0.41 to 0.97) and those 21 years of age or younger (hazard ratio, 0.85; 95% CI, 0.45 to 1.60; P=0.43 for treatment-by-age interaction). Among participants with HIV-1 infection, nonnucleoside reverse-transcriptase inhibitor resistance mutations were detected in 14 of 77 participants in the dapivirine group (18.2%) and in 9 of 56 (16.1%) in the placebo group. Serious adverse events occurred more often in the dapivirine group (in 38 participants [2.9%]) than in the placebo group (in 6 [0.9%]). However, no clear pattern was identified. CONCLUSIONS: Among women in sub-Saharan Africa, the dapivirine ring was not associated with any safety concerns and was associated with a rate of acquisition of HIV-1 infection that was lower than the rate with placebo. (Funded by the International Partnership for Microbicides; ClinicalTrials.gov number, NCT01539226 .).

3 Article Pre- and post-natal macronutrient supplementation for HIV-positive women in Tanzania: Effects on infant birth weight and HIV transmission. 2018

Magohe, Albert / Mackenzie, Todd / Kimario, Josephine / Lukmanji, Zohra / Hendricks, Kristy / Koethe, John / Neke, Nyasule Majura / Tvaroha, Susan / Connor, Ruth / Waddell, Richard / Maro, Isaac / Matee, Mecky / Pallangyo, Kisali / Bakari, Muhammad / von Reyn, C Fordham / Anonymous12711104. ·Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. · Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America. · Vanderbilt University School of Medicine, Nashville, TN, United States of America. · Tokyo Medical and Dental University, Tokyo, Japan. ·PLoS One · Pubmed #30307945.

ABSTRACT: OBJECTIVE: To determine if a protein-calorie supplement (PCS) plus a micronutrient supplement (MNS) improves outcomes for HIV-infected lactating women and their infants. DESIGN: Randomized, controlled trial. SETTING: Dar es Salaam, Tanzania. SUBJECTS, PARTICIPANTS: Pregnant HIV-infected women enrolled in PMTCT programs who intended to breastfeed for 6 months. INTERVENTION: Randomization 1:1 to administration of a PCS plus MNS versus MNS alone among 96 eligible women beginning in the third trimester and continuing for 6 months of breast-feeding. MAIN OUTCOME MEASURE(S): Primary: infant weight at 3 months. Secondary: maternal BMI at 6 months. RESULTS: PCS resulted in significant increases in daily energy intake compared to MNS at all time points (range of differences: +388-719 Kcal); and increases in daily protein intake (range of differences: +22-33 gm). Infant birth weight (excluding twins) was higher in the PCS than MNS groups: 3.30 kg vs 3.04 kg (p = 0.04). Infant weight at 3 months did not differ between PCS and MNS groups: 5.63 kg vs 5.99 kg (p = 0.07). Maternal BMI at 6 months did not differ between PCS and MNS groups: 24.3 vs 23.8 kg/m2 (p = 0.68). HIV transmission occurred in 0 infants in the PCS group vs 4 in the MNS group (p = 0.03). CONCLUSIONS: In comparison to MNS the PCS + MNS intervention was well tolerated, increased maternal energy and protein intake, and increased infant birth weight, but not weight at 3 months or maternal BMI at 6 months. Reduced infant HIV transmission in the PCS + MNS group was observed. TRIAL REGISTRATION: Clinical Trials.Gov NCT01461863.

4 Article Antifungal Combinations for Treatment of Cryptococcal Meningitis in Africa. 2018

Molloy, Síle F / Kanyama, Cecilia / Heyderman, Robert S / Loyse, Angela / Kouanfack, Charles / Chanda, Duncan / Mfinanga, Sayoki / Temfack, Elvis / Lakhi, Shabir / Lesikari, Sokoine / Chan, Adrienne K / Stone, Neil / Kalata, Newton / Karunaharan, Natasha / Gaskell, Kate / Peirse, Mary / Ellis, Jayne / Chawinga, Chimwemwe / Lontsi, Sandrine / Ndong, Jean-Gilbert / Bright, Philip / Lupiya, Duncan / Chen, Tao / Bradley, John / Adams, Jack / van der Horst, Charles / van Oosterhout, Joep J / Sini, Victor / Mapoure, Yacouba N / Mwaba, Peter / Bicanic, Tihana / Lalloo, David G / Wang, Duolao / Hosseinipour, Mina C / Lortholary, Olivier / Jaffar, Shabbar / Harrison, Thomas S / Anonymous1461061. ·From the Centre for Global Health, Institute for Infection and Immunity, St. George's University of London (S.F.M., A.L., N.S., N. Karunaharan, J.A., T.B., T.S.H.), University College London (R.S.H.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (J.B.), London, and Liverpool School of Tropical Medicine, Liverpool (T.C., D.G.L., D.W., S.J.) - all in the United Kingdom · the University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe (C. Kanyama, C.C., C.H., M.C.H.), Malawi-Liverpool-Wellcome Trust Clinical Research Programme (R.S.H., N. Kalata, K.G., M.P., J.E.) and the College of Medicine, University of Malawi (R.S.H., N. Kalata, K.G., M.P., J.E., J.J.O.), Blantyre, and Dignitas International, Zomba Central Hospital, Zomba (A.K.C., P.B., D.L., J.J.O.) - all in Malawi · University of Dschang, Dschang (C. Kouanfack), Hôpital Central Yaoundé/Site Agence Nationale de Recherche sur le Sida (ANRS) Cameroun, Yaoundé (C. Kouanfack, S. Lontsi, J.-G.N., V.S.), and Douala General Hospital (E.T., Y.N.M.) and University of Douala (Y.N.M.), Douala - all in Cameroon · the Institute for Medical Research and Training (D.C., N.S., N. Karunaharan, P.B.), University Teaching Hospital (D.C., S. Lakhi, N.S., N. Karunaharan, P.B.), and the Department of Internal Medicine and Directorate of Research and Postgraduate Studies, Lusaka Apex Medical University (P.M.), Lusaka, Zambia · the National Institute for Medical Research, Muhimbili Medical Research Centre, Dar Es Salaam, Tanzania (S.M., S. Lesikari) · Institut Pasteur, Molecular Mycology Unit (E.T., O.L.), and Paris Descartes University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine, Assistance Publique-Hôpitaux de Paris (O.L.), Paris · the Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (A.K.C.) · and the University of North Carolina, Chapel Hill (C.H., M.C.H.). ·N Engl J Med · Pubmed #29539274.

