Mwanza Intervention Trials Unit

High blood pressure (BP) among adolescents is a growing public health problem known to persist into adulthood. However, there is a scarcity of longitudinal BP data in Sub‐Saharan Africa (SSA). We aimed to describe sex differences in BP trajectories and determine the incidence of high BP among 500 secondary school−attending adolescents enrolled in a 2‐year closed cohort study in urban Tanzania. We collected data across three time points, spaced at 12‐month intervals. Participants were defined as having high BP if they had elevated BP or hypertension as per the standard guideline. Overall, there was a significant decline in BP from enrollment to Year 1, possibly attributable to the white coat effect. Between Year 1 and Year 2, we found a steeper longitudinal BP increase, particularly in males. The incidence of high BP was 5.5 cases per 100 person‐years and was significantly higher in males and among underweight participants. We recommend integrating routine BP measurement in the existing adolescent health programs and tailoring cardiovascular preventive messages to address gender‐specific risk factors.

The SARS-CoV-2 pandemic remains crucial for understanding the epidemiology of future respiratory infections. Gaining insights into the climatic factors influencing the transmissibility of SARS-CoV-2 is an important public health issue in the control and prevention of the disease. Hence, this study aimed to assess the association between SARS-CoV-2 transmissibility and both humidity and temperature. Articles published between December 2019 and August 2024 were identified from PubMed, Africa Journal Online, Science Direct, and Hinari databases following PRISMA guidelines. The focus was on studies that reported transmissibility based on basic reproductive number, specifically correlation coefficients between basic reproductive number and temperature, or humidity, or corresponding regression coefficients, and their standard errors. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess the risk of bias. Random effect models were applied. The meta-analysis was done in R version 4.3.0. 9 studies qualified, but 5 were excluded for missing coefficients, leaving 4 for meta-analysis. The study analysis revealed a significant negative correlation between temperature and SARS-CoV-2 transmissibility (r = -0.509, 95% CI: -0.680 to -0.338, p < 0.001). Similarly, a significant but weaker negative correlation was found between humidity and SARS-CoV-2 transmissibility (r = -0.426, 95% CI: -0.548 to -0.303, p < 0.001). A unit increase in humidity measured in percentage was associated with a decrease in transmissibility by 0.006 (95% CI: -0.007 to -0.004, p < 0.001), while a unit increase in temperature in Celsius (°C) was associated with a reduction of transmissibility by 0.008 (95% CI: -0.030 to -0.030, p < 0.001). Temperature and humidity were negatively associated with SARS-CoV-2 transmissibility; thus, disease transmissibility decreased as temperature or humidity increased. Climatic factors are important considerations for effective disease surveillance and preparedness strategies. https://www.crd.york.ac.uk/PROSPERO, CRD42025637440.

Abstract Background As more countries plan and launch human papillomavirus (HPV) vaccination campaigns, reliable self-sampling methods are essential for detecting high-risk HPV (HR-HPV) types and assessing public health impact. This study compared HR-HPV detection in self-collected vaginal swabs (SCVS) and first-void urine (FVU) among sexