Ministry of Health, Community Development, Gender, Elderly and Children

Abstract Background Routine viral load monitoring is essential for assessing treatment effectiveness and for achieving global HIV treatment targets. Although viral load testing capacity has expanded across sub-Saharan Africa, gaps remain in monitoring coverage and equitable treatment outcomes. National-level analyses examining viral load uptake, suppression, and geographic variation in Tanzania remain limited. Methods We conducted a retrospective observational analysis using routinely collected HIV programme data from the National AIDS and Sexually Transmitted Infections Control Programme (NASHCoP) Care and Treatment Clinic database. The analysis included 70,000 individuals receiving antiretroviral therapy between 2017 and 2021 across all regions of mainland Tanzania. Viral load uptake was defined as the presence of at least one documented viral load test during the observation period. Viral suppression was defined as a viral load result <1,000 copies/mL among individuals with available test results. Descriptive analyses summarized demographic and treatment characteristics, while multivariable logistic regression models identified predictors of viral load uptake and viral suppression. Geographic variation in programme performance was examined at regional and district levels using choropleth maps. Results Among 70,000 individuals included in the analysis, 49,820 (71.2%) had at least one documented viral load result. Among those tested, 44,187 (88.7%) achieved viral suppression. Viral load uptake was lowest among young adults and slightly lower among males than females. Viral suppression was lower among children and adolescents than among older age groups. Individuals receiving dolutegravir-based regimens demonstrated higher viral suppression than those receiving NNRTI-based regimens. Substantial geographic heterogeneity was observed, with viral load uptake varying across regions and districts. Several districts characterized by mobile populations and seasonal migration patterns demonstrated comparatively lower monitoring coverage. Conclusions Although viral load monitoring coverage and suppression levels among those tested were relatively high, important gaps remain in testing uptake and geographic equity. Adolescents, young adults, and populations in certain districts experience lower monitoring coverage and treatment outcomes. Strengthening viral load monitoring systems, expanding youth-responsive HIV services, and addressing geographic disparities will be important for sustaining progress toward national and global HIV treatment targets.

Globally, 24 measles virus genotypes have been detected, and these genotypes have been classified into eight clades based on 450 nucleotides of the C-terminal region of the nucleoprotein gene. Genotype B3 is predominant in Africa, but there are limited data from Tanzania since the introduction of the second dose of measles-containing vaccine in 2014. A total of 129 nasopharyngeal samples and corresponding sera were collected during measles outbreaks between 2022 and 2024. Viral RNA was extracted from nasopharyngeal swabs prior to RT-qPCR and sequencing of a 450-nucleotide segment of the nucleoprotein (N) gene. Out of 129 nasopharyngeal samples, 73 (56%) were successfully amplified and identified as endemic measles virus genotype B3. Nine distinct sequence identifiers were detected, with seven reported for the first time in the MeaNS database. All the Tanzanian B3 sequences were closely related and clustered with genotype B3, similar to those reported from Kenya, Ethiopia, Rwanda, Uganda, Burundi, and South Africa. On multivariate analysis, only inpatient admission status (p = 0.014) and positive measles IgM (p = 0.003) were found to be associated with positive measles RT-qPCR. Our results indicate that genotype B3 remains endemic in Tanzania and is closely related to other genotype B3 reported globally, indicating its high stability and transmissibility.

While universities in Tanzania have consistently mobilised research funds to drive sustainable development, the long-term sustainability of these projects is often hindered by fragmented management approaches. This study aimed to institutionalise a robust mechanism for managing research-based project funds by developing an integrated framework. Using a case study of a prominent research-intensive university in Tanzania, selected for its extensive experience in administering diverse research portfolios, the study employed a descriptive research design. A mixed-methods approach was adopted, utilising both quantitative and qualitative data to ensure triangulation and a comprehensive understanding of the phenomenon. Data were collected from a sample of 65 respondents through questionnaires and semi-structured interviews. Quantitative data were analysed using SPSS, while qualitative insights were subjected to thematic analysis to align with the research objectives. The findings reveal a high level of institutional readiness to adopt and support an integrated framework to enhance research project performance. Consequently, the study recommends that government bodies and policymakers engage in effective stakeholder consultation when rectifying regulations. Such an approach ensures informed decision-making and fosters an environment conducive to sustainable research management in the higher education sector.