ABSTRACT: BACKGROUND: Cryptococcal meningitis accounts for more than 100,000 human immunodeficiency virus (HIV)-related deaths per year. We tested two treatment strategies that could be more sustainable in Africa than the standard of 2 weeks of amphotericin B plus flucytosine and more effective than the widely used fluconazole monotherapy. METHODS: We randomly assigned HIV-infected adults with cryptococcal meningitis to receive an oral regimen (fluconazole [1200 mg per day] plus flucytosine [100 mg per kilogram of body weight per day] for 2 weeks), 1 week of amphotericin B (1 mg per kilogram per day), or 2 weeks of amphotericin B (1 mg per kilogram per day). Each patient assigned to receive amphotericin B was also randomly assigned to receive fluconazole or flucytosine as a partner drug. After induction treatment, all the patients received fluconazole consolidation therapy and were followed to 10 weeks. RESULTS: A total of 721 patients underwent randomization. Mortality in the oral-regimen, 1-week amphotericin B, and 2-week amphotericin B groups was 18.2% (41 of 225), 21.9% (49 of 224), and 21.4% (49 of 229), respectively, at 2 weeks and was 35.1% (79 of 225), 36.2% (81 of 224), and 39.7% (91 of 229), respectively, at 10 weeks. The upper limit of the one-sided 97.5% confidence interval for the difference in 2-week mortality was 4.2 percentage points for the oral-regimen group versus the 2-week amphotericin B groups and 8.1 percentage points for the 1-week amphotericin B groups versus the 2-week amphotericin B groups, both of which were below the predefined 10-percentage-point noninferiority margin. As a partner drug with amphotericin B, flucytosine was superior to fluconazole (71 deaths [31.1%] vs. 101 deaths [45.0%]; hazard ratio for death at 10 weeks, 0.62; 95% confidence interval [CI], 0.45 to 0.84; P=0.002). One week of amphotericin B plus flucytosine was associated with the lowest 10-week mortality (24.2%; 95% CI, 16.2 to 32.1). Side effects, such as severe anemia, were more frequent with 2 weeks than with 1 week of amphotericin B or with the oral regimen. CONCLUSIONS: One week of amphotericin B plus flucytosine and 2 weeks of fluconazole plus flucytosine were effective as induction therapy for cryptococcal meningitis in resource-limited settings. (ACTA Current Controlled Trials number, ISRCTN45035509 .).

5 Article Time trends in management of HIV-positive pregnant women in Northern Tanzania: A registry-based study. 2017

Rebnord, Tormod / Østbye, Truls / Mmbaga, Blandina Theophil / Mchome, Bariki / Lie, Rolv Terje / Daltveit, Anne Kjersti. ·Department of Global Public Health and Primary Care (IGS), Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway. · Duke University, Durham, North Carolina, United States of America. · Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Moshi, Tanzania. · Kilimanjaro Clinical Research Institute, Moshi, Tanzania. · Norwegian Institute of Public Health, Bergen, Norway. ·PLoS One · Pubmed #28957345.

ABSTRACT: OBJECTIVE: To examine time trends in antenatal factors and delivery characteristics in Northern Tanzania, and relate these to national guidelines for HIV in pregnancy. DESIGN: Registry-based study. SETTING: Northern Tanzania, 2000-2014. POPULATION OR SAMPLE: Deliveries (n = 33 346). METHODS: HIV-positive women were compared with HIV-negative women during four periods spanning changing national guidelines. MAIN OUTCOME MEASURES: Known maternal HIV status, HIV treatment for woman, number of antenatal care (ANC) visits, routine folate/iron in pregnancy, anemia, delivery complications/interventions. RESULTS: We observed an increase in deliveries with known maternal HIV status and women receiving HIV treatment, and a decline in deliveries with positive maternal HIV status (p-values for trend <0.001). The proportion of women with less than four ANC visits increased to above 30 percent irrespective of HIV status. Use of routine folate/iron increased, corresponding to a decrease in anemia which was strongest in HIV-negative women. Incidence of elective caesarean section (CS) and emergency CS remained unchanged for HIV-positive women (7.1% and 25.5%, respectively, in the last period). Use of invasive procedures declined in both groups of women. Mothers who were young, single, had low education, high parity or lived in the rural area more often had indicators of poor antenatal care. CONCLUSIONS: Increasing adherence to national guidelines over time was found for most selected outcomes. Still, a high occurrence of insufficient ANC, anemia and emergency CS call for efforts to explore and identify barriers that hinder optimal care.

6 Article Effects of schistosomiasis on susceptibility to HIV-1 infection and HIV-1 viral load at HIV-1 seroconversion: A nested case-control study. 2017

Downs, Jennifer A / Dupnik, Kathryn M / van Dam, Govert J / Urassa, Mark / Lutonja, Peter / Kornelis, Dieuwke / de Dood, Claudia J / Hoekstra, Pytsje / Kanjala, Chifundo / Isingo, Raphael / Peck, Robert N / Lee, Myung Hee / Corstjens, Paul L A M / Todd, Jim / Changalucha, John M / Johnson, Warren D / Fitzgerald, Daniel W. ·Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America. · Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania. · Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands. · National Institute for Medical Research, Mwanza, Tanzania. · Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, the Netherlands. · Department of Applied Biostatistics, London School of Hygiene and Tropical Medicine, London, United Kingdom. ·PLoS Negl Trop Dis · Pubmed #28945756.

ABSTRACT: BACKGROUND: Schistosomiasis affects 218 million people worldwide, with most infections in Africa. Prevalence studies suggest that people with chronic schistosomiasis may have higher risk of HIV-1 acquisition and impaired ability to control HIV-1 replication once infected. We hypothesized that: (1) pre-existing schistosome infection may increase the odds of HIV-1 acquisition and that the effects may differ between men and women, and (2) individuals with active schistosome infection at the time of HIV-1 acquisition may have impaired immune control of HIV-1, resulting in higher HIV-1 viral loads at HIV-1 seroconversion. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a nested case-control study within a large population-based survey of HIV-1 transmission in Tanzania. A population of adults from seven villages was tested for HIV in 2007, 2010, and 2013 and dried blood spots were archived for future studies with participants' consent. Approximately 40% of this population has Schistosoma mansoni infection, and 2% has S. haematobium. We tested for schistosome antigens in the pre- and post-HIV-1-seroconversion blood spots of people who acquired HIV-1. We also tested blood spots of matched controls who did not acquire HIV-1 and calculated the odds that a person with schistosomiasis would become HIV-1-infected compared to these matched controls. Analysis was stratified by gender. We compared 73 HIV-1 seroconverters with 265 controls. Women with schistosome infections had a higher odds of HIV-1 acquisition than those without (adjusted OR = 2.8 [1.2-6.6], p = 0.019). Schistosome-infected men did not have an increased odds of HIV-1 acquisition (adjusted OR = 0.7 [0.3-1.8], p = 0.42). We additionally compared HIV-1 RNA levels in the post-seroconversion blood spots in HIV-1 seroconverters with schistosomiasis versus those without who became HIV-infected in 2010, before antiretroviral therapy was widely available in the region. The median whole blood HIV-1 RNA level in the 15 HIV-1 seroconverters with schistosome infection was significantly higher than in the 22 without schistosomiasis: 4.4 [3.9-4.6] log10 copies/mL versus 3.7 [3.2-4.3], p = 0.017. CONCLUSIONS/SIGNIFICANCE: We confirm, in an area with endemic S. mansoni, that pre-existing schistosome infection increases odds of HIV-1 acquisition in women and raises HIV-1 viral load at the time of HIV-1 seroconversion. This is the first study to demonstrate the effect of schistosome infection on HIV-1 susceptibility and viral control, and to differentiate effects by gender. Validation studies will be needed at additional sites.

7 Article Primary mediastinal large B cell lymphoma in a woman who is human immunodeficiency virus positive presenting with superior vena cava syndrome: a case report. 2017

Pallangyo, Pedro / Nicholaus, Paulina / Lyimo, Frederick / Urio, Elikaanany / Kisenge, Peter / Janabi, Mohamed. ·Department of Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania. pedro.pallangyo@gmail.com. · Department of Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania. · Department of Radiology, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania. ·J Med Case Rep · Pubmed #28187791.

