Artigos de revistas sobre o tema "Tanzania AIDS Project"

The continued success of entertainment education programmes around the world has seen anincrease in the use of theatre for HIV/AIDS interventions. Both UNAIDS and UNESCO recommendthe use of such cultural strategies for HIV/AIDS awareness. A brief survey of current evaluationsin this field reveals such projects in Kenya, Angola, Mozambique, the Netherlands and Honduras,amongst other countries. Forum theatre is reported as being used as a technique to deepenunderstanding of HIV/AIDS issues in programmes in Georgia, Tanzania, Burkina Faso and SouthAfrica (The Communication Initiative, 2007).This paper explores the application of participatory theatre techniques in a South African factoryenvironment in 2003. It investigates the conditions and context for the project, some of the theoreticalunderpinnings of the forum theatre concept, and the reception of the project by the factory audience.Essentially, the paper seeks to determine whether forum theatre is an appropriate strategy to usefor HIV/AIDS awareness in this environment.

BackgroundDREAMM is an implementation study aiming to reduce meningo-encephalitis related mortality. Delays in diagnosis and treatment through poor access to diagnostics and treatments are significant contributing factors to the ongoing high mortality of HIV-associated central nervous system (CNS) infections, causing up to 25% of all HIV-related deaths in sub-Saharan Africa.MethodsA before-after design is being implemented across 3 sites in Africa; Lilongwe, Malawi, Dar Es Salaam, Tanzania and Yaoundé, Cameroon. The study is composed of 3 phases: Observation, Training and Implementation.ResultsThe observation phase (audit of practice) happened between November 2016 – May 2017 in Malawi and Tanzania. Overall, 110 patients were included. Ten-week all-cause mortality was 64% (42/66) in Tanzania and 37% (13/35) in Malawi. Approximately 75% of patients were ART experienced. Across sites, 76.6% of patients presented with abnormal mental status, with a median baseline CD4 count of 50 cells/µL. Only 2/75 patients in Tanzania had a lumbar puncture ordered compared to 27/35 in Malawi. All patients in Tanzania received empirical Fluconazole monotherapy whereas almost 1/3 patients in Malawi (11/35) were treated with Amphotericin B which is not readily available in both countries.The training phase (completed in November 2017 for Malawi and Tanzania) used the train-the-trainer approach. Interactive workshops on using rapid diagnostic tests (RDTs), performing basic microbiological techniques and safe administration of medicines were chosen as the most pertinent to reducing mortality. Patient and laboratory pathways were optimised afterwards by increasing the routine laboratory capacity, performing CSF analysis, providing infectious diseases mentorship for clinicians and procuring RDTs and reagents not locally available.Implementation is underway in Malawi and Tanzania and the audit phase is scheduled for autumn in Cameroon. Upon completion, the project is expected to create a sustainable approach to reduce the high mortality of HIV-related meningo-encephalitis with the optimised patient and laboratory pathways embedded within routine care.

A research project on community-based theatre in Tanzania questions the efficacy of the genre in combating the AIDS epidemic. If performances are well attended, and participants are informed on the causes of the virus, why is it still rampant? Efficacy will be possible only when gender inequities and taboos are openly confronted.

Although several international and national HIV/AIDS conferences exist, there was not a national conference in Tanzania focusing on HIV/AIDS disseminating and implementation research conducted in the country and abroad. This created a missed opportunity for researchers to share their research findings with local policymakers and HIV program implementers who can influence the adoption and implementation of promising research in public health and clinical practice settings. In response, the first HIV/AIDS D&I Research Forum designed to enhance local D&I efforts for HIV research, was organized in Tanzania in 2018. This paper explores the perceived benefits of the HIV/AIDS D&I Research Forum and potential challenges of developing similar forums and recommendation for future HIV research D&I conference in Tanzania. During the second day of the Forum, which was held in September 2018 in Morogoro, Tanzania, a 1-hour structured brainstorming session was conducted with the Forum attendees (n = 50), including researchers, medical professionals, policymakers, representatives from different ministries. Transcription of the brainstorming session was analyzed to identify benefits of the Forum, perceived challenges for organizing similar HIV/AIDS research dissemination events, and recommendations for addressing the challenges. Overall, participants perceived the forum to be beneficial because it provided opportunities for strategic collaborations between researchers, policymakers, and other stakeholders and for them to discuss challenges for D&I efforts. Forum attendees also identified several potential challenges for future D&I research forums such as the abstract requirement which may deter non-researchers, costs, meeting frequencies, and lack of funding and coordination between organizations involved in D&I research efforts. To address these concerns, a recommendation was made to host a biennial national conference in order to allow more time for ethical review and feedback that can enhance contribution of the project to D&I efforts and to raise funds. The benefits identified for the Forum highlight the importance of organizing similar D&I meetings for HIV-related research at the national level in Tanzania. However, the potential challenges discussed need to be addressed in order to develop a sustainable national D&I research conference by incorporating recommendations that forum attendees proposed.