Integrating digital technologies in clinical dentistry training is increasingly recognized as essential for modernizing competency-based education. However, structured frameworks for digital technology adoption in dental training are lacking, particularly in resource-limited settings such as Tanzania. This study assesses digital technology integration in clinical dentistry training and proposes a structured framework to enhance competency-based education. A mixed-methods research design was employed, integrating quantitative and qualitative approaches. Data were collected from dental students, educators, graduates, and policymakers through structured questionnaires, semi-structured interviews, and focus group discussions. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were subjected to thematic analysis. The study found that while 57% of institutions had access to electronic health records (EHR) systems and 25% had digital imaging tools, advanced digital technologies such as AI-powered diagnostics and teledentistry platforms were absent. Significant digital competency gaps were identified, with only 27.5% of students and graduates rating their proficiency as "good" or "very good." Faculty training remained limited, with only 20% of public institution faculty receiving digital training. Key barriers to digital integration included financial constraints, inadequate infrastructure, and lack of structured policies. The study highlights the need for a structured digital integration framework in Tanzanian dental training institutions. The proposed framework emphasizes institutional readiness, faculty training, infrastructure development, and student competency enhancement. Implementing these measures will enhance digital literacy and ensure that graduates are equipped for modern dental practice. Not applicable.

Abstract Background In Tanzania, unmet need for family planning (FP) presents a major challenge for preventing unintended pregnancies and their associated maternal and child health morbidities. Understanding factors associated with unmet need for FP is critical for effective policy formulation and improving maternal and child health outcomes. Therefore, this study aimed to determine the prevalence and associated factors of unmet need for FP among women in sexual unions in Tanzania. Methods An analytical cross-sectional study was conducted using secondary data from the 2022 TDHS. A generalized logistic regression model was used to determine factors associated with unmet need for FP. Odds ratio and 95% confidence Intervals (CI) were computed to estimate the strength and magnitude of association. Statistical significance was set at p < 0.05. Results The prevalence of unmet need for family planning was 20.7% (95%CI: 18.9–22.6). For the factors, women aged 25–34 years (AOR = 0.47, 95%CI: 0.35–0.63) and those aged 35–49 years (AOR = 0.37, 95%CI: 0.25–0.54) had lower odds of unmet need for FP than their counterparts. Women who were working had lower odds of unmet need for FP compared to their counterparts (AOR = 0.71, 95%CI: 0.56–0.87). The increase in the number of children was associated with a higher likelihood of unmet need for FP (AOR = 1.30, 95%CI: 1.22–1.38). Women with a history of pregnancy termination were 26% less likely to have unmet need for FP than their counterparts (AOR = 0.74, 95%CI: 0.53–0.97). Conclusion The established findings of this study indicate that factors such as age, parity, and employment status significantly influence the likelihood of unmet need, with younger and non-working women often facing greater challenges. Addressing this public health challenge necessitates a concerted and targeted approach, focusing on enhancing the accessibility and quality of family planning services, particularly for rural and younger populations.

BackgroundEnsuring the widespread availability and accessibility of anticancer medications is crucial. This aligns with the World Health Organization's recommendation to achieve a coverage of over 80%.ObjectiveThis study aimed to analyse anticancer procurement data to identify utilisation patterns and expenditures, aiding future planning and investment in oncology pharmacy services. The findings can enhance resource allocation, ensuring better availability and accessibility for patient care.MethodologyThe retrospective cross-sectional descriptive study meticulously examined procurement, prescribing, and dispensing records at Benjamin Mkapa Hospital (BMH).ResultsThe expenses linked to anticancer medications have markedly escalated, experiencing successive increases of 5.74%, 16.12%, 24.10%, and 17.73% in 2020, 2021, 2022, and 2023, respectively. Notably, Bevacizumab, Rituximab, Trastuzumab, Docetaxel, Paclitaxel and Goserelin (3.6 mcg) were the most frequently utilised anticancer medications, accounting for over 64% of total drug dispensation from 2020 to 2023. Concurrently, the availability of essential anticancer treatments significantly improved, rising from 54% in 2020 to 84% in 2022 and 2023. Over the four-year period (2020-2023), anticancer drugs comprised a mere 2.8% (580 out of 20,542) of all prescriptions, predominantly for patients aged 46 and above, with 85% covered by health insurance. Breast, prostate, and stomach cancers stood out as the most prevalent, representing over 40%, 30%, and 5% of all reported cases, respectively.ConclusionThe oncology pharmacy department at BMH improved anticancer drug availability from 54% to 84% over four years, primarily treating breast, prostate, and stomach cancers with Taxane and ACT regimens.