ABSTRACT: BACKGROUND: The risk of non-Hodgkin lymphoma is increased 200-fold in individuals seropositive for human immunodeficiency virus compared to those free from human immunodeficiency virus. Human immunodeficiency virus-associated non-Hodgkin lymphoma is known for its atypical presentation, aggressive ability, widespread involvement, poor response to chemotherapy, and high relapse potential which makes both the diagnosis and management a difficult undertaking especially in resource-poor settings. CASE PRESENTATION: We report a case of primary mediastinal large B cell lymphoma in a 46-year-old woman of African descent who is human immunodeficiency virus positive who presented with symptoms of superior vena cava syndrome. Her past medical history was remarkable for a 23-year history of systemic hypertension and a 10-year history of human immunodeficiency virus infection. A physical examination revealed an underweight woman with right-sided facial, neck, upper limb, and trunk swelling together with distended veins on her chest and abdomen draining downwards. A respiratory examination revealed a reduced chest expansion, stony dull percussion note, and absent breath sounds on her entire right side with a left-sided tracheal deviation. She had a CD4 count of 146 cells/μL. A chest X-ray revealed a homogenous opacification on her right side with a left-sided tracheal deviation while a computed tomography scan of her chest revealed a solid mass on her right side. An echocardiogram showed a huge well-circumscribed mass (4.6×3.3 cm) with spontaneous echocardiographic contrast compressing her heart inferiorly. She had severe pulmonary hypertension (right ventricular systolic pressure 58 mmHg) but preserved left ventricular systolic function, no thrombus was seen, and her pericardium was normal. A computed tomography angiography of her aorta ruled out an aortic aneurysm. Finally, she underwent mediastinoscopy and a direct biopsy of the mass was taken for histopathology. Hematoxylin and eosin staining demonstrated a dense lymphoid infiltrate of large malignant cells with pleomorphic nuclei in clusters, compartmentalized by fine bands of fibrosis, and frequent mitoses were present. A diagnosis of mediastinal large B cell lymphoma was reached. CONCLUSIONS: The presence of a mediastinal widening coupled with a history of unintentional yet significant weight loss in an individual who is human immunodeficiency virus seropositive should raise an index of suspicion for lymphomas and warrant aggressive investigations and timely management.

8 Article Why being an expert - despite xpert -remains crucial for children in high TB burden settings. 2017

Bacha, Jason M / Ngo, Katherine / Clowes, Petra / Draper, Heather R / Ntinginya, Elias N / DiNardo, Andrew / Mangu, Chacha / Sabi, Issa / Mtafya, Bariki / Mandalakas, Anna M. ·Baylor College of Medicine Children's Foundation - Tanzania, Centre of Excellence at Mbeya Zonal Referral Hospital, Mbeya, Tanzania. bacha@bcm.edu. · Baylor International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA. bacha@bcm.edu. · The Global Tuberculosis Program, Texas Children's Hospital, Global and Immigrant Health, Department of Pediatrics Baylor College of Medicine, Houston, TX, 77030, USA. · National Institute of Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania. ·BMC Infect Dis · Pubmed #28166728.

ABSTRACT: BACKGROUND: As access to Xpert expands in high TB-burden settings, its performance against clinically diagnosed TB as a reference standard provides important insight as the majority of childhood TB is bacteriologically unconfirmed. We aim to describe the characteristics and outcomes of children with presumptive TB and TB disease, and assess performance of Xpert under programmatic conditions against a clinical diagnosis of TB as a reference standard. METHODS: Retrospective review of children evaluated for presumptive TB in Mbeya, Tanzania. Baseline characteristics were compared by TB disease status and, for patients diagnosed with TB, by TB confirmation status using Wilcoxon rank sum test for continuous variables and the Chi-square test for categorical variables. Sensitivity and specificity were calculated to assess the performance of Xpert, smear, and culture against clinical TB. Kappa statistics were calculated to assess agreement between Xpert and smear to culture. RESULTS: Among children (N = 455) evaluated for presumptive TB, 70.3% (320/455) had Xpert and 62.8% (286/455) had culture performed on sputa. 34.5% (157/455) were diagnosed with TB: 80.3% (126/157) pulmonary TB, 13.4% (21/157) bacteriologically confirmed, 53.5% (84/157) HIV positive, and 48.4% (76/157) inpatients. Compared to the reference standard of clinical diagnosis, sensitivity of Xpert was 8% (95% CI 4-15), smear 6% (95% CI 3-12) and culture 16% (95% CI 9-24), and did not differ based on patient disposition, nutrition or HIV status. CONCLUSION: Despite access to Xpert, the majority of children with presumptive TB were treated based on clinical diagnosis. Reflecting the reality of clinical practice in resource limited settings, new diagnostics such as Xpert serve as important adjunctive tests but will not obviate the need for astute clinicians and comprehensive diagnostic algorithms.

9 Article Evaluation of the Antibody in Lymphocyte Supernatant Assay to Detect Active Tuberculosis. 2017

Sariko, Margaretha / Anderson, Caitlin / Mujaga, Buliga S / Gratz, Jean / Mpagama, Stellah G / Heysell, Scott / Kibiki, Gibson / Mmbaga, Blandina / Houpt, Eric / Thomas, Tania. ·Kilimanjaro Clinical Research Institute, Moshi, Tanzania. · Kilimanjaro Christian Medical University College, Moshi Tanzania. · Kilimanjaro Christian Medical Centre, Moshi, Tanzania. · University of Washington, Seattle, United States of America. · University of Virginia, Charlottesville, United States of America. · Kibong'oto Infectious Diseases Hospital, Kilimanjaro, Tanzania. ·PLoS One · Pubmed #28085899.

ABSTRACT: BACKGROUND: We aimed to evaluate the antibody in lymphocyte supernatant (ALS) assay as a biomarker to diagnose tuberculosis among adults from Tanzania with and without HIV. METHODS: Adults admitted with suspicion for tuberculosis had sputa obtained for GeneXpert MTB/RIF, acid-fast bacilli smear and mycobacterial culture; blood was obtained prior to treatment initiation and after 4 weeks. Adults hospitalized with non-infectious conditions served as controls. Peripheral blood mononuclear cells were cultured unstimulated for 72 hours. Anti-mycobacterial antibodies were measured from culture supernatants by ELISA, using BCG vaccine as the coating antigen. Median ALS responses were compared between cases and controls at baseline and between cases over time. RESULTS: Of 97 TB cases, 85 were microbiologically confirmed and 12 were clinically diagnosed. Median ALS responses from TB cases (0.366 OD from confirmed cases and 0.285 from clinical cases) were higher compared to controls (0.085, p<0.001). ALS responses did not differ based on HIV status, CD4 count or sputum smear status. Over time, the median ALS values declined significantly (0.357 at baseline; 0.198 after 4-weeks, p<0.001). CONCLUSIONS: Robust ALS responses were mounted by patients with TB regardless of HIV status, CD4 count, or low sputum bacillary burden, potentially conferring a unique niche for this immunologic biomarker for TB.

10 Article Risk factors for HIV positivity among more than 3,400 Tanzanian women. 2017

Faber, Mette Tuxen / Munk, Christian / Mwaiselage, Julius / Dartell, Myassa / Kahesa, Crispin / Iftner, Thomas / Rasch, Vibeke / Kjaer, Susanne K. ·a Virus, Lifestyle and Genes , Danish Cancer Society Research Center , Copenhagen , Denmark. · b Division of Cancer Prevention , Ocean Road Cancer Institute , Dar es Salaam , Tanzania. · c Department of International Health, Public Health Institute , University of Copenhagen , Copenhagen , Denmark. · d Division of Experimental Virology , University Hospital Tuebingen , Tuebingen , Germany. · e Institute of Clinical Research , University of Southern Denmark , Odense , Denmark. · f Department of Obstetrics and Gynecology , Odense University Hospital , Odense , Denmark. · g Department of Gynecology, Rigshospitalet , University of Copenhagen , Copenhagen , Denmark. ·Women Health · Pubmed #27379612.

