Management and Development for Health

<title>Abstract</title> <bold>Background</bold> Despite substantial achievements in scaling up the Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Tanzania, new pediatric HIV infections persist, particularly during the postnatal period. Understanding the incidence of infection and the sociocultural factors influencing transmission is crucial to achieving the elimination of mother-to-child transmission (eMTCT) goals by 2030. <bold>Methods:</bold> A mixed-methods convergent parallel design was used. Quantitative data were extracted from a retrospective cohort of 797 HIV-exposed infants and their mothers enrolled in PMTCT services in the Manyara Region between 2019 and 2023. Incidence rates were computed per 1000 person-months. The qualitative component involved 26 mothers of HIV-exposed infants and 5 healthcare providers interviewed using a grounded theory approach to explore sociocultural, behavioural, and systemic factors influencing postnatal HIV transmission. Thematic analysis was conducted using NVivo 12. <bold>Results:</bold> Among 797 HIV-exposed infants, 17 (2.1%) tested HIV-positive by 18 months, giving an incidence rate of 1.92 per 1,000 person-months (95% CI: 1.19-3.09). Most infections occurred between 3 and 15 months postpartum. Four qualitative themes explained persistent transmission: (1) stigma and non-disclosure undermining adherence, (2) traditional and economic influences on feeding, (3) health system challenges, and (4) peer and community support as enablers. <bold>Conclusion:</bold> Despite high PMTCT coverage, postnatal HIV infections persist in Manyara Region. The incidence remains low but concentrated during the breastfeeding period. Sociocultural and systemic barriers continue to compromise ART adherence and safe infant feeding. Strengthening community-based adherence support and addressing stigma and traditional practices are critical to sustain eMTCT progress.

Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of both healthcare-associated and community-acquired infections, characterized by limited treatment options and substantial morbidity and mortality, particularly in low- and middle-income countries such as Tanzania. However, genomic data which provides valuable insights into the pathogen’s genetic landscape, remains scarce. This study utilized whole-genome sequencing (WGS) to examine local molecular epidemiological profiles of 14 MRSA isolates isolated from blood, urine, and pus samples during (n=6; June 2019 – June 2020) and after (n=8; March – August 2023) the implementation of the National Action Plan on Antimicrobial Resistance (NAP-AMR) in Mwanza, Tanzania. All isolates belonged to sequence type 8 (ST8), and 92.9% (13/14) were spa type t1476. Phenotypic and genotypic antimicrobial resistance results were consistent for all antibiotics tested, with the exception of tetracycline. Pairwise single-nucleotide polymorphism (SNP) analysis revealed genetic diversity, with SNP differences ranging from 4 to 140. Maximum likelihood phylogeny analysis based on SNP data identified two closely related MRSA pairs, one from multiple wards and the other confined within the same ward of the same hospital. The WGS of MRSA isolates revealed that all MRSA isolates belonged to ST8 with substantial genetic diversity and phylogenetic analysis revealed two closely related MRSA pairs, suggesting potential transmission events. These findings highlight the importance of genomic surveillance for uncovering MRSA transmission patterns and guiding infection prevention efforts.