BackgroundGlobally, health systems focus on improving the quality of healthcare services through policy changes. Sub-Saharan African countries have been enacting reforms to strengthen their primary healthcare and referral systems including devolution of authority to healthcare facilities. Devolving health facility financing to primary healthcare providers is a crucial strategy to enhance autonomy in planning, management and resource utilization. In Tanzania, this strategy is called Direct Health Facility Financing (DHFF), and is envisaged to impact on the quality of health services in primary healthcare facilities. This study aimed to determine the effect of DHFF on quality of health services after 3 years of its implementation.MethodsThis study employed a before–after noncontrolled analysis of the quality scores by considering compliance of public primary health facilities with healthcare quality standards by using star rating assessment data before and after DHFF implementation. Quality scores were established by performance of service areas, namely organization of services, emergencies and referrals; infrastructure, infection prevention and control; clinical services; and clinical support services. Distribution normality of compliance scores was determined through the Shapiro–Wilk test for normal data and were observed to be non-normal. Median change in quality compliance scores were established, Wilcoxon matched pairs sum rank tests estimated probabilities of the change (α = 0.05) and Cohen’s d estimator (d) calculated the effect size of DHFF.FindingsThis study involved 1216 primary healthcare (PHC) facilities from 10 regions of Tanzania’s mainland, the majority of which were dispensaries (88.8%) and rurally located (86.3%). Findings showed significant positive median change in compliance with quality standards from 0.53 to 0.57 (P < 0.001). However, effect size of DHFF as an intervention is small (d = 0.27).ConclusionsDirect health facility financing has impacted a small change in quality of health services. As evidenced by several studies, challenges regarding fidelity to its implementation process including lower spending on health commodities, dependence on and delayed disbursement of Health Sector Basket Funds (HSBF), poor facilities’ planning capacity and shortage of human resources for health must be addressed for it to yield its intended outcome.

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.

Abstract Background The introduction of HIV self-test (HIVST) kits offered a significant advancement in fighting HIV/AIDS, particularly for vulnerable populations. Despite its potential, self-testing uptake varies. In Tanzania, where HIV prevalence among women remains a concern, this study aimed to identify the socio-demographic and behavioural predictors of self-testing for effective prevention. Methods We conducted a cross-sectional analysis using data from the 2022 Tanzania Demographic and Health Survey. Data management and analysis were performed using Stata 18.5. Given the survey’s complex design, a multilevel mixed-effect logistic regression model was used to identify predictors of HIVST kit use, with results presented as adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Statistical significance was set at p &lt; 0.05. Results The prevalence of HIVST kit usage among women of reproductive age in Tanzania was 3.2% (95% CI: 2.8–3.7%). Individual-level factors associated with a higher likelihood of HIV self-test kit use included age, 25–34 (AOR = 1.93, 95%CI: 1.43–2.60) and 35–49 (AOR = 1.60, 95%CI:1.43–2.26), secondary/higher education (AOR = 2.77, 95%CI: 1.57–4.85), belonging to the rich wealth quintile (AOR = 2.69, 95%CI: 1.52–4.77), internet use (AOR = 3.04, 95%CI: 2.04–4.52), awareness of sexually transmitted infections (STIs) (AOR = 2.03, 95%CI: 1.21–3.42), and one or higher number of sexual partners. At the community level, geographical zone was associated with increased odds of use, while living in a high-poverty community (AOR = 0.52, 95%CI: 0.30–0.89) was associated with a lower likelihood of HIV self-test kit use. Conclusion This study reveals a low uptake of HIVST kits among women of reproductive age in Tanzania, highlighting the influence of both individual-level factors, such as age, education, wealth, internet access, STI awareness, and sexual behaviours, as well as community-level factors like geographical zone and community poverty. These findings underscore the importance of considering both individual characteristics and the broader community context when designing targeted interventions to promote HIVST kits.