SummaryAmong women in mainland Tanzania, Iringa region in the southern highlands has the highest HIV/AIDS prevalence rate while Arusha region in the north-east has the lowest prevalence rate. In a 2007/8 survey, Iringa's HIV rate for women was 18.6% versus 0.8% in Arusha. Using data from a survey of women aged 15–49 years conducted in 2009 by the Champion project of EngenderHealth, a comparison was made of HIV/AIDS knowledge, attitude and practice between women in Iringa and Arusha regions. It was found that women in Arusha region had more knowledge of HIV/AIDS than women in Iringa region, and that more than three-quarters of the women in each region were married and 12% of the women in Arusha region had never been married compared with 8% of the women in Iringa region. The majority of women in each region had at least primary school education and there was no significant difference between their educational levels. Women in Arusha region were economically less active than women in Iringa region, a statistically significant association. More women in Arusha region than in Iringa region had never had children (24% versus 12%). Similarly, women in Arusha region had significantly fewer children compared with women in Iringa.

Major challenges for the HIV program in the Muheza district of Tanzania, East Africa were to increase HIV testing for men and retain HIV patients on treatment. The USAID funded Applied Science to Strengthen, and Improve Systems (ASSIST) project implemented the Community Health System Strengthening (CHSS) model to improve linkages between health facilities and communities to increase HIV testing and retention in care. The project formed a community team from representatives of the formal and informal pre-existing structures and their networks who worked with the local Home-Based Care (HBC) volunteers. The community improvement team members relayed information from the facility to the community households through their community group members and vice-versa. The application of CHSS model was able to increase the testing of males from 42 to 159 in one month. Over the course of seven months, the CHSS system was able to trace 39 of 44 patients who were lost to follow-up; of these, 23 went back to treatment, five had moved to a different health facility, 11 had died, and five were still unaccounted for. This case study describes the process undertaken, and perspectives of the community members and health facility personnel, who were involved in the project.

Citizen and collective advocacy is often regarded as a critical way to hold governments to account for the services they expected to deliver and combat the marginalisation of certain groups. This article presents a qualitative analysis of the application of a “rights-based” and advocacy approach as a means for People Living with HIV (PLWHIV) to claim their legislative rights to basic services such as education, and combat behaviour that is stigmatising. Data was obtained from a project in Northern Tanzania that works with more than 40 self-help groups to empower them to claim their rights as stipulated in the 2008 HIV/AIDS Act. The findings suggest that knowing one’s rights does seem to enable groups to start asking questions about their entitlements to services. As has been alluded to already, it is not enough for one to simply know their rights when their actions and responses are fundamentally limited by lack of resource and power, vague legislative commitments and weak local institutional capacity to respond. These findings have implications for the many social policy initiatives, which seek to use citizen or group-based advocacy to address discrimination or poor public service delivery.

BackgroundPalliative care (PC) need in Africa is projected to rise by 300% over the next 20 years.1 Late presentation and poor community awareness of services are recognised challenges to effective healthcare delivery.2 3Traditional and faith healers (TFH) hold cultural importance and provide a significant proportion of primary healthcare in Africa.4 5 This project sought to explore their understanding and management of terminal illness with the aim of improving PC delivery through collaborations between TFH and allopathic services.MethodologyData were collected through semi-structured qualitative interviews with traditional healers (n=11) and faith healers (n=8) working within the Kilimanjaro region of Tanzania. Participants were recruited through convenience and purposive sampling. Interviews were audio-recorded and translated transcripts analysed by thematic analysis.FindingsAll TFH had experience of terminally ill and dying patients. Participants had a holistic approach to healthcare with themes of biological psychological social and spiritual factors identified throughout conceptualisation and management of both terminal illness and death. This also informed opinions towards collaboration seeing healthcare professionals and TFH holding different roles within these areas.ConclusionsThe overlap with allopathic explanatory models of health (i.e. the BioPsychoSocial model) provides positive grounds for future collaborations. TFH could complement allopathic PC services through culturally acceptable spiritual care perceived to be lacking in hospitals. Joint dialogue and education between practitioners is necessary to begin collaboration. A significant challenge to this is mistrust between traditional healers and faith healers. The findings merit further research into patient’s preferences and experiences of TFHs in terminal illness.References. Grant L, Downing J, Namukwaya E. Palliative care in Africa since 2005: Good progress but much further to go. BMJ Supportive & Palliative Care2011;1(2).. Harding R, et al. Current HIV/AIDS end-of-life care in sub-Saharan Africa: A survey of models services challenges and priorities. BMC Public Health2003;3(33).. Lewis EG, Oates LL, Rogathi J, Duinmaijer A, Shayo A, Megiroo S, Bakari B, Dewhurst F, Walker RW, Dewhurst M, Urasa S. ‘We never speak about death.’ Healthcare professionals’ views on palliative care for inpatients in Tanzania: A qualitative study. Palliat Support CareAugust 2017;22:1–14.. World Health Organisation. WHO: Traditional medicine strategy: 2014–2023 2013. Geneva: World Health Organisation Geneva.. Stanifer JW, et al. The determinants of traditional medicine use in Northern Tanzania: A mixed-methods study. PLoS One2015;10(4):e0122638.