ABSTRACT: In a cross-sectional study of 3,424 women from urban (Dar es Salaam) and rural (Pwani, Mwanza, and Mtwara) Tanzania, conducted in 2008-2009, we investigated risk factors for human immunodeficiency virus (HIV) and the association between different measures of human papillomavirus (HPV) and HIV positivity. Study participants were interviewed about socio-demographic and reproductive factors and sexual behavior. Blood samples were tested for HIV, and the women underwent a gynecological examination. HPV status was determined by Hybrid Capture 2, and HPV genotyping was performed using the LiPA Extra test. Multivariable logistic regression models estimating odds ratios (OR) and 95% confidence intervals (CI) were used. The overall HIV prevalence was 10.2%. HIV-positive women were more likely to have high-risk (HR) HPV detected (OR = 4.11; 95% CI: 3.23-5.24) and clinically visible genital warts (OR = 4.37; 95% CI: 1.81-10.5). Other risk factors included age, place of residence, education, number of births, lifetime number of sexual partners, and time in present relationship. HIV risk factors among urban and rural women and among HPV-positive and HPV-negative women were similar. HPV vaccination may provide some protection against HIV infection in Tanzania, but focus must still be on preventing established risk factors for HIV.

11 Article Association between Taenia solium infection and HIV/AIDS in northern Tanzania: a matched cross sectional-study. 2016

Schmidt, Veronika / Kositz, Christian / Herbinger, Karl-Heinz / Carabin, Hélène / Ngowi, Bernard / Naman, Ezra / Wilkins, Patricia P / Noh, John / Matuja, William / Winkler, Andrea Sylvia. ·Department of Neurology, University Hospital, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany. veronika.schmidt@tum.de. · Department of Neurology, University Hospital, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany. · Department of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany. · Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, USA. · Muhimbili Medical Research Centre, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania. · HIV Care and Treatment Centre, Haydom Lutheran Hospital, Haydom, Tanzania. · Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA. · Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. · Centre of Global Health, University of Oslo, Oslo, Norway. ·Infect Dis Poverty · Pubmed #27903304.

ABSTRACT: BACKGROUND: The frequency of Taenia solium, a zoonotic helminth, is increasing in many countries of sub-Saharan Africa, where the prevalence of the human immunodeficiency virus (HIV) is also high. However, little is known about how these two infections interact. The aim of this study was to compare the proportion of HIV positive (+) and negative (-) individuals who are infected with Taenia solium (TSOL) and who present with clinical and neurological manifestations of cysticercosis (CC). METHODS: In northern Tanzania, 170 HIV+ individuals and 170 HIV- controls matched for gender, age and village of origin were recruited. HIV staging and serological tests for TSOL antibodies (Ab) and antigen (Ag) were performed. Neurocysticercosis (NCC) was determined by computed tomography (CT) using standard diagnostic criteria. Neurological manifestations were confirmed by a standard neurological examination. In addition, demographic, clinical and neuroimaging data were collected. Further, CD4 RESULTS: No significant differences between HIV+ and HIV- individuals regarding the sero-prevalence of taeniosis-Ab (0.6% vs 1.2%), CC-Ab (2.4% vs 2.4%) and CC-Ag (0.6% vs 0.0%) were detected. A total of six NCC cases (3 HIV+ and 3 HIV-) were detected in the group of matched participants. Two individuals (1 HIV+ and 1 HIV-) presented with headaches as the main symptom for NCC, and four with asymptomatic NCC. Among the HIV+ group, TSOL was not associated with CD4 CONCLUSIONS: This study found lower prevalence of taeniosis, CC and NCC than had been reported in the region to date. This low level of infection may have resulted in an inability to find cross-sectional associations between HIV status and TSOL infection or NCC. Larger sample sizes will be required in future studies conducted in that area to conclude if HIV influences the way NCC manifests itself.

12 Article A Qualitative Exploration of the Mental Health and Psychosocial Contexts of HIV-Positive Adolescents in Tanzania. 2016

Ramaiya, Megan K / Sullivan, Kristen A / O' Donnell, Karen / Cunningham, Coleen K / Shayo, Aisa M / Mmbaga, Blandina T / Dow, Dorothy E. ·Center for Health Policy & Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America. · Department of Psychology, University of Washington, Seattle, Washington, United States of America. · Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America. · Center for Child & Family Health, Duke University, Durham, North Carolina, United States of America. · Department of Pediatrics, Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America. · Kilimanjaro Christian Medical Centre, Moshi, Tanzania. ·PLoS One · Pubmed #27851797.

ABSTRACT: Although 85% of HIV-positive adolescents reside in sub-Saharan Africa, little is known about the psychosocial and mental health factors affecting their daily well-being. Identifying these contextual variables is key to development of culturally appropriate and effective interventions for this understudied and high-risk population. The purpose of this study was to identify salient psychosocial and mental health challenges confronted by HIV-positive youth in a resource-poor Tanzanian setting. A total of 24 qualitative interviews were conducted with a convenience sample of adolescents aged 12-24 receiving outpatient HIV care at a medical center in Moshi, Tanzania. All interviews were audio-recorded, transcribed, and coded using thematic analysis. Psychosocial challenges identified included loss of one or more parents, chronic domestic abuse, financial stressors restricting access to medical care and education, and high levels of internalized and community stigma among peers and other social contacts. Over half of youth (56%) reported difficulties coming to terms with their HIV diagnosis and espoused related feelings of self-blame. These findings highlight the urgent need to develop culturally proficient programs aimed at helping adolescents cope with these manifold challenges. Results from this study guided the development of Sauti ya Vijana (The Voice of Youth), a 10-session group mental health intervention designed to address the psychosocial and mental health needs of HIV-positive Tanzanian youth.

13 Article Isolated congenital complete heart block in a five-year-old seronegative girl born to a woman seropositive for human immunodeficiency virus: a case report. 2016

Pallangyo, Pedro / Mawenya, Isaac / Nicholaus, Paulina / Mayala, Henry / Kalombola, Amida / Sharau, Godwin / Majani, Naiz / Janabi, Mohamed. ·Department of Cardiovascular Medicine, The Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania. pedro.pallangyo@gmail.com. · Department of Cardiovascular Medicine, The Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania. · Department of Pediatric and Child Health, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania. · Department of Pediatric Cardiology, The Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania. ·J Med Case Rep · Pubmed #27756424.

ABSTRACT: BACKGROUND: Congenital complete heart block is a life-threatening condition which is highly associated with autoimmune and connective tissue disorders. Presence of maternal autoantibodies for associated conditions increases the risk of delivering a child with congenital complete heart block, however, less than a half of all women with such antibodies are symptomatic even after delivery. Mortality rate is highest during the neonatal period (45 %) and about two-thirds of all cases will require permanent pacing at some point in their lives. CASE PRESENTATION: We report a case of isolated complete heart block in a 5-year-old HIV-free girl of African descent born to an HIV-infected woman with no prior history of autoimmune disorders. She was referred to us with chief complaints of recurrent syncopal attacks and effort intolerance since birth. A physical examination was unremarkable except for her being small for her age (body mass index 16.3 kg/m CONCLUSIONS: Despite its infrequency and life-threatening potential, patients with congenital complete heart block have an excellent survival rate with timely diagnosis and intervention. An incidental detection of bradycardia in a fetus during routine obstetrical ultrasound examination should increase the index of suspicion for congenital complete heart block and warrant a screening for associated maternal autoantibodies.

