BackgroundMental illness may cause a variety of psychosocial problems such as decreased quality of life of the patient’s family members as well as increased social distance for the patient and the family caring for the patient. Psychosocial challenges are enhanced by the stigma attached to mental illness, which is a problem affecting not only the patient but also the family as a whole. Coping mechanisms for dealing with mentally ill patients differ from one family to another for a variety of reasons.The aim of the study was to determine the psychosocial problems of mental illness on the family including the coping strategies utilized by family members caring for a person with mental illness.MethodA qualitative study was conducted, involving four focus group discussions and 2 in-depth interviews of family members who were caring for patient with mental illness at Temeke Municipality, Dar es Salaam. Purposive sampling procedure was used to select participants for the study. Audio-recorded interviews in Swahili were conducted with all study participants. The recorded interview was transcribed and qualitative content thematic analysis was used to analyse the data.ResultsFinancial constraints, lack of social support, disruption of family functioning, stigma, discrimination, and patients’ disruptive behaviour emerged as the main themes in this study. Acceptance and religious practice emerged as the major coping strategies used by family members.ConclusionFamilial care for a person with mental illness has its advantages, yet it has multiple social and psychological challenges. Coping strategies and skills are important for the well-being of the caregiver and the patient. Addressing these psychosocial challenges requires a collaborative approach between the health care providers and government so that the needs of the family caregivers and those of the patients can be addressed accordingly.

BackgroundEvidence suggests that a substantial proportion of new HIV infections in African countries are associated with herpes simplex virus type 2 (HSV-2). Thus, the magnitude of HSV-2 infection in an area may suggest the expected course of the HIV epidemic. We determined prevalence of genital herpes, syphilis and associated factors among pregnant women from a remote rural Tanzanian community that has a low but increasing HIV prevalence.MethodsWe analysed 1296 sera and responses to a standard structured questionnaire collected from pregnant women aged between 15–49 years, attending six different antenatal clinics within rural Manyara and Singida regions in Tanzania. Linked anonymous testing (with informed consent) of the serum for specific antibodies against HSV-2 was done using a non-commercial peptide- 55 ELISA. Antibodies against syphilis were screened by using rapid plasma reagin (RPR) and reactive samples confirmed by Treponema pallidum haemagglutination assay (TPHA).ResultsPrevious analysis of the collected sera had shown the prevalence of HIV antibodies to be 2%. In the present study the prevalence of genital herpes and syphilis was 20.7% (95% CI: 18.53–23.00) and 1.6% (95% CI: 1.03–2.51), respectively. The presence of HSV-2 antibodies was associated with polygamy (OR 2.2, 95% CI: 1.62 – 3.01) and the use of contraceptives other than condoms (OR 1.7, 95% CI: 1.21 – 2.41). Syphilis was associated with reporting more than one lifetime sexual partner (OR 5.4, 95% CI: 1.88 – 15.76) and previous spontaneous abortion (OR 4.3, 95% CI: 1.52–12.02).ConclusionThe low prevalence of HIV infection offers a unique opportunity for strengthening HIV prevention in a cost-effective manner. The identification and control of other prevalent curable STIs other than syphilis and specific intervention of HSV-2 in specific populations like pregnant women would be one among approaches towards preventing incident HIV infections.

Background: Many national antenatal clinics (ANC) based HIV surveillance systems in subSaharan Africa have limited coverage of remote rural sites, a weakness that compromises adequate estimation, monitoring and development of effective preventive and care programmes. To address this void in rural Manyara and Singida within Northern Tanzania, we conducted antenatal clinicbased sentinel surveillance.

The Tanzania HIV Care and Treatment Plan was launched in October 2004 aiming at providing 440,000 AIDS patients with antiretroviral drugs (ARVs) and track disease progression in 1.2 million HIV+ persons by the end of the 2008. This paper is intended to provide information to stake holders of the achievements and challenges of the HIV Care and Treatment Plan since its inception in 2004. Facility patient reports are aggregated at district and then regional level before being sent to the national level where they are aggregated to form a national report. By December 2007, 210 health facilities were offering HIV care and treatment services in Tanzania. About 123,147 (5 %) of the 2,636,785 estimated people living with HIV and AIDS were enrolled, and 71,439 (13.6 %) of the estimated 527,357 AIDS cases commenced ART. More females than males started ART, F: M ratio being 3: 2. Most (49 %) patients were started ART due to low CD4 counts (<200). About 6,618 patients had their initial ARV regimen changed due to starting anti-TB treatment 679 (10 %), peripheral neuropathy 812 (12%), skin rash 378 (6 %), and stock out 247 (4 %) or other reasons (18 %), while 2,653 (42 %) had no reason recorded. The proportion of patients still alive and on ART at 6, 12 and 24 months after initiation of treatment was 60 %, 60 % and 50 %, respectively, while those collecting ARVs on schedule was 34 %, 25 % and 10 % respectively. About 3,084 patients developed TB after starting ART, of whom 1,557 (~50%) patients during the fi rst three months of treatment. During the three years (2004)(2005)(2006)(2007) of HIV care and treatment services in Tanzania, there has been an increase in the number of CTC facilities, geographical coverage of services, the number of enrolled patients and those on ART. However, the set target for ART services has not been achieved and there are signifi cant geographical variations in these achievements, which do not correspond with either population density or disease burden. Efforts should be made to i) ensure equitable accessibility when scaling up ART services in Tanzania, ii) improve the recording and reporting system and iii) harmonize the activities of various stakeholders. _______________________________________________________________________________________