The COVID-19 pandemic resulted in significant disruptions to HIV services globally. The impact of COVID-19 on mental wellbeing and HIV outcomes among adolescents with HIV (AWH) in Tanzania is unknown. We assessed the burden of generalized and COVID-19 related anxiety and associations with adherence to HIV care and treatment and viral load suppression (VLS) among AWH during the peak of the COVID-19 pandemic in Tanzania.MethodsThis cross-sectional study was conducted among AWH aged 15–19 years attending 10 clinics in Dar es Salaam from April-December 2022. Trained RAs administered a questionnaire to study participants which included questions on Generalized Anxiety Disorder (GAD), COVID-19 related anxiety, and other psychosocial and physical health and support measures such as self-management and quality of physical health. HIV clinic visit adherence, viral load and sociodemographic data were abstracted from patient health records. Multivariable quasibinomial and logistic regression models examined associations of Generalized and COVID-19 related anxiety with visit adherence (attending all scheduled visits (+/- 3 days) for 12 months prior to September 2019) and HIV virologic suppression (HIV VL < 50 copies/mL), respectively. Data were analyzed using R software.ResultsFive hundred sixty seven AWH (48% male, median time on ART 125 (interquartile range (IQR) 79 months)) were included in this analysis. Over half (53%) attended at least 75% of their scheduled clinic visits, and 78% were HIV virologically suppressed (< 50 copies/mL). The median GAD and COVID-19-related anxiety scores were 1 [IQR: 4], and 25 [IQR: 31], respectively. Only 2% scored moderate-severe generalized anxiety (score 10–21). We found no significant associations between COVID-19 related anxiety [adjusted odds ratio (AOR) = 1.00 (95% CI 0.90, 1.00)] or GAD [AOR = 1.03 (0.99, 1.07)] and visit adherence. Higher GAD was inversely associated with VLS [AOR: 0.90 (95% CI 0.81, 0.99]. Female gender [AOR = 1.67 (95% CI 1.05, 2.66)], higher quality of physical life [AOR 1.17 (95% CI 1.04, 1.32)] and living with parents [AOR = 1.61 (1.00, 2.57)] were significantly associated with VLS.ConclusionsLow levels of generalized and COVID-19 related anxiety were reported among Tanzanian AWH. Scaling up integrated screening and management of GAD into HIV care for AWH could improve VLS among this population.

BackgroundDespite significant progress in HIV prevention and treatment, uptake of evidence-based interventions among adolescents and young adults (AYA), particularly in low- and middle-income countries (LMICs), remains low. Implementation research can optimize strategies to enhance reach, uptake, and equitable access to these innovations. The Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource-Constrained Settings Implementation Science Network (PATC3H-IN) leverages implementation science to strengthen the delivery and sustainability of evidence-based HIV prevention and care for AYA across six countries in sub-Saharan Africa. This paper outlines PATC3H-IN’s goals, summarizes the implementation science (IS) data that will be collected, and highlights the advantages of research networks in advancing science.MethodsThe PATC3H-IN builds on the existing PATC3H consortium to advance IS research targeting AYA in LMICs. The PATC3H-IN comprises eight Clinical Research Centers (CRCs) located in Nigeria, Uganda, Malawi, South Africa, Zambia, and Tanzania. Representatives from the CRCs were asked to provide information on the IS components of their proposed studies, including details on study populations, IS frameworks, outcomes, and strategies, mechanisms of change, effectiveness outcomes, and documentation of intervention adaptations. The reports from the CRCs were compared to identify opportunities for advancing science across study sites.ResultsThe PATC3H-IN studies will enroll AYA aged 12–24 years, with some emphasizing key subpopulations, namely AYA living with HIV, sexual and gender minorities, and adolescent girls and young women. All PATC3H-IN studies will be guided by one or more implementation science frameworks and theories, with the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework most frequently cited (n = 4/8). Across the CRCs, 54 unique implementation strategies will be used, with community engagement being the most common. Several studies will document intervention adaptations, and all studies will collect a set of common data elements to facilitate secondary data analyses across projects.ConclusionsThe PATC3H-IN represents a significant contribution to advancing HIV prevention and care research for AYA in resource-constrained settings. Findings from PATC3H-IN will extend our understanding of IS in sub-Saharan Africa, a region particularly burdened by HIV, and for AYA who are traditionally under-represented in IS research.Clinical trial numberNot Applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24995-0.

BackgroundDespite Antiretroviral Therapy (ART) progress, Human Immunodeficiency Virus (HIV) remains a major issue in Tanzania (4.65% prevalence). World Health Organization (WHO) introduced Enhanced Adherence Counselling (EAC) in 2016 to improve adherence, but many patients still struggle to suppress viral load after EAC.ObjectiveThis study evaluated the effectiveness of Enhanced Adherence Counselling for people living with HIV with unsuppressed viral load in Ilala, Dar es Salaam.MethodsA cross-sectional study was conducted in eight Ilala Care and Treatment Clinic (CTCs), selected using multistage sampling based on patient volume, for this study, patient volume was defined as the number of CTC clients, with high-volume facilities referring to those serving more than 1000 patients. Records of patients with unsuppressed viral load (≥1000 copies/mL) in 2023 were reviewed. Data were analysed in STATA SE 14 using descriptive, ordered, and multivariable logistic regression, with significance set at p < 0.05.ResultsOut of 361 people living with HIV with high viral load, 86.2% enrolled in EAC and 70.9% completed it. Among completers, 68.4% achieved viral suppression. Viral load suppression was significantly associated with age and initial viral load, with younger individuals being less likely to achieve suppression, while those with lower initial viral load (VL) had a higher likelihood of suppression. Median EAC initiation time was 27 days, with most completing it within 3months.ConclusionThe study reveals gaps in transitioning people living with HIV with unsuppressed viral load to EAC enrolment and completion, undermining EAC's effectiveness. While 68% viral load suppression among those who completed EAC is promising, low enrolment and retention into EAC may impact overall success. Further research is needed to explore barriers to full participation into EAC sessions and its impact on viral load suppression.