14 Article Taking forward the World TB Day 2016 theme 'Unite to End Tuberculosis' for the WHO Africa Region. 2016

Ntoumi, Francine / Kaleebu, Pontiano / Macete, Eusebio / Mfinanga, Sayoki / Chakaya, Jeremiah / Yeboah-Manu, Dorothy / Bates, Matthew / Mwaba, Peter / Maeurer, Markus / Petersen, Eskild / Zumla, Alimuddin. ·Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany. Electronic address: fntoumi@fcrm-congo.com. · Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda. · Centro de Investigação em Saude de Manhiça, and National Directare of Public Health, Ministry of Health, Maputo, Mozambique. · Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania. · Department of Medicine, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya. · Noguchi Memorial Institute for Medical Research, Accra, Ghana. · UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia. · UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia; Ministry of Health, Lusaka, Zambia. · Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, and Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden. · University of Aarhus, Aarhus, Denmark; The Royal Hospital, Muscat, Oman. · UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia; Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK. ·Int J Infect Dis · Pubmed #26969406.

ABSTRACT: Tuberculosis (TB) remains a global emergency, with an estimated 9.6 million new TB cases worldwide reported in 2014. Twenty-eight percent of these cases were in the World Health Organization (WHO) Africa Region, where the annual case detection rate was 281 per 100000 population-more than double the global average of 133 per 100000. Of the 9.6 million people who developed TB, an estimated 1.2 million (12%) were HIV-positive, and the Africa Region accounted for 74% of these cases. Three million people with TB remain undiagnosed and untreated. Globally, an estimated 480000 had multidrug-resistant TB (MDR-TB). Whilst of the African countries, only South Africa has reported a high prevalence of MDR-TB, it is likely that all of Sub-Saharan Africa has an unreported high load of drug-resistant TB. Tragically, in 2014, only 48% of individuals diagnosed with MDR-TB had successful treatment and an estimated 190000 people died of MDR-TB. Of the global TB funding gap of US$ 0.8 billion, the largest funding gap was in the Africa Region, amounting to US$ 0.4 billion in 2015. The MDR-TB pandemic in particular now threatens to devastate entire regions and may fundamentally alter the life-expectancy and demographic profile of many countries in Sub-Saharan Africa. The theme designated for this year's World TB Day, March 24, 2016, is 'Unite to End TB'. From the Africa Region, there is an urgent need to seriously address the political, economic, and social factors that influence host-Mycobacterium tuberculosis interactions and result in disease. Recent political and funder initiatives that provide renewed hope for the alleviation of Africa's TB and TB/HIV problems are discussed.

15 Article Characteristics and geographic distribution of HIV-positive women diagnosed with cervical cancer in Dar es Salaam, Tanzania. 2016

Lovgren, Kathleen / Soliman, Amr S / Ngoma, Twalib / Kahesa, Crispin / Meza, Jane. ·Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. · Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA amr.soliman@unmc.edu. · Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania. · Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. ·Int J STD AIDS · Pubmed #26464500.

ABSTRACT: Cervical cancer is the leading incident cancer and the main cause of cancer-related mortality among women in sub-Saharan Africa. Furthermore, HIV-infected women are at a higher risk of developing cervical cancer than HIV-negative women. The purpose of this study was to distinguish differences in characteristics of HIV-positive and HIV-negative patients with cervical cancer in Dar es Salaam, Tanzania. The HIV status of cervical cancer patients diagnosed and/or treated at Ocean Road Cancer Institute in Dar es Salaam, Tanzania, during the period 2007-2011 was abstracted from the medical records. Additional abstracted information included patient's name, age, place of residence, occupation, education, marital status, age at marriage, gravidity, and screening clinic visit results. Ocean Road Cancer Institute patients came from two sources: the screening clinic followed by treatment clinic or the treatment clinic without prior screening. HIV-positive and HIV-negative patients were compared regarding the above-listed clinical and epidemiologic factors. Multivariable analysis was also performed to assess the risk factors associated with cervical cancer treatment without prior screening at Ocean Road Cancer Institute. HIV-positive cervical cancer patients tended to be younger, with higher education and lower parity. Patients screened for cervical cancer prior to treatment were more likely to be HIV-positive (OR: 2.09, 95% CI: 1.36, 3.21), less likely to have higher disease stages (OR: 0.64, 95% CI: 0.43, 0.94), and less likely to reside outside of Dar es Salaam (OR: 0.44, 95% CI: 0.30, 0.65). Screening for cervical cancer at Ocean Road Cancer Institute is utilised by more HIV-positive patients from Dar es Salaam. Future studies should focus on identifying the reasons for lower utilisation of screening by HIV-negative patients and patients from other distant rural regions in Tanzania.

16 Article Prevalence and predictors of HIV sero-discordance among cohabiting couples tested in northern Tanzania. 2015

Ngilangwa, David Paul / Ochako, Rhoune / Mboya, Beati Alphonce / Noronha, Rita Honoratha / Mgomella, George Suleman. ·Amref Health Africa, P.O Box 2773 Dar es Salaam, Tanzania; Kilimanjaro Reproductive Health Program, Moshi, Tanzania. · Population Services International, Nairobi, Kenya. · Amref Health Africa, P.O Box 2773 Dar es Salaam, Tanzania. · Kilimanjaro Reproductive Health Program, Moshi, Tanzania; Department of Medicine, Strangeways Research Laboratory, University of Cambridge, Worts' Causeway, Cambridge CB1 8RN, UK. ·Pan Afr Med J · Pubmed #26958138.

ABSTRACT: INTRODUCTION: In sub-Saharan Africa where HIV/AIDS epidemic is predominantly generalized, majority of HIV infections occur among heterosexual couples. The majority of people do not know their sero-status. Thus, utilisation of Couples' HIV Counselling and Testing (CHCT) services remain to be critical in preventing new infections. The objective was to establish prevalence and predictors of HIV sero-discordance among cohabiting couples presenting for CHCT services in northern Tanzania. METHODS: A cross-sectional study inteveviewed 1,333 couples aged 18-49 years tested from 2005 to 2007 in Kilimanjaro and Arusha regions. A CHCT checklist was used to collect data from couples. Data were analyzed using STATA 10. RESULTS: Generally, 220(16%) out of 1,333 couples were HIV sero-discordant. In sero-discordance unions, women were likely to be HIV positive than men (71% versus 29% respectively p<0.001). HIV sero-discordant relationship was associated with age (35-45 years) for both men and women (Adjusted Odds Ratio (AOR): 2.3, 95% Confidence Interval (CI): 1.7-3.2) and (AOR: 2.6, 95% CI 1.9-3.7) respectively. Women with older men partners were less likely to be in HIV sero-discordance relationships (AOR: 0.5 95% CI 0.3-09). Arusha couples were likely to be HIV sero-discordant than those of Kilimanjaro (AOR: 2.3 95% CI 1.7-3.2). Couples living far away from CHCT centres were less likely to be sero-discordant than those live nearby (AOR: 0.4 95% CI 0.2-0.9). CONCLUSION: HIV sero-discordance prevalence is high among our participants. Thus, we recommend CHCT utilization should widely be promoted as entry point in treatment as prevention strategy in order to protect uninfected partners in HIV sero-discordance relationships.