Background: HIV-related stigma is a major barrier to the timely linkage and retention of patients in HIV care in sub-Saharan Africa, where most people living with HIV/AIDS reside. In this implementation study we aim to evaluate the effect of stigma-directed services on linkage to care and other health outcomes in newly diagnosed HIV-positive patients. Methods: In a nested project of the Kilombero and Ulanga Antiretroviral Cohort in rural Tanzania, we conduct a prospective observational pre-post study to assess the impact of a bundle of stigma-directed services for newly diagnosed HIV positive patients. Stigma-directed services, delivered by a lay person living with HIV, are i) post-test counseling, ii) post-test video-assisted teaching, iii) group support therapy and group health education, and iv) mobile health. Patients receiving stigma services (enrolled from 1st February 2020 to 31st August 2021) are compared to a historical control receiving the standard of care (enrolled from 1st July 2017 to 1st February 2019). The primary outcome is ‘linkage to care’. Secondary endpoints are retention in care, viral suppression, death and clinical failure at 6-12 months (up to 31st August 2022). Self-reported stigma and depression are assessed using the Berger Stigma scale and the PHQ-9 questionnaire, respectively. The sample size calculation was based on cohort data from 2018. Assuming a pre-intervention cohort of 511 newly diagnosed adults of whom 346 (68%) were in care and on antiretroviral treatment (ART) at 2 months, a 10% increase in linkage (from 70 to 80%), a two-sided type I error rate of 5%, and 90% power, 321 adults are required for the post-implementation group. Discussion: We expect that integration of stigma-directed services leads to an increase of proportions of patients in care and on ART. The findings will provide guidance on how to integrate stigma-directed services into routine care in rural sub-Saharan Africa.

Background: HIV-related stigma is a major barrier to the timely linkage and retention of patients in HIV care in sub-Saharan Africa, where most people living with HIV/AIDS reside. In this implementation study we aim to evaluate the effect of stigma-directed services on linkage to care and other health outcomes in newly diagnosed HIV-positive patients. Methods: In a nested project of the Kilombero and Ulanga Antiretroviral Cohort in rural Tanzania, we conduct a prospective observational pre-post study to assess the impact of a bundle of stigma-directed services for newly diagnosed HIV positive patients. Stigma-directed services, delivered by a lay person living with HIV, are i) post-test counseling, ii) post-test video-assisted teaching, iii) group support therapy and group health education, and iv) mobile health. Patients receiving stigma services (enrolled from 1st February 2020 to 31st August 2021) are compared to a historical control receiving the standard of care (enrolled from 1st July 2017 to 1st February 2019). The primary outcome is ‘linkage to care’. Secondary endpoints are retention in care, viral suppression, death and clinical failure at 6-12 months (up to 31st August 2022). Self-reported stigma and depression are assessed using the Berger Stigma scale and the PHQ-9 questionnaire, respectively. The sample size calculation was based on cohort data from 2018. Assuming a pre-intervention cohort of 511 newly diagnosed adults of whom 346 (68%) were in care and on antiretroviral treatment (ART) at 2 months, a 10% increase in linkage (from 70 to 80%), a two-sided type I error rate of 5%, and 90% power, 321 adults are required for the post-implementation group. Discussion: We expect that integration of stigma-directed services leads to an increase of proportions of patients in care and on ART. The findings will provide guidance on how to integrate stigma-directed services into routine care in rural sub-Saharan Africa.

This article discusses the functions of African community theatre in general, and its preventive capacity in the HIV/AIDS epidemic in particular. By delineating the parallel developments of community theatre and HIV prevention, the reciprocal needs of the practices are assessed in light of certain cases in Tanzania. This country has taken a leading position in the implementation of sustainable and locally owned theatre projects, but the challenges of the AIDS epidemic have proven so vast that the previously assumed purposes of community theatre must be called into question. Rather than being viewed as a means in itself, or a means for rapid change, community theatre is viewed as a relational means in coordinated programmes against AIDS. However, in spite of functioning as an exceptional relational agency for the most exposed cohort in the epidemic (women aged between fifteen and twenty-four), the social, gender and epidemic predicaments will persist as long as policy-makers do not fully recognize the status of young people and the capacity of community theatre.

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This paper discusses the manner and the extent to which countries of the Global South have engaged in the fight against pandemics. It shows how Southern countries, like their brothers in the North, played a significant role in the fight against diseases such as AIDS. It unveils that despite its multilateral engagement in global health from the 2000s following its domestic health crisis, the Chinese government engaged in several bilateral health projects to fight pandemics in Southern countries. Using the Chinese-funded HIV/AIDS Traditional Chinese Medicine (TCM) research and treatment project in Tanzania as its focal point, the paper examines the history of the project from its inception in 1987 to its decline in 2014, and shows the contexts that influenced its establishment, practice, and perceptions by patients. The paper argues that although the Sino-Tanzanian HIV/AIDS TCM research and treatment project was less impactful in addressing the disease and transmitting medical knowledge to local researchers and practitioners, it realized the contribution of countries of the Global South to global health. More importantly, the use of TCM in fighting HIV/AIDS demonstrated the prospects of traditional medicine in addressing global health challenges.

