Background Adherence to antiretroviral (ARV) treatment for HIV infection is challenging because of many factors. The World Health Organization (WHO) has recommended using digital adherence technologies (DATs). However, there is limited evidence on how DATs improve adherence. Wisepill® is an internet-enabled medication dispenser found feasible and acceptable in several studies. However, limited evidence is available on its effectiveness in improving ART adherence, specifically among children and adolescents. Furthermore, DATs are often developed without involving the target groups. We propose a two-stage project consisting of a formative study to customize an existing Wisepill DAT intervention and a randomized clinical trial to investigate the effectiveness of DAT combined with reminder cues and tailored feedback on adherence to ARV treatment among children and adolescents living with HIV and retention in care among breastfeeding women living with HIV in Kilimanjaro and Arusha Region, Tanzania. Methods We will conduct a formative mixed-methods study and three sub-trials in Kilimanjaro and Arusha Regions among (1) children aged 0–14 years and their caregivers, (2) adolescents aged 15–19 years and (3) breastfeeding women and their HIV-negative infants. In the formative study, we will collect and analyse data on needs and contents for DATs, including the contents of short message service (SMS) texts and tailored feedback. The results will inform the customization of the DAT to be tested in the sub-trials. In the trials, participants will be randomized in the intervention arm, where the DAT will be implemented or the control arm, where standard care will be followed. Participants in the intervention arm will take their medication from the Wisepill box and receive daily reminder texts and tailored feedback during clinic visits. Discussion If the intervention improves adherence to ART and the devices are acceptable, accurate and sustainable, the intervention can be scaled up within the National Aids Control Programmes. Trial registration PACTR202301844164954, date 27 January 2023.

This book contains the abstracts of the papers/posters presented at the Tanzania Health Summit 2020 (THS-2020) Organized by the Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender, and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS) held on 25–26 November 2020. The Tanzania Health Summit is the annual largest healthcare platform in Tanzania that attracts more than 1000 participants, national and international experts, from policymakers, health researchers, public health professionals, health insurers, medical doctors, nurses, pharmacists, private health investors, supply chain experts, and the civil society. During the three-day summit, stakeholders and decision-makers from every field in healthcare work together to find solutions to the country’s and regional health challenges and set the agenda for a healthier future.

Children and adolescents living with HIV (CALHIV) form a significant proportion of people living with HIV (PLHIV). Optimal adherence (>95%) to medication is needed to achieve viral suppression. However, optimal adherence remains a challenge among CALHIV. Digital adherence tools (DAT) like the Wisepill® device have proven feasible among adult PLHIV. Still, there are concerns about unwanted disclosure of HIV status due to content in short message service (SMS) that serve as reminders. We assessed the needs, contents, and acceptability of a DAT intervention among CALHIV. We conducted a mixed-methods study among CALHIV with their parents/guardians. We performed a survey and then purposively selected participants who used the intervention for one month. They received SMS text reminders that differed over time from asking if the medication was taken to more neutral SMS like “take care”. After one month, participants received tailored feedback based on automatically generated adherence reports. Afterwards, we completed exit interviews, in-depth interviews, and focus-group discussions. We analysed quantitative findings descriptively and used thematic content analysis for qualitative data. We included 284 participants in the survey and 40 used the intervention. Among participants who often forgot medication intakes, 93% of adolescents and 83% of children's parents/guardians were interested in receiving reminders. Among participants who used DAT, 90% had good experience receiving reminders and agreed that SMS made them take medication. However, 25% experienced network problems. Participants were happy to use the device. Further, they preferred neutral reminder SMSs that did not mention the word ‘medication’, but preserved confidentiality. Adherence reports inspired good adherence. None of the participants experienced unwanted disclosure or stigmatisation due to DAT. However, 5% of adolescents were concerned about being monitored daily. This study provided insights on how to customise DAT. We will implement this in a clinical trial to assess effectiveness in improving adherence.