17 Article Sero-conversion rate of Syphilis and HIV among pregnant women attending antenatal clinic in Tanzania: a need for re-screening at delivery. 2015

Lawi, John D T / Mirambo, Mariam M / Magoma, Moke / Mushi, Martha F / Jaka, Hyasinta M / Gumodoka, Balthazary / Mshana, Stephen E. ·Ministry of health and social welfare, Department of Curative services, P.O. Box 9083, Dar esSalaam, Tanzania. lawi.john@yahoo.com. · Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania. mmmirambo@gmail.com. · Evidence for Action Project, P.O. Box 13731, Dar es salaam, Tanzania. drmagomasn@yahoo.com. · Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania. mushimartha@gmail.com. · Department of Internal medicine, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania. yasintaliwa5@gmail.com. · Department of Obstetrics & Gynecology Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania. balthgumo@yahoo.com. · Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania. mshana72@yahoo.com. ·BMC Pregnancy Childbirth · Pubmed #25613487.

ABSTRACT: BACKGROUND: Despite the available cost effective antenatal testing and treatment, syphilis and human immunodeficiency virus (HIV) are still among common infections affecting pregnant women especially in developing countries. In Tanzania, pregnant women are tested only once for syphilis and HIV during antenatal clinic (ANC) visits. Therefore, there are missed opportunities for syphilis and HIV screening among those who were not tested during ANC visits and those acquiring infections during the course of pregnancy. This study was designed to determine the syphilis and HIV seroprevalence at delivery and seroconversion rate among pregnant women delivering at Bugando Medical Centre (BMC). METHODS: A cross sectional, hospital-based study involving pregnant women attending Bugando Medical Centre (BMC) antenatal clinic was done from January to March 2012. Serum samples were collected and tested for HIV and syphilis using HIV and syphilis rapid tests. Demographic and clinical data were collected using a standardized data collection tool and analysed using STATA version 11. RESULTS: A total of 331 and 408 women were screened for syphilis and HIV during antenatal respectively. Of 331 women who screened negative for syphilis at ANC, nine (2.7%) were seropositive at delivery while of 391who tested negative for HIV during ANC eight (2%) were found to be positive at delivery. Six (1.8%) and 23 (9%) of women who did not screen for syphilis and HIV at ANC were seropositive for syphilis and HIV at delivery respectively. There was significant difference of seroprevalence for HIV, among women who tested negative at ANC and those who did not test at ANC (2% vs.9%, P,<0.001). The overall prevalence of syphilis and HIV at delivery was 15 (2.3%) and 48 (7.2%) respectively. Syphilis seropositivity at delivery was significantly associated with HIV co-infection (p < 0.001), male partner circumcision (p = 0.011) and alcohol use among women (p < 0.001). CONCLUSIONS: The current protocol of screening for syphilis and HIV only once during pregnancy as practiced in Tanzania may miss women who get re-infected and seroconvert during pregnancy. Re-screening for syphilis and HIV during the course of pregnancy and at delivery is recommended in Tanzania as it can help to identify such women and institute appropriate treatment.

18 Article Changes in the pattern of Kaposi's sarcoma at Ocean Road Cancer Institute in Tanzania (2006-2011). 2015

Koski, Lia / Ngoma, Twalib / Mwaiselage, Julius / Le, Lynne / Soliman, Amr S. ·University of Michigan School of Public Health, Ann Arbor USA. · Ocean Road Cancer Institute, Dar es Salaam, Tanzania. · Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. · Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA amr.soliman@unmc.edu. ·Int J STD AIDS · Pubmed #25080290.

ABSTRACT: Tanzania has high human immunodeficiency virus and human herpes virus-8 rates linked to Kaposi's sarcoma. We conducted a study at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania to examine changes in proportions of Kaposi's sarcoma to all cancers over the period (2006-2011) of increased acquired immune deficiency syndrome management by anti-retroviral therapy. We included 1504 Kaposi's sarcoma cases from Ocean Road Cancer Institute and abstracted information regarding age, gender, human immunodeficiency virus and tuberculosis, anti-retroviral therapy duration and Kaposi's sarcoma lesions. Male Kaposi's sarcoma patients (59.6%) were older (42.1 ± 11.5 years) than women (40.4%) (36.2 ± 9.6 years). Kaposi's sarcoma proportions declined from 10.1% in 2003 to 7.4% in 2011. Being a woman was associated with increased oral and generalized lesions and higher numbers of lesion locations (odds ratio [OR] = 2.17, 95% confidence interval [CI]: 1.35, 3.51; OR = 1.49, CI: 1.08, 2.06; OR = 1.06, CI: 0.79, 1.41, respectively). Tuberculosis was associated with oral, generalized and number of lesion locations (OR = 2.08, CI: 1.10, 3.93; OR = 2.06, CI: 1.28, 3.33; OR = 1.88, CI: 1.19, 2.97, respectively). Anti-retroviral therapy duration showed a protective effect with oral, generalized and number of lesion locations (OR = 0.55, CI: 0.33, 0.91; OR = 0.73, CI: 0.52, 1.01; OR = 0.89, CI: 0.67, 1.18, respectively). With increasing number of patients receiving prolonged anti-retroviral therapy, future studies should investigate long-term effect of anti-retroviral therapy and tuberculosis in Tanzania and countries with human immunodeficiency virus infection.

19 Article HSV oropharyngeal shedding among HIV-infected children in Tanzania. 2015

Zuckerman, Richard / Manji, Karim / Matee, Mecky / Naburi, Helga / Bisimba, Jema / Martinez, Raquel / Wieland-Alter, Wendy / Kim, Faith / von Reyn, C Fordham / Palumbo, Paul. ·Dartmouth Hitchcock Medical Center, Lebanon, NH, USA Dartmouth College, Hanover, NH, USA richard.a.zuckerman@hitchcock.org. · DarDar Pediatric Program, Dar es Salaam, United Republic of Tanzania Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania. · Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania. · DarDar Pediatric Program, Dar es Salaam, United Republic of Tanzania. · Dartmouth College, Hanover, NH, USA Department of Laboratory Medicine, University of Washington, Seattle, WA, USA. · Dartmouth College, Hanover, NH, USA. · Dartmouth College, Hanover, NH, USA DarDar Programs, Lebanon, NH, USA. · Dartmouth Hitchcock Medical Center, Lebanon, NH, USA Dartmouth College, Hanover, NH, USA DarDar Pediatric Program, Dar es Salaam, United Republic of Tanzania. ·Int J STD AIDS · Pubmed #25028453.

ABSTRACT: Herpes simplex virus (HSV) oral shedding has not been studied among HIV-positive children in Africa. We sought to evaluate longitudinal oral HSV reactivation in HIV-positive and -negative children. Twenty HIV-positive antiretroviral-naive and 10 HIV-negative children aged 3-12 years in Tanzania were followed prospectively for 14 days. Oral swabs were collected daily and submitted for HSV DNA PCR analysis. Clinical data were collected via chart review and daily diaries. HSV DNA was detected in 10 (50%) of HIV-positive and 4 (40%) of HIV-negative children. Children who shed HSV had virus detected in a median of 21.4% of samples; shedding was intermittent. Median CD4 count among HIV-infected children was 667 cells/µL in those with positive HSV DNA and 886 cells/µL in those who were negative (p = 0.6). Of the HIV-positive children reporting prior sores, five (83%) had positive HSV swabs, whereas the one HIV-negative child with prior sores did not have a PCR-positive swab. HSV is detected frequently in children with and without HIV. HIV-infected children reporting oral sores have a high rate of HSV detection. Given the proven strong interactions between HIV and HSV, further study of co-infection with these viruses is warranted in children.