Abstract The purpose is to scope the existing literature on trilateral cooperation with South-South cooperation for development assistance. For example, a South Africa-Tanzania-United States project on HIV/AIDS, with at least two countries from the Global South.

Abstract Background HIV/AIDS remains the leading cause of death in sub-Saharan Africa. Due to multiple constraints experienced by households that seem to be disproportionally affected, families generally seek assistance from the community and external economic support. Previous researchers studied socioeconomic and gender inequality in HIV/AIDS prevalence in sub-Saharan African countries. However, very few researchers have paid attention to the external economic support for HIV/AIDS affected households in Tanzania. This study investigates the difference in economic support among households affected or not affected by the HIV/AIDS epidemic in Tanzania. Methods Data used stemmed from the Tanzania HIV Impact Survey 2016–2017 (THIS) of the Population-based HIV Impact Assessment (PHIA) project, collected between 2016 and 2017 in Tanzania. The study population were the heads of households (adults) with age greater than 15. The dependent variable for the study was economic support. This consisted of both material and non-material assistance obtained from outside the household. Socio-demographic (economics) characteristics constituted the predictors of the study. Descriptive statistics and econometric modelling were used to analyse determinants associated with external economic support. Oaxaca-Blinder decomposition method was also performed to investigate the difference in economic support depending on households’ serological status in Tanzania. Results A total of 12,008 households were included. Almost 11% of the household heads indicated that their households received economic support. HIV/AIDS affected 7% of households. The mean age of the household heads was 45 years (SD ± 15) with a range of 16–80. The majority of household heads were men (72%). Being a household head affected by HIV/AIDS increases the probability to receive external economic support (p < 0.05). The difference in external economic support between the two groups (HIV/AIDS and no- HIV/AIDS households) was - 0.032 (p < 0.01). This gap was observed to favour households affected by HIV/AIDS. Almost 72% (− 0.023/− 0.032) of this difference was explained by characteristics such as the wealth index (p < 0.01), residence area (urban) (p < 0.01), marital status (widowed (p < 0.05) and divorced or separated) (p < 0.1) and age (p < 0.01). Conclusion The difference in economic support across households affected or not affected by HIV/AIDS was explained by wealth index, residence area, marital status and age. These findings represent important implications for health policy regarding future economic support strategies for HIV/AIDS-affected households.

Abstract The overall rise in deaths from preventable communicable diseases in the African Region is of utmost concern from a public health perspective. Sub-Saharan Africa (SSA) is home to a severe generalized HIV epidemic with the value of targeted health promotion only recently gaining momentum. The transport sector and transport corridors represent a major transmission route for HIV, fueled by unemployment, multiple sexual partnerships, gender-based violence (GBV), migrant workers and poor access to quality health information and services. In Tanzania, targeted sensitization and health promotion interventions spanning two major road corridors and their large-scale construction projects led to improved knowledge and behavior change among the road construction workers, community leaders and local residents in the communities along the road project as measured during a baseline and end line survey. Taking a comprehensive approach to health promotion the road project in Tanzania focused on: Educational and behavioral change campaigns, aimed via road shows at creating awareness on HIV and AIDS, STI, TB and GBV and encouraged people to know their sero status at mobile outlets of the HIV Counselling and Testing Services (HTS) during community bonanzas, featuring edutainment.Training peer educators from communities and road construction workers on basic knowledge and communication skills to transfer information along the roads, within the communities and in the nearby schools.Establishing village multi-sectoral HIV/AIDS committees.Development of SBCC materials with targeted messages to road construction workers and community members, developed jointly with multiple stakeholders.HIV Testing Services in collaboration with districts and health facilities along the roads.Capacity development of health workers and relevant stakeholders. Lessons learnt can provide guidance for similar settings in SSA and stimulate also a fresh view on promotive activities in Europe.

INTRODUCTION Background: Quality data is critical for public health decision-making; however, adequate, high-quality data required to answer public health questions is not always available, particularly at sub-national levels. Triangulation is the practice of arraying different types of existing data from diverse sources to answer public health questions.The Tanzanian Triangulation Project was implemented to enhance understanding of the HIV epidemic at sub-national levels and promote a culture of data use among providers. Methods:We conducted triangulation workshops with regional-, district-, and facility-level HIV/AIDS service providers. Workshops included building capacity in MS Excel, DHIS2, and mapping software to produce visual data displays; support in carrying out the triangulation process; and the development of regional HIV triangulation reports to assess and address challenges affecting service provision.Results:Twenty-one workshops were completed covering 24 regions of Tanzania (mainland and Zanzibar) from 2009-2016. Participants were enthusiastic about seeing their data displayed visually in tables, charts and maps, often for the first time. Every workshop had data quality challenges and resulted in recommendations to improve data quality. Most (83%) participants reported learning new Excel skills, and among those, 86%reported using these skills after the workshop. Decision-makers at regional and district levels reported using their triangulation reports for strategic planning and decision-making. Conclusion: Triangulation is an effective means of using existing data when exhaustive data is not available to understand the HIV epidemic at sub-national levels. While more work is needed, triangulation promotes a culture of data use for evidence-based decisions in the HIV response in Tanzania.