Background: Previous surveillance among antenatal clinic (ANC) attendees within the remote rural Manyara and Singida regions in Tanzania identified an imminent but still, relatively low HIV epidemic. We conducted a population-based HIV study to identify risk factors and validate the representativeness of ANC-based estimates.Methods: Using a two-stage cluster sampling approach, we enrolled and then interviewed and collected saliva samples from 1,698 adults aged 15-49 years between December 2003 and May 2004. We anonymously tested saliva samples for IgG antibodies against HIV using Bionor HIV-1&2 assays ® . Risk factors for HIV infection were analysed by multivariate logistic regression using the rural population of the two regions as a standard. Results:The prevalence of HIV in the general population was 1.8% (95%CI: 1.1-2.4), closely matching the ANC-based estimate (2.0%, 95% CI: 1.3-3.0). The female to male prevalence ratio was 0.8 (95%CI 0.4-1.7). HIV was associated with being a resident in a fishing community, and having recently moved into the area. Multiple sexual partners increased likelihood of HIV infection by 4.2 times (95% CI; 1.2-15.4) for men. In women, use of contraceptives other than condoms was associated with HIV infection (OR 6.5, 95% CI; 1.7-25.5), while most of the population (78%) have never used condoms. Conclusion:The HIV prevalence from the general population was comparable to that of pregnant women attending antenatal clinics. The revealed patterns of sexual risk behaviours, for example, close to 50% of men having multiple partners and 78% of the population have never used a condom; it is likely that HIV infection will rapidly escalate. Immediate and effective preventive efforts that consider the socio-cultural contexts are necessary to reduce the spread of the infection.

By the development of a mHealth tablet app together with modular interactive tiles for rehabilitation, we intend to facilitate the co-design, adaptation, demonstration and validation of modular ICT solutions for rehabilitation in deep rural sub-Saharan Africa. This results in highly mobile, modular and energy efficient technology which can be set up and used anywhere and anytime. We have formed a national partnership for sustainable implementation, comprising a governmental representative, national hospital, national health university department, regional hospitals, Living Labs and NGOs performing community-based rehabilitation. Thereby, we investigate the adaptation, contextualisation and implementation in different rehabilitation methods and centres, including hospitals both in a city centres and in a rural area, NGO's performing community based rehabilitation, and rehabilitation centres. Together, the partners contextualise the eHealth solution to fit the needs in urban, rural and deep rural areas.

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

The ideal approach for calculating effective coverage of health services using ecological linking requires accounting for variability in facility readiness to provide health services and patient volume by incorporating adjustments for facility type into estimates of facility readiness and weighting facility readiness estimates by service-specific caseload. The aim of this study is to compare the ideal caseload-weighted facility readiness approach to two alternative approaches: (1) facility-weighted readiness and (2) observation-weighted readiness to assess the suitability of each as a proxy for caseload-weighted facility readiness. We utilised the 2014–2015 Tanzania Service Provision Assessment along with routine health information system data to calculate facility readiness estimates using the three approaches. We then conducted equivalence testing, using the caseload-weighted estimates as the ideal approach and comparing with the facility-weighted estimates and observation-weighted estimates to test for equivalence. Comparing the facility-weighted readiness estimates to the caseload-weighted readiness estimates, we found that 58% of the estimates met the requirements for equivalence. In addition, the facility-weighted readiness estimates consistently underestimated, by a small percentage, facility readiness as compared to the caseload-weighted readiness estimates. Comparing the observation-weighted readiness estimates to the caseload-weighted readiness estimates, we found that 64% of the estimates met the requirements for equivalence. We found that, in this setting, both facility-weighted readiness and observation-weighted readiness may be reasonable proxies for caseload-weighted readiness. However, in a setting with more variability in facility readiness or larger differences in facility readiness between low caseload and high caseload facilities, the observation-weighted approach would be a better option than the facility-weighted approach. While the methods compared showed equivalence, our results suggest that selecting the best method for weighting readiness estimates will require assessing data availability alongside knowledge of the country context.