20 Article Diagnostic accuracy of computer-aided detection of pulmonary tuberculosis in chest radiographs: a validation study from sub-Saharan Africa. 2014

Breuninger, Marianne / van Ginneken, Bram / Philipsen, Rick H H M / Mhimbira, Francis / Hella, Jerry J / Lwilla, Fred / van den Hombergh, Jan / Ross, Amanda / Jugheli, Levan / Wagner, Dirk / Reither, Klaus. ·Swiss Tropical and Public Health Institute, Basel, Switzerland; Ifakara Health Institute, Bagamoyo, United Republic of Tanzania; Center for Infectious Diseases and Travel Medicine, University Hospital Freiburg, Freiburg, Germany. · Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands. · Ifakara Health Institute, Bagamoyo, United Republic of Tanzania. · PharmAccess International, Dar es Salaam, United Republic of Tanzania. · Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland. · Swiss Tropical and Public Health Institute, Basel, Switzerland; Ifakara Health Institute, Bagamoyo, United Republic of Tanzania; University of Basel, Basel, Switzerland. · Center for Infectious Diseases and Travel Medicine, University Hospital Freiburg, Freiburg, Germany. ·PLoS One · Pubmed #25192172.

ABSTRACT: BACKGROUND: Chest radiography to diagnose and screen for pulmonary tuberculosis has limitations, especially due to inter-reader variability. Automating the interpretation has the potential to overcome this drawback and to deliver objective and reproducible results. The CAD4TB software is a computer-aided detection system that has shown promising preliminary findings. Evaluation studies in different settings are needed to assess diagnostic accuracy and practicability of use. METHODS: CAD4TB was evaluated on chest radiographs of patients with symptoms suggestive of pulmonary tuberculosis enrolled in two cohort studies in Tanzania. All patients were characterized by sputum smear microscopy and culture including subsequent antigen or molecular confirmation of Mycobacterium tuberculosis (M.tb) to determine the reference standard. Chest radiographs were read by the software and two human readers, one expert reader and one clinical officer. The sensitivity and specificity of CAD4TB was depicted using receiver operating characteristic (ROC) curves, the area under the curve calculated and the performance of the software compared to the results of human readers. RESULTS: Of 861 study participants, 194 (23%) were culture-positive for M.tb. The area under the ROC curve of CAD4TB for the detection of culture-positive pulmonary tuberculosis was 0.84 (95% CI 0.80-0.88). CAD4TB was significantly more accurate for the discrimination of smear-positive cases against non TB patients than for smear-negative cases (p-value<0.01). It differentiated better between TB cases and non TB patients among HIV-negative compared to HIV-positive individuals (p<0.01). CAD4TB significantly outperformed the clinical officer, but did not reach the accuracy of the expert reader (p = 0.02), for a tuberculosis specific reading threshold. CONCLUSION: CAD4TB accurately distinguished between the chest radiographs of culture-positive TB cases and controls. Further studies on cost-effectiveness, operational and ethical aspects should determine its place in diagnostic and screening algorithms.

21 Article Poor nutrition status and associated feeding practices among HIV-positive children in a food secure region in Tanzania: a call for tailored nutrition training. 2014

Sunguya, Bruno F / Poudel, Krishna C / Mlunde, Linda B / Urassa, David P / Yasuoka, Junko / Jimba, Masamine. ·Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. · Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America. · School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. ·PLoS One · Pubmed #24846016.

ABSTRACT: METHODS: We conducted this mixed-method study among 748 children aged 6 months-14 years attending 9 of a total of 32 care and treatment centers in Tanga region, Tanzania. We collected quantitative data using a standard questionnaire and qualitative data through seven focus group discussions (FGDs). RESULTS: HIV-positive children had high magnitudes of undernutrition. Stunting, underweight, wasting, and thinness were prevalent among 61.9%, 38.7%, 26.0%, and 21.1% of HIV-positive children, respectively. They also had poor feeding practices: 88.1% were fed at a frequency below the recommendations, and 62.3% had a low level of dietary diversity. Lower feeding frequency was associated with stunting (β = 0.11, p = 0.016); underweight (β = 0.12, p = 0.029); and thinness (β = 0.11, p = 0.026). Lower feeding frequency was associated with low wealth index (β = 0.06, p<0.001), food insecurity (β =  -0.05, p<0.001), and caregiver's education. In the FGDs, participants discussed the causal relationships among the key associations; undernutrition was mainly due to low feeding frequency and dietary diversity. Such poor feeding practices resulted from poor nutrition knowledge, food insecurity, low income, and poverty. CONCLUSION: Feeding practices and nutrition status were poor among HIV-positive children even in food rich areas. Improving feeding frequency may help to ameliorate undernutrition. To improve it, tailored interventions should target children of poor households, the food insecure, and caregivers who have received only a low level of education.

22 Article Early versus delayed initiation of highly active antiretroviral therapy for HIV-positive adults with newly diagnosed pulmonary tuberculosis (TB-HAART): a prospective, international, randomised, placebo-controlled trial. 2014

Mfinanga, Sayoki G / Kirenga, Bruce J / Chanda, Duncan M / Mutayoba, Beatrice / Mthiyane, Thuli / Yimer, Getnet / Ezechi, Oliver / Connolly, Cathy / Kapotwe, Vincent / Muwonge, Catherine / Massaga, Julius / Sinkala, Edford / Kohi, Wanze / Lyantumba, Lucinda / Nyakoojo, Grace / Luwaga, Henry / Doulla, Basra / Mzyece, Judith / Kapata, Nathan / Vahedi, Mahnaz / Mwaba, Peter / Egwaga, Saidi / Adatu, Francis / Pym, Alex / Joloba, Moses / Rustomjee, Roxana / Zumla, Alimuddin / Onyebujoh, Philip. ·National Institute for Medical Research, Muhumbili, Tanzania. · Department of Medicine, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda. · Institute for Medical Research & Training and UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia. Electronic address: duncanchanda@gmail.com. · Clinical Trials Unit, Medical Research Council, Durban, South Africa. · Addis Ababa University, Addis Ababa, Ethiopia. · Division of Clinical Sciences, Nigerian Institute of Medical Research, Lagos, Nigeria. · Institute for Medical Research & Training and UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia. · WHO/TDR TB-HAART Project, Kampala, Uganda. · National TB/Leprosy Programme, Ministry of Health, Kampala, Uganda. · National TB Reference Laboratory, Muhimbili National Hospital, Dar-es-Salaam, Tanzania. · National TB/Leprosy Program, Ministry of Health, Lusaka, Zambia. · Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland. · Institute for Medical Research & Training and UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia; Ministry of Health, Lusaka, Zambia. · National TB/Leprosy Programme, Ministry of Health and Social Welfare, Dar-es-Salaam, Tanzania. · Supra-National TB Laboratory, Ministry of Health, Lusaka, Zambia. · Institute for Medical Research & Training and UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia; Center for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK; NIHR Biomedical Research Centre, University College Hospitals, London, UK. · Inter-country Support Team for East and Southern Africa, WHO Regional Office for Africa, Harare, Zimbabwe. ·Lancet Infect Dis · Pubmed #24810491.