Abstract Background Despite extensive efforts to scale up counseling and testing services and care and treatment clinics (CTCs) in Tanzania, linkage between points of diagnosis and CTCs remains low. Studies have looked at barriers such as lack of trained health providers, poor referral system, economic costs or distance to health facilities, but fewer assessed the association between caregivers’ vulnerability such as disability and linkage of orphans and vulnerable children (OVCs) in their care to health facilities. This study describes the magnitude of caregivers’ disability and assesses its relationship with successful linkage to care of their OVC living with HIV/AIDS in Tanzania. Methods Data for this analysis came from the USAID Kizazi Kipya project in 79 councils of Tanzania. Data on HIV risk, service use and ART adherence among OVC aged 0–19 years were collected during the project’s quarterly routine data collection (Oct 2017-Sep 2018). Characteristics of caregivers were collected during the project beneficiary screening and enrollment process. Generalized estimating equation models were used to analyze the factors that are associated with linkage of 14,538 HIV positive OVC to CTC, who were taken care of by 11,834 caregivers. Results The majority of caregivers (70%) were females, had completed primary education (67%), 54% were married or cohabiting. Of all the OVC, 3% were living with disabled caregivers; of whom 89% were physically disabled while 11% were mentally disabled. OVCs living with disabled caregivers were less likely to be linked to care (OR 0.76, 95% CI 0.58, 0.99). Factors positively associated with OVC linkage to care were high caregivers’ education level (OR 1.99, 95% CI 1.51, 2.63) and OVC living with a HIV positive caregivers (OR 1.25, 95% CI 1.12, 1.41). OVC living in household with high socio-economic status were less likely to be linked to care (OR 0.76, 95% CI 0.67, 0.86) than those in low-SES households. Conclusion These results suggest HIV positive OVC living with disabled caregivers had poor linkage to care. The findings highlighted the need to focus attention to the disabilities-led household to promote inclusion and improve access to the HIV services.

Despite the global progress in response to HIV and AIDS, notable challenges remain for children, especially identification, linkage, and retention in HIV care and treatment services. To succeed in pediatric HIV programming requires the linkage and retention of the children in those services over time. This study assessed the level of retention to antiretroviral therapy (ART) and its associated factors among orphans and vulnerable children living with HIV (OVCLHIV) in Tanzania. Data were obtained from the USAID Kizazi Kipya project that collected pediatric ART data from October 2017 to October 2019 in 81 district councils of Tanzania. Community-based volunteers supported the linkage and retention of the OVCLHIV on ART. Analysis of on-ART status was conducted in a cohort of OVCLHIV aged 0–20 years enrolled in the project and monitored for 24 months. OVCLHIV who remained on ART until the end of the follow-up period were referred to as “retained,” otherwise, “not retained”. Multivariable analysis was conducted using logistic regression, adjusting for baseline characteristics. Of the 5,304 OVCLHIV analyzed, the mean age was 13.1 years, 51.5% were female, and 72.2% were living with female caregivers. Their overall rate of retention on ART over the 24 months was 86.7%. Multivariable analysis showed that as the higher frequency of home visit by the project staff increased, the likelihood of retention increased by 8% [adjusted odds ratio (aOR) = 1.08, 95% CI 1.06–1.11, p &lt; 0.001]. Membership in people living with HIV (PLHIV) support groups was associated with a higher likelihood of retention compared to nonmembership (aOR = 3.31, 95% CI 2.60–4.21, p &lt; 0.001). Children in larger family size were 22% less likely to sustain ART (aOR = 0.78, 95% CI 0.72–0.84, p &lt; 0.001). Urban OVCLHIV were 18% less likely to remain on ART than their rural counterparts (aOR = 0.82, 95% CI 0.69–0.98, p = 0.030). Remaining on ART was 49% more likely for OVC in economically better-off households than those in destitute households (aOR = 1.49, 95% CI 1.22–1.81, p &lt; 0.001). Male OVC were 17% less likely to be retained on ART than their female counterparts (aOR = 0.83, 95% CI 0.71–0.99, p = 0.033). Community-based OVC support resulted in a high pediatric retention rate over the 24 months of follow-up. While key enablers of retention were higher frequency of home visits by the project volunteer, participation in PLHIV support groups, and better economic status, large family sizes, urban place of residence, and male gender of the OVC were barriers. This study brings useful evidence to inform strategies for advancing retention of OVCLHIV on ART for their better health outcomes and overall wellbeing.