Background Adherence to antiretroviral (ARV) treatment for HIV infection is challenging because of many factors. The World Health Organization (WHO) has recommended using digital adherence technologies (DATs). However, there is limited evidence on how DATs improve adherence. Wisepill® is an internet enable medication dispenser found feasible and acceptable in several studies. However, limited evidence is available on its effectiveness in improving ART adherence, specifically among children and adolescents. Furthermore, DATs are often developed without involving the target groups. We propose a two-stage project consisting of a formative study to customize an existing Wisepill DAT intervention and a randomized clinical trial, to investigate the effectiveness of DAT combined with reminder cues and tailored feedback on adherence to ARV treatment among children and adolescents living with HIV and retention in care among breastfeeding women living with HIV in Kilimanjaro and Arusha Region, Tanzania. Methods We will conduct a formative study mixed-methods study and three sub-trials in Kilimanjaro and Arusha Regions among (1) children aged 0–14 years and their caregivers, (2) adolescents aged 15–19 years and (3) breastfeeding women and their HIV-negative infants. In the formative study, we will collect and analyse data on needs and contents for DATs, including the contents of short message service (SMS) texts and tailored feedback. The results will inform the customization of the DAT to be tested in the sub-trials. In the trials, participants will be randomized in the intervention arm, where the DAT will be implemented or the control arm, where standard care will be followed. Participants in the intervention arm will take their medication from the Wisepill-box and receive daily reminder texts and tailored feedback during clinic visits. Discussion If the intervention improves adherence to ART and the devices are acceptable, accurate and sustainable, the intervention can be scaled up within the National Aids Control Programmes. Trial registration: PACTR202301844164954, date 27 January 2023

Background: In Tanzania, disclosure of HIV status to children remains a challenge despite the World Health Organization (WHO) recommendation that children should be informed about their HIV status between the ages of 6 to 12 years. This study aims to determine HIV status disclosure and related factors among children living with HIV in Kilimanjaro, Tanzania. Method: A cross-sectional study using a convergent parallel mixed-methods design was conducted from September 2021 to February 2022 among children aged 6-14 years receiving HIV care. Semi-structured questionnaires were collected from caregivers of undisclosed children, including socio-demographic data and reasons for non-disclosure. Additionally, we interviewed 20 caregivers of children in-depth who had disclosed and not disclosed the status to their children; we also interviewed children whose HIV status had been disclosed, followed by a focus group discussion. Bivariate and multivariate logistic regression analyses identified factors associated with HIV status disclosure. P<0.05 was considered statistically significant. We did thematic content analysis for qualitative data. Results: 121 children and their parents or caregivers were included in the analysis and 51(42%) knew about their HIV status. 31%(n=38) of children were between the ages 6-8 and among them, 33(87%) did not know about their status. Thirty-nine percent (n=47) of children were between the ages of 9-11; 32(68%) did not know about their status. 30% (n=36) of the children were above 12 years old, and 5(14%) did not know their status. 60 children were girls (49.5%); the majority (n=75;62%) lived with their biological parents; 112 children had primary education (93%); and 94 (78%) children attended referral hospitals for ART services. Moreover, 86(71%) of the children had caregivers who had been interviewed. In the final multivariate model, children aged above 12 years (OR= 30; 95%; Cl= 7.2-124); children aged 9-11(OR=2.7;95%; CI= 0.8-9.0) and having a treatment supporter (OR=2.9; 95%CI=1.0-8.2) were significantly associated with HIV status disclosure to their children compared to their counterparts respectively. Through IDI, we revealed the following themes: (1) HIV disclosure challenges and reasons not to disclose the status, (2) the process of the disclosure, and (3) the Importance of disclosure. Conclusion: HIV status disclosure to children living with HIV in Kilimanjaro region was associated with age above 12 years and having a treatment supporter, unlike the WHO recommendation. Therefore, health facilities should introduce new strategies to ensure children know their HIV status.

Introduction: In Sub-Saharan Africa, there are knowledge gaps on adverse drug reactions (ADRs) of antiretroviral treatment (ART). Studies have shown that limited training capacity among healthcare workers has affected reporting of ADRs and weakened the pharmacovigilance system in Tanzania. Studies have shown that the use of digital tools, including SMS communication, might be a viable way to increase knowledge and understanding of reporting ADRs. This study aimed to examine the acceptability and feasibility of SMS texts to increase awareness about the importance of reporting ADRs of ART among people living with HIV (PLHIV) in Tanzania. We also explored different ADR profiles that were reported by the participants. Methodology: This was a prospective implementation pilot study. PLHIV who consented to the study received a biweekly message to ask them how they were doing. We programmed keywords in the system that could be used for responding to the presence of ADR. The response to messages generated a flow of SMS that determined the presence of ADRs and informed participants to report. The technical feasibility was calculated based on the percentages of SMS which were sent and delivered about ADR and acceptability was measured based on the percentage of SMS that was replied to by the participants. We also collected data on different types of ADR reported by the participants. We conducted focus group discussions with participants and in-depth interviews with health workers to understand their experiences with and acceptability of the system. Results: Over a 12-month study period, a total of 92 participants were recruited. Sixty-two (67.4%) were women. The mean age of our participants was 42 years (SD 12). Forty (43.5%) participants were on ART for less than 3 months and the other 52 (56.5%) participants were on first-line ART. The system successfully sent and delivered 105 follow-up messages to all participants who consented to receive SMS. Among all the sent SMS 100 (95.2%) were replied to by the participants. Commonly reported ADRs were itching, gastrointestinal discomfort, joint pain, malaise and headache. The themes identified through FGD and IDI were: high motivation to report ADR, well-understood SMS content, the system to remain the same, no concerns about unwanted disclosure, and difficulties in replying to SMS due to network. The latter was mentioned by a few participants. Conclusion: SMS for creating awareness on ADRs reporting is a user-friendly intervention and highly accepted based on qualitative data among PLHIV in Tanzania. Also use of SMS is a low-cost intervention and a simple way to improve public health issues with society. Keywords: Short Message Services; Adverse drug reactions; Awareness; Acceptability