ABSTRACT: BACKGROUND: WHO guidelines recommend early initiation of antiretroviral therapy (ART) irrespective of CD4 cell count for all patients with tuberculosis who also have HIV, but evidence supporting this approach is poor quality. We assessed the effect of timing of ART initiation on tuberculosis treatment outcomes for HIV-positive patients with CD4 counts of 220 cells per μL or more. METHODS: We did this randomised, placebo-controlled trial between Jan 1, 2008, and April 31, 2013 at 26 treatment centres in South Africa, Tanzania, Uganda, and Zambia. We enrolled HIV-positive patients with culture-confirmed tuberculosis who had tolerated 2 weeks of tuberculosis short course chemotherapy. Participants were randomly allocated (1:1) to early ART (starting after 2 weeks of tuberculosis treatment) or delayed ART (placebo, then starting ART at the end of 6 months of tuberculosis treatment). Randomisation was computer generated, with permuted blocks of size eight, and stratified by CD4 count (220-349 cells per μL vs ≥350 cells per μL). Patients and investigators were masked to treatment allocation until completion of 6-months' tuberculosis treatment, after which the study was open label. The primary endpoint was a composite of failure of tuberculosis treatment, tuberculosis recurrence, and death within 12 months of starting tuberculosis treatment in the modified intention-to-treat population. Secondary endpoints included mortality. The study is registered with controlled-trials.com (ISRCTN77861053). FINDINGS: We screened 13,588 patients and enrolled 1675: 834 assigned early ART, 841 delayed ART. The primary endpoint was reached by 65 (8·5%) of 767 patients in the early ART group versus 71 (9·2%) of 771 in the delayed ART group (relative risk [RR] 0·91, 95% CI 0·64-1·30; p=0·9). Of patients with a CD4 cell count of 220-349 cells per μL, 26 (7·9%) of 331 patients versus 33 (9·6%) of 342 reached the primary endpoint (RR 0·80, 95% CI 0·46-1·39; p=0·6). For those with 350 cells per μL or more, 39 (8·9%) of 436 versus 38 (8·9%) of 429 reached the primary endpoint (RR 1·01, 95% CI 0·63-1·62; p=0·4). Mortality did not differ significantly between treatment groups (RR 1·4, 95% CI 0·8-2·3; p=0·23). Grade 3 and 4 adverse events occurred in 149 (18%) of 834 patients assigned early ART versus 174 (21%) of 841 assigned delayed ART (p=0·37). 87 (10%) of 834 versus 84 (10%) of 841 had immune reconstitution inflammatory syndrome (p=0·56). INTERPRETATION: ART can be delayed until after completion of 6 months of tuberculosis treatment for HIV-positive patients with tuberculosis who have CD4 cell counts greater than 220 cells per μL. WHO guidelines should be updated accordingly. FUNDING: USAID, Zambia Ministry of Health, Tanzania Commission for Science and Technology, WHO-TDR.

23 Article Using vignettes in qualitative research to explore barriers and facilitating factors to the uptake of prevention of mother-to-child transmission services in rural Tanzania: a critical analysis. 2014

Gourlay, Annabelle / Mshana, Gerry / Birdthistle, Isolde / Bulugu, Grace / Zaba, Basia / Urassa, Mark. ·National Institute for Medical Research, P,O, Box 1462, Mwanza, Tanzania. gmshana@nimr.or.tz. ·BMC Med Res Methodol · Pubmed #24512206.

ABSTRACT: BACKGROUND: Vignettes are short stories about a hypothetical person, traditionally used within research (quantitative or qualitative) on sensitive topics in the developed world. Studies using vignettes in the developing world are emerging, but with no critical examination of their usefulness in such settings. We describe the development and application of vignettes to a qualitative investigation of barriers to uptake of prevention of mother-to-child transmission (PMTCT) HIV services in rural Tanzania in 2012, and critique the successes and challenges of using the technique in this setting. METHODS: Participatory Learning and Action (PLA) group activities (3 male; 3 female groups from Kisesa, north-west Tanzania) were used to develop a vignette representing realistic experiences of an HIV-infected pregnant woman in the community. The vignette was discussed during in-depth interviews with 16 HIV-positive women, 3 partners/relatives, and 5 HIV-negative women who had given birth recently. A critical analysis was applied to assess the development, implementation and usefulness of the vignette. RESULTS: The majority of in-depth interviewees understood the concept of the vignette and felt the story was realistic, although the story or questions needed repeating in some cases. In-depth interviewers generally applied the vignette as intended, though occasionally were unsure whether to steer the conversation back to the vignette character when participants segued into personal experiences. Interviewees were occasionally confused by questions and responded with what the character should do rather than would do; also confusing fieldworkers and presenting difficulties for researchers in interpretation. Use of the vignette achieved the main objectives, putting most participants at ease and generating data on barriers to PMTCT service uptake. Participants' responses to the vignette often reflected their own experience (revealed later in the interviews). CONCLUSIONS: Participatory group research is an effective method for developing vignettes. A vignette was incorporated into qualitative interview discussion guides and used successfully in rural Africa to draw out barriers to PMTCT service use; vignettes may also be valuable in HIV, health service use and drug adherence research in this setting. Application of this technique can prove challenging for fieldworkers, so thorough training should be provided prior to its use.

24 Article Evidence from the field: missed opportunities for identifying and linking HIV-infected children for early initiation of ART. 2013

Chamla, Dick / Mbori-Ngacha, Dorothy / Newman, Morkor / Kellerman, Scott E / Sugandhi, Nandita / Rwebembera, Anath / Elyanu, Peter / Murungu, Joseph / Kiyaga, Charles / Luo, Chewe / McClure, Craig / Anonymous5040779. ·aHIV Section, UNICEF, New York, USA bRegional Office, Eastern and Southern Africa, UNICEF, Johannesburg, South Africa cInter-country Support Team, Eastern and Southern Africa, WHO, Harare, Zimbabwe dGlobal HIV Technical Lead, Management Sciences for Health, Arlington, Virginia eGlobal HIV Programme, Clinton Health Access, New York, USA fNational AIDS Control Programme, Ministry of Health, Dar-Es-Salaam, Tanzania gNational STD/AIDS Control Programme, Ministry of Health, Kampala, Uganda hNational HIV Treatment Programme, Ministry of Health, Harare, Zimbabwe. ·AIDS · Pubmed #24361623.

ABSTRACT: -- No abstract --

25 Article Mathematical modeling of the HIV/Kaposi's sarcoma coinfection dynamics in areas of high HIV prevalence. 2013

Lungu, E / Massaro, T J / Ndelwa, E / Ainea, N / Chibaya, S / Malunguza, N J. ·Department of Mathematics, University of Botswana, Gaborone, Botswana. · Department of Mathematics, University of Tennessee, TN, USA. · Department of Mathematics, University of Dar es Salaam, Dar es Salaam, Tanzania. · Department of Applied Mathematics, National University of Science and Technology, Bulawayo, Zimbabwe. ·Comput Math Methods Med · Pubmed #24348744.

ABSTRACT: We formulate a deterministic system of ordinary differential equations to quantify HAART treatment levels for patients co-infected with HIV and Kaposi's Sarcoma in a high HIV prevalence setting. A qualitative stability analysis of the equilibrium states is carried out and we find that the disease-free equilibrium is globally attracting whenever the reproductive number ℛk < 1. A unique endemic equilibrium exists and is locally stable whenever ℛk > 1. Therefore, reducing ℛk to below unity should be the goal for disease eradication. Provision of HAART is shown to provide dual benefit of reducing HIV spread and the risk of acquiring another fatal disease for HIV/AIDS patients. By providing treatment to 10% of the HIV population, about 87% of the AIDS population acquire protection against coinfection with HIV and Kaposi's Sarcoma (KS). Most sub-Sahara African countries already have programmes in place to screen HIV. Our recommendation is that these programmes should be expanded to include testing for HHV-8 and KS counseling.

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