Infants born to pregnant women living with HIV (WLHIV) are at greater risk for morbidity and mortality and may also have poorer developmental outcomes as compared with infants who are not exposed to HIV. Nutrition interventions in pregnancy may affect developmental outcomes. This study evaluated the effect of maternal vitamin D supplementation on infant development outcomes. We conducted a secondary analysis of a randomised, triple-blind, placebo-controlled trial of maternal vitamin D supplementation from June 2015 to October 2019. Antenatal care clinics in Dar es Salaam, Tanzania. Pregnant WLHIV and their offspring. Daily 3000 IU vitamin D3 or placebo supplements taken during pregnancy and lactation. Infants were assessed for cognitive, language and motor development at 1 year of age with the Caregiver Reported Early Development Instruments (CREDI). A total of 2167 infants were eligible, and 1312 of them completed CREDI assessments at 1 year of age. Vitamin D supplementation had no effect on overall CREDI z-scores (standardised mean difference (SMD) 0.03, 95% CI -0.09, 0.15, p value 0.66). There was also no evidence of a difference between vitamin D and placebo groups in language (SMD 0.06, 95% CI -0.08, 0.21, p value 0.40), motor (SMD 0.02, 95% CI -0.09, 0.14, p value 0.69) or cognitive domain z-scores (SMD 0.05, 95% CI -0.08, 0.17, p 0.48). Maternal vitamin D supplementation during pregnancy and lactation did not affect infant development outcomes. ClinicalTrials.gov identifier: NCT02305927.

IntroductionTanzania declared a Marburg Virus Disease (MVD) outbreak on March 21, 2023, reporting nine cases and six deaths (case fatality rate (CFR) 66.7%). Detection began when a Community Health Worker (CHW) reported unexplained illness via the electronic EBS (e-EBS) system, triggering a national outbreak response. This study documents the Early Warning, Alert and Response (EWAR) interventions carried out during the MVD outbreak response in the Kagera region to identify strengths and bottlenecks for strengthening future outbreak preparedness and response efforts.MethodWe documented EWAR interventions using retrospective surveillance document review. MVD outbreak detection and reporting timeliness were compared with Tanzania’s EBS indicators and the 7-1-7 target. Surveillance interventions included additional staff deployment, equipment addition, and tool adoption. Community sensitization efforts utilized Swahili-translated informational cards to facilitate early detection and reporting of signals through multiple channels, including the 199-hotline number, EBS desk numbers and via e-EBS and verified using the standard case definition (SCD). Signals were compiled in Microsoft Excel, where descriptive analysis using frequencies to show trends was conducted. Suspected MVD cases were sent for laboratory confirmation.FindingsOn March 15, 2023, a CHW reported a signal in the e-EBS system within 24 hours. However, a community member and HCWs missed unusual signs of the MVD index case. Five additional members were deployed to support data management using the equipment provided, including three laptops, ten smartphones, and adapted tools. A total of 6,260 informational cards were distributed during community sensitization; 176 MVD signals were reported, where 48 (27.3%) met the SCD, and 37 were sent for laboratory confirmation, of which 2.7% tested positive for the virus. Most signals, 107 (60.8%), were reported in April.Conclusions and recommendationsThe government should adopt the 7-1-7 target and strengthen community and health facility EBS through ongoing mentorship for EWAR.