Background Retention in care and adherence to medication among pregnant and breastfeeding women living with HIV (PBWLH) are crucial for the prevention of mother-to-child transmission (PMTCT) of HIV. Wide coverage of mobile phones, digital tools, including the use of internet-enabled medication dispensers and short message service (SMS), have been recommended as potential interventions to improve adherence to medication by PBWLH. The main objective of the study was to understand the needs and contents for a customized digital tool for retention in care and medication adherence among PBWLH. Method A mixed-methods study was conducted from September 2021 to March 2022 at five health facilities in Kilimanjaro region. Pregnant and breastfeeding women receiving PMTCT services were included in a survey using a semi-structured questionnaire. Among the interviewed, twenty breastfeeding women were purposively selected and enrolled to use an internet-enabled Wisepill medication dispenser for one month. They received different types of SMS reminders for a period of one month and feedback on their adherence patterns was received after one month using adherence graph from the Wisepill digital tool. Later, exit interviews and in-depth interviews were conducted to explore the needs and contents for a future customized digital adherence tool. Descriptive analyses for quantitative data and thematic content analyses for qualitative data were also done. Results Among 142 women interviewed, 42(30%) were pregnant and 100 (70%) were breastfeeding. A majority of 136 (95%) had access to mobile phones and used SMS daily, while 90% were interested in receiving reminder messages. Qualitative findings revealed more insights on reminders’ content and educational SMS. Most people preferred neutral SMS which does not contain the word “medication”. Health educational SMS content was preferred to be on breastfeeding, opportunistic diseases, nutrition and entrepreneurship education. Overall, SMSs were regarded helpful to remind clients of medication time and the medication dispenser provided them with privacy and safe storage for their medication. Conclusions Findings from this study will help to construct useful content for future digital adherence tools to support the health of pregnant and breastfeeding women living with HIV.

Background: Retention in care and adherence to medication among pregnant and breastfeeding women living with HIV (PBWLH) are crucial for prevention of mother-to-child transmission (PMTCT) of HIV. Due to the comprehensive coverage of mobile phones, digital tools, including the use of internet-enabled medication dispensers and short message service (SMS), have been described as potential interventions to improve adherence. Therefore, the study’s main objective was to understand the needs and contents of a customized digital tool for retention in care and medication adherence among PBWLH. Method: A mixed-methods study was conducted from September 2021 to March 2022 at five health facilities in Kilimanjaro region. Pregnant and breastfeeding receiving PMTCT services were included in a survey using a semi-structured questionnaire. Among the interviewed, twenty breastfeeding participants were purposively selected, trained, and enrolled to use an internet-enabled medication dispenser for one month. They received different types of SMS reminders for four weeks and feedback on their adherence patterns from a nurse counsellor after one month using an adherence graph from Wisepill. Later, exit interview and an in-depth interview (IDI) were conducted to explore needs and content. We did descriptive analyses for quantitative data and thematic content analyses for qualitative data. Results: Among 142 women interviewed, 42(29.5%) were pregnant, and 100 (70.5%) were breastfeeding. A majority of 136(95%) had access to mobile phones and used SMS daily. Ninety-six percent were interested in receiving reminder messages. Nearly 86(61%) preferred to be reminded daily before medication intake time. Showing adherence graphs during tailored feedback sessions was highly appreciated. Qualitative findings revealed more insights into the content of reminders and educational SMS. Most people prefer neutral SMS which does not contain the word “medication”. Health educational SMS contents preferred breastfeeding, opportunistic diseases, nutrition, and entrepreneurship education. Overall, SMSs were regarded as helpful in reminding clients of medication time and medication dispenser provided them with privacy and safe storage for their medication. Conclusion: This study helps to construct useful content for future digital adherence tools to support the health of pregnant and breastfeeding women living with HIV. Digital tools seem to be highly needed.