Introduction: The United States Centers for Disease Control and Prevention (CDC), through U.S. President's Emergency Plan for AIDS Relief (PEPFAR), supports a third of all people receiving HIV care globally. CDC works with local partners to improve methods to find, treat, and prevent HIV and tuberculosis. However, a shortage of trained medical professionals has impeded efforts to control the HIV epidemic in Sub-Saharan Africa and Asia. The Project Extension for Community Healthcare Outcomes (ECHOTM) model expands capacity to manage complex diseases, share knowledge, disseminate best practices, and build communities of practice. This manuscript describes a practical protocol for an evaluation framework and toolkit to assess ECHO implementation.Methods and Analysis: This mixed methods, developmental evaluation design uses an appreciative inquiry approach, and includes a survey, focus group discussion, semi-structured key informant interviews, and readiness assessments. In addition, ECHO session content will be objectively reviewed for accuracy, content validity, delivery, appropriateness, and consistency with current guidelines. Finally, we offer a mechanism to triangulate data sources to assess acceptability and feasibility of the evaluation framework and compendium of monitoring and evaluation tools.Expected impact of the study on public health: This protocol offers a unique approach to engage diverse group of stakeholders using an appreciative inquiry process to co-create a comprehensive evaluation framework and a compendium of assessment tools. This evaluation framework utilizes mixed methods (quantitative and qualitative data collection tools), was pilot tested in Tanzania, and has the potential for contextualized use in other countries who plan to evaluate their Project ECHO implementation.

Abstract Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Background: Cryptococcal meningitis (CM) remains a leading cause of HIV-related meningoencephalitis in African low- and middle-income countries (LMICs), causing 15%-20% of HIV-related deaths. Rapid Diagnostic Tests (RDTs) are powerful tools and key to speeding-up the diagnosis at the bedside, allowing for rapid and targeted treatment, especially in LMICs. For the past 10 years, Cryptococcal Antigen (CrAg) RDTs have a major role in CM management. Driving Reduced AIDS Meningo-Encephalitis Mortality (DREAMM) was a multicenter implementation science study and a capacity-building project to reduce the mortality of HIV-related central nervous system infections (CNS). One of the main DREAMM approaches was to improve the diagnosis of CNS infections at the bedside and in parallel in local laboratories. Within DREAMM, HIV-infected, adult people living with HIV (&gt;18 years old) with suspected CNS infections were recruited in five hospital sites in Cameroon, Malawi, and Tanzania. Objectives Our objective was to evaluate the implementation of CrAg CryptoPS (Biosynex, Illkirch Graffenstaden, France), a new semi-quantitative RDT, in routine care settings in Sub-Saharan Africa. Methods All CrAg CryptoPS performed were compared to the reference CrAg lateral flow assay (Immy®). The evaluation was done by the local research teams in four DREAMM laboratories sites. CrAg CryptoPS's implementation was evaluated in 301 plasma samples and 258 cerebrospinal fluid (CSF) samples from 320 participants (patients diagnosed with cerebral toxoplasmosis did not have a lumbar puncture). In this analysis, the results will be considered in a binary way (positive/negative). Results Between January 2018 and March 2021, 356 participants were prospectively enrolled with suspected HIV-related CNS infections, including CM, tuberculous meningitis, cerebral toxoplasmosis, and bacterial meningitis cases. Cryptococcal meningitis was the leading cause of CNS infections in Malawi and Tanzania with 66.3% (53/80) and 59.6% (59/99) cases respectively, and the second cause in Cameroon with 40.0% (39/90) cases after cerebral toxoplasmosis. In plasma, CryptoPS's sensitivity was 99.23% (95% CI, 0.98-1.01) and specificity was 94.15% (95% CI, 0.91-0.98); positive and negative predictive values were 92.8% and 99.4%, respectively. In CSF, the sensitivity and specificity of CryptoPS were 100% (95% CI, 0.0-0.0), and 99.26% (95% CI, 0.98-1.01), respectively; positive and negative predictive values were both 100%. A low number of false-positives were observed (&lt;4% in plasma and &lt;0.5% in CSF). Conclusion CryptoPS was evaluated in a context of hospitalized patients within a project including all causes of HIV-related CNS infection, not only CM. The sensitivity and specificity of CryptoPS calculated in these preliminary results are promising. Semi-quantitative CryptoPS has the potential to be used to tailor antifungal therapy but further optimizations need to be done prior to large-scale implementation in African LMICs. In addition, future work to determine CrAg antigen titres is planned, in the perspective to optimize treatment of CrAg positive cases who decline lumbar puncture.