SummarySustained engagement in HIV care and adherence to antiretroviral therapy (ART) are essential for achieving the UNAIDS “95-95-95” targets. Despite increased ART access, disengagement from care remains a significant issue, particularly in sub-Saharan Africa. Traditional machine learning (ML) models have shown moderate success in predicting care disengagement, which would enable early intervention. We develop an enhanced large language model (LLM) fine-tuned with electronic medical records (EMRs) to predict people at risk of disengaging from HIV care in Tanzania and to provide interpretative insights into modifiable risk factors.MethodsWe developed a novel AI model by enhancing a pre-trained LLM (LLaMA 3.1, an open-source pre-trained LLM released by Meta) using routinely collected EMRs from Tanzania’s National HIV Care and Treatment Program from January 1, 2018, to June 30, 2023 (4,809,765 records for 261,192 people) to identify people at risk of disengaging from HIV care or developing adverse outcomes. Outcomes included risk of ART non-adherence, non-suppressed viral load, and loss to follow-up. Models were evaluated internally (Kagera region) and externally (Geita region), with performance compared against state-of-art ML models and zero-shot LLMs. Additionally, a team of HIV physicians in Tanzania assessed the LLM’s predictions along with LLM provided justifications for a subset of patient records to evaluate their clinical relevance and reasoning.FindingsThe enhanced LLMs consistently outperformed the supervised ML model and zero-shot LLMs across all outcomes in both internal and external validation datasets. When focusing on the 25% of PLHIV predicted as most likely to lost-to-follow-up (LTFU), the model correctly identified 78% (2,515 of 3,224) of people living with HIV (PLHIV) genuinely at risk in internal validation and 73% (7,105 of 9,733) in external validation. Attention score analysis indicated that the enhanced LLM focused on keywords such as gaps in follow-up care and ART adherence. The human expert evaluation showed alignment between clinician assessments and the LLM’s predictions in 65% of cases, with experts finding the model’s justifications reasonable and clinically relevant in 92.3% of aligned cases.InterpretationIf implemented in HIV clinics, this LLM-based AI model could help allocate resources efficiently and deliver targeted interventions, improving retention in care and advancing the UNAIDS “95-95-95” targets. By functioning like a clinician–analyzing patient summaries, predicting risks, and offering reasoning–the enhanced LLM could be integrated into clinical workflows to complement human expertise, facilitating timely interventions and informed decision-making. If implemented widely, this human-AI collaboration has the potential to improve health outcomes for people living with HIV and reduce onward transmission.FundingThe study was supported by a grant from the US National Institutes of Health (NIH): NIH NIMH 1R01MH125746.

Background:Globally about 9 million neonates are diagnosed with birth asphyxia yearly. In Tanzania 40.6% of all neonatal deaths are attributed to birth asphyxia. There is scarcity of evidence on predictors of in-hospital survival among asphyxiated neonates in Tanzania, therefore study aimed to determine trends and predictors of survival among neonates who sustained birth asphyxia at Kilimanjaro Christian Medical Center, Northern Tanzania.Method and materials:This was a hospital-based retrospective cohort study, conducted at Kilimanjaro Christian Medical Center among 7,783 admitted asphyxiated neonates from 2000 to 2022. The predictors of survival were determined by using the Weibull survival regression model and the statistically significant results were declared at a p-value of <.05. Data were managed and analyzed using Stata 18.Results:Overall finding from this study showed significant increase in the trends of survival from birth asphyxia from 2000 to 2022, from 68% to 80% respectively (p-value < .001). The median survival time was 4 days (95% CI:3.0-6.0). Overall survival rate was 195.32/1000 person-days-of observation (95% CI: 190.57, 200.18). Antenatal care (ANC) stages (AHR: 0.74; 95% CI: 0.62-0.89), gestation age (AHR: 0.81; 95% CI: 0.76-0.86), birth weight (AHR: 1.19; 95% CI: 1.12-1.26), mode of delivery (AHR: 1.69; 95% CI: 1.60-1.78), Aminophylline (AHR: 1.56; 95% CI: 1.52-1.60), oxygen (AHR: 1.32; 95% CI: 1.23-1.42), resuscitation (AHR: 1.32; 95% CI: 1.24-1.42) and HIE(AHR: 1.85; 95% CI: 1.79-1.91) were all independent significant predictors of survival.Conclusion:There is a need for health professionals to remain vigilant and promptly assess and stabilize the airway, breathing, and circulation, initiate resuscitation, provide oxygen, administer medications such as aminophylline to neonates who are diagnosed with birth asphyxia.

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