CLINICAL outcomes and loss to follow-up among people living with HIV participating in the NAMWEZA intervention in Dar es Salaam, Tanzania: a prospective cohort study

Siril, Hellen; Kaaya, Sylvia; Fawzi, Mary Kay Smith; Mtisi, Expeditho; Somba, Magreat; Kilewo, Japheth; Mugusi, Ferdinand; Minja, Anna; Kaale, Anna; Todd, Jim

doi:10.1186/s12981-017-0145-z

Cited by 26 publications

(31 citation statements)

References 26 publications

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“…Retention in care (ie, repeat utilisation) is a frequently used measure of health system quality for conditions that require a course of continuous care, such as HIV and non-communicable diseases as well as immunisation. 21 , 22 , 23 Because condition-specific utilisation measures were not available for all 61 conditions in LMICs, we used population utilisation data for conditions with similar clinical features and level of acuity. 24 For conditions such as neonatal HIV and vaccine preventable diseases, the health system can prevent all incidental cases when people seek preventive care.…”

Section: Methodsmentioning

confidence: 99%

Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries

et al. 2018

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SummaryBackgroundUniversal health coverage has been proposed as a strategy to improve health in low-income and middle-income countries (LMICs). However, this is contingent on the provision of good-quality health care. We estimate the excess mortality for conditions targeted in the Sustainable Development Goals (SDG) that are amenable to health care and the portion of this excess mortality due to poor-quality care in 137 LMICs, in which excess mortality refers to deaths that could have been averted in settings with strong health systems.MethodsUsing data from the 2016 Global Burden of Disease study, we calculated mortality amenable to personal health care for 61 SDG conditions by comparing case fatality between each LMIC with corresponding numbers from 23 high-income reference countries with strong health systems. We used data on health-care utilisation from population surveys to separately estimate the portion of amenable mortality attributable to non-utilisation of health care versus that attributable to receipt of poor-quality care.Findings15·6 million excess deaths from 61 conditions occurred in LMICs in 2016. After excluding deaths that could be prevented through public health measures, 8·6 million excess deaths were amenable to health care of which 5·0 million were estimated to be due to receipt of poor-quality care and 3·6 million were due to non-utilisation of health care. Poor quality of health care was a major driver of excess mortality across conditions, from cardiovascular disease and injuries to neonatal and communicable disorders.InterpretationUniversal health coverage for SDG conditions could avert 8·6 million deaths per year but only if expansion of service coverage is accompanied by investments into high-quality health systems.FundingBill & Melinda Gates Foundation.

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Section: Methodsmentioning

confidence: 99%

Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries

et al. 2018

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“…In addition, Network Members who were living with HIV demonstrated an increase in access to HIV treatment. Although examining clinical outcomes was beyond the scope of this trial, an observational study comparing people living with HIV in NAMWEZA with those who did not participate demonstrated an increase in weight and greater treatment retention at follow-up among those in the programme 56. This finding supports a fundamental goal of the NAMWEZA programme— to improve the overall health and well-being of people living with HIV, which in turn strengthens their capacity to serve as Change Agents in their communities.…”

Section: Resultsmentioning

confidence: 58%

Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of theNAMWEZAintervention in Dar es Salaam, Tanzania

et al. 2019

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IntroductionNAMWEZA is a novel intervention that focuses on preventing HIV and promoting sexual and reproductive health and rights by addressing underlying factors related to vulnerability of acquiring HIV, such as depression, intimate partner violence (IPV) and stigma. The goal of the study was to evaluate the effect of the NAMWEZA intervention on risk behaviour as well as factors potentially contributing to this vulnerability for people living with HIV and their network members.MethodsA stepped-wedge randomised controlled trial was conducted from November 2010 to January 2014 among people living with HIV and their network members in Dar es Salaam, Tanzania. 458 people living with HIV were randomised within age/sex-specific strata to participate in the NAMWEZA intervention at three points in time. In addition, 602 members of their social networks completed the baseline interview. Intention-to-treat analysis was performed, including primary outcomes of uptake of HIV services, self-efficacy, self-esteem, HIV risk behaviour and IPV.ResultsFor people living with HIV, a number of outcomes improved with the NAMWEZA intervention, including higher self-efficacy and related factors, as well as lower levels of depression and stigma. IPV reduced by 40% among women. Although reductions in HIV risk behaviour were not observed, an increase in access to HIV treatment was reported for network members (72% vs 94%, p=0.002).ConclusionThese results demonstrate the complexity of behavioural interventions in reducing the vulnerability of acquiring HIV, since it is possible to observe a broad range of different outcomes. This study indicates the importance of formally evaluating interventions so that policymakers can build on evidence-based approaches to advance the effectiveness of HIV prevention interventions.Trial registration numberNCT01693458.

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“…The PST component includes six psychosocial group therapy sessions plus one orientation session prior to delivery. Implementation strategies for the PST sessions are borrowed from NAMWEZA [36], a participatory and strengths-based program that was adapted for an urban Tanzanian context and demonstrated improved clinical outcomes in PLH [37]. This approach promotes awareness of one's own strengths and assertive communication skills.…”

Section: Intervention and Control Conditionsmentioning

confidence: 99%

Healthy Options: study protocol and baseline characteristics for a cluster randomized controlled trial of group psychotherapy for perinatal women living with HIV and depression in Tanzania

et al. 2020

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Background: Perinatal women accessing prevention of mother-to-child transmission of HIV (PMTCT) services are at an increased risk of depression; however, in Tanzania there is limited access to services provided by mental health professionals. This paper presents a protocol and baseline characteristics for a study evaluating a psychosocial support group intervention facilitated by lay community-based health workers (CBHWs) for perinatal women living with HIV and depression in Dar es Salaam.Methods: A cluster randomized controlled trial (RCT) is conducted comparing: 1) a psychosocial support group intervention; and 2) improved standard of mental health care. The study is implemented in reproductive and child health (RCH) centers providing PMTCT services. Baseline characteristics are presented by comparing sociodemographic characteristics and primary as well as secondary outcomes for the trial for intervention and control groups. The trial is registered under clinicaltrials.gov (NCT02039973).Results: Among 742 women enrolled, baseline characteristics were comparable for intervention and control groups, although more women in the control group had completed secondary school (25.2% versus 18.2%). Overall, findings suggest that the population is highly vulnerable with over 45% demonstrating food insecurity and 17% reporting intimate partner violence in the past 6 months. Conclusions: Baseline characteristics for the cluster RCT were comparable for intervention and control groups. The trial will examine the effectiveness of a psychosocial support group intervention for the treatment of depression among women living with HIV accessing PMTCT services. A reduction in the burden of depression in this vulnerable population has implications in the short-term for improved HIV-related outcomes and for potential long-term effects on child growth and development.Trial registration: The trial is registered under clinicaltrials.gov (NCT02039973).

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CLINICAL outcomes and loss to follow-up among people living with HIV participating in the NAMWEZA intervention in Dar es Salaam, Tanzania: a prospective cohort study

Cited by 26 publications

References 26 publications

Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries

Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries

Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of theNAMWEZAintervention in Dar es Salaam, Tanzania

Healthy Options: study protocol and baseline characteristics for a cluster randomized controlled trial of group psychotherapy for perinatal women living with HIV and depression in Tanzania

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