Abstract Background The quality of caregiving and the parent-child relationship is critical for early child development (ECD) and has been shown to be modifiable. This study evaluated an ECD project in Tanzania, assessing the effectiveness of radio messaging (RM) alone and a combined radio messaging/video job aids/ECD (RMV-ECD) intervention. Methods This two-arm pre-post evaluation study enrolled a cohort of caregivers of children 0–24 months in four districts of Tabora region, following them for 9 months. ECD radio messages were broadcast on popular stations at least 10 times/day reaching all study districts. In two districts, community health workers (CHW), trained in UNICEF’s Care for Child Development package, used ECD videos in home- and facility-based sessions with caregivers. We used McNemar’s testing (pre-post pairs) within intervention group to describe how the intervention was associated with change in five outcomes: ECD knowledge, early stimulation, father engagement, responsive care, and environment safety. Logistic regression was used to describe the relative benefits of the combined intervention package (RMV-ECD) compared to radio messaging (RM). Results In the RMV-ECD arm, all outcomes at endline except environment safety significantly improved after the intervention with the largest change seen in ECD knowledge (35.8% increase, p < .0001) and the smallest in father engagement (6.7%, p = .015). In the RM arm, ECD knowledge (5.7%, p = .031) and environment safety (18.1%, p = <.0001) improved. High measures of parenting stress were associated with lower likelihood of having good ECD knowledge (AOR 0.50, 95%CI: 0.35, 0.71), father engagement (AOR 0.72, 95%CI: 0.52, 0.99) and responsive care (AOR 0.31, 95%CI: 0.18, 0.54). Conclusions An intervention that includes mass media, educational video content and CHWs who counsel caregivers in their homes and health facilities was associated with significant improvements in ECD parenting knowledge and behaviors but a relationship with responsive care could not be established. The less costly mass media-only intervention was associated with improved parenting knowledge and household environment safety. Parenting interventions targeting young children could be improved by incorporating more messaging and caregiver coaching in managing parental stress. Trial registration NCT05244161 (17/02/2022); retrospectively registered with the US National Institutes of Health ClinicalTrials.gov.

Abstract 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.

Abstract S7.1 Update in management of fungal infection in adult hematology, September 23, 2022, 10:30 AM - 12:00 PM Background: Bedside point-of-care (POC) testing, with parallel laboratory testing, represents a unique opportunity to improve and speed up the diagnostic workup of people living with HIV with suspected CNS infection in resource-limited settings. Objectives To assess the agreement between POC tests for Cryptococcus neoformans, Mycobacterium tuberculosis, and Streptococcus pneumoniae performed at the bedside and in the routine laboratory, in African low- and middle-income countries (LMICs). Methods From January 2018 to March 2021, the following POC tests were performed in parallel at the bedside and in the routine laboratory: Cryptococcal antigen lateral flow assay (CrAg LFA, Immy) in blood and cerebrospinal fluid (CSF), tuberculosis lipoarabinomannan (TB-LAM, Alere) in urine, and, where indicated, pneumococcal antigen (Streptococcus pneumoniae (SP), Biosynex) in CSF. Participants: HIV-infected adults (&gt;18 years old) suspected of CNS infection. Setting: The prospective multicenter DREAMM project (Driving Reduced AIDS Meningo-Encephalitis Mortality) in five hospital sites in Cameroon, Malawi, and Tanzania. Primary outcome: Cohen's kappa statistic of agreement between the results of POC tests obtained at the bedside and the routine laboratory. Results The study included 356 consecutive participants (mean age 39.5 +/- 10 years; 68.7% ART-experienced; 46.3% male; median CD4 count 75/mm3; abnormal mental status 75%). In total, 148/355 (41.7%) participants had positive bedside CrAg in blood, 140/315 (44.4%) positive bedside CrAg in CSF, 64/339 (18.9%) positive bedside TB-LAM in urine, and 10/175 (5.7%) positive bedside SP in CSF. Kappa statistics evaluating agreement between bedside and laboratory test results were: 0.98 [95% confidence interval (CI) 0.96-1.00; n = 347] for blood CrAg, 0.99 (95%CI, 0.98-1.00; n = 307) for CSF CrAg, 0.92 (95% CI, 0.87-0.98; n = 330) for urinary TB-LAM, and 0.68 (95%CI, 0.40-0.96; n = 34) for CSF SP. Conclusions: Bedside POC tests for Cryptococcus spp. are highly reliable and can be safely performed in parallel to laboratory testing to expedite targeted treatment in people living with HIV with suspected CNS infection in African LMICs. Other bedside POC tests need further evaluation before large-scale implementation.

There is growing recognition of the importance of maternal mental health for the well‐being of both mothers and children. In addition to being of importance to public health concern on its own right, maternal depression could impede women's capacity to provide quality care to their children. However, the covariates of maternal depression, especially in low‐resource settings, are not well‐understood. In particular, the role of gender equity in maternal depression needs further investigation. Therefore, we sought to understand covariates associated with maternal depression in a rural farming community in Tanzania. We hypothesized that greater food insecurity and gender inequity in a household would be positively correlated with maternal depression.The Singida Nutrition and Agroecology Project (SNAP‐Tz) is a participatory agroecology and nutrition intervention with rural farmers with children <1 y in Singida, Tanzania. As part of the baseline assessment in February 2016, women from the 587 participating households were asked about a range of socio‐demographic, agricultural, health, and nutrition topics. The Center for Epidemiologic Studies Depression Scale (CES‐D, range: 0–65) was used to measure maternal depression. The Household Food Insecurity Access Scale (HFIAS, range: 0–27) was used to measure household food insecurity. Gender equity was indicated by a summed score of husband's help with household chores (range: 0–7), women's (dis)satisfaction with leisure time, and women's experience with domestic violence. Social support was measured using the Perceived Social Support scale (PSS, range:0–40). Multivariate linear regression models of depression were then built using backwards stepwise elimination and include village fixed effects. Standard error estimates considered clustering at the village level.CESD scores indicated probable depression (CES‐D≥17) among 69.2% of women. Probable major depression (CES‐D≥26) was indicated for 42.5% women. The mean HFIAS of 14.0 (sd: 7.9) suggested that food insecurity was also very common. In multivariate models of depression, food insecurity score was positively and strongly correlated with maternal depression score (β=0.62, p=0.000). Having experienced domestic violence was positively associated with increased maternal depression score (β=4.29, p=0.004). Greater help from husband and satisfaction with amount of leisure time were negatively correlated with maternal depression score (β=−0.65, p=0.011 and β=−3.00, p=0.000, respectively).In sum, the prevalence of maternal depression is very high in Singida, Tanzania. While some covariates were not modifiable, several important ones were, including food insecurity, unbalanced household division of task, and domestic violence. Causality should be further explored, but these data suggest important and novel domains in which to intervene to improve maternal mental health.Support or Funding Information(1) Collaborative Crop Research Program, McKnight Foundation. (2) Sera L Young was supported by the National Institutes of Health (K01 MH098902) Household characteristics of participants of Singida Nutrition and Agroecology Project, February 2016 Mean (sd) or n(%) Range HFIAS, mean (sd)1 14.02 (7.89) 0 – 27 Age, mean (sd) 29.59 (7.51) 15.7 – 48.1 Education (years), mean (sd) 5.98 (2.68) 0 – 11 Marital status, n(%) Monogamous married 495 (84.9%) Polygamous married 46 (7.9%) Separated/divorced/widowed 26 (4.5%) Never married 16 (2.7%) Household dependency ratio, mean (sd)2 1.56 (1.03) 0.1 – 7 Social support score, mean (sd)3 34.36 (8.36) 0 – 40 Husband drink more than 3x/week, n (%) 182 (32.8%) Proportion of asset owned by woman, mean (sd) 1.29 (1.66) 0 – 10.5 Husband help score, mean (sd) 2.47 (2.06) 0 – 7 Satisfaction with leisure time, mean (sd) 1.41 (1.06) −2 – 2 Acceptance towards domestic violence, mean (sd)4 4.09 (2.52) 0 – 7 Experience with domestic violence, n (%) 186 (32.2%) Coates, J., Swindale, A. & Bilinsky, P. Household Food Insecurity Access Scale (HFIAS) for measurement of Food access: indicator guide. (Food and Nutrition Technical Assistance (FANTA), 2007). Population's Division, U.N. World Population Prospects: The 2006 Revision, vol. I: Comprehensive Tables. (2007). Antelman, G. et al. Predictors of HIV‐1 serostatus disclosure: a prospective study among HIV‐infected pregnant women in Dar es Salaam, Tanzania. Aids 15, 1865–1874 (2001). DHS Questionnaire Modules (English, French). Available at: http://dhsprogram.com/publications/publication‐dhsqm‐dhs‐questionnaires‐and‐manuals.cfm Bivariate and multivariate linear regression models of maternal depression score bivariate β (p) multivariate, all β (p) multivariate, parsimonious β (p) HFIAS 0.75 (0.00)*** 0.62 (0.00)*** 0.62 (0.00)*** Social support score −3.36 (0.02)** −2.97 (0.07)* −3.38 (0.02)** Husband drink alcohol more than 3x/week 4.19(0.00)*** 1.12 (0.27) Women drink alcohol more than 3x/week 3.08(0.15) Proportion of asset owned by woman 1.43(0.00)*** 0.42 (0.32) Husband help score −1.35(0.00)*** −0.67 (0.01)** −0.65(0.01)** Satisfaction with leisure time −4.41 (0.00)*** −3.03 (0.00)*** −3.00 (0.00)*** Attitude towards domestic violence 0.64(0.01)** 0.18 (0.26) Experience with domestic violence 4.26 (0.00)*** 4.09 (0.00)*** 4.30(0.01)*** Age 0.20 (0.02)** 0.02 (0.86) Education (years) −0.44 (0.03)** −0.69 (0.76) Marital status Married, monogamous (comparison) (comparison) (comparison) Married, polygamous −2.07 (0.32) −1.63(0.33) −1.04 (0.52) Separated/divorced/widowed 9.79 (0.00)*** 5.32 (0.06)* 6.70 (0.01)** Never married −0.08 (0.98) −0.53(0.81) −0.54 (0.80) Asset index deciles −0.68 (0.00)*** 0.04 (0.85) Household dependency ratio 0.93 (0.08)* −0.40 (0.42) Whether women born in the village −(0.19 (0.87) Tribe (comparison) Nyaturu 1.07 (0.78) Nyiramba 4.98 (0.27) Other (comparison) Religion 0.77 (0.54) Muslim 4.57 (0.73) Christian −5.43 (0.69) Traditional African Other N 566 572 Adjusted R‐2 0.369 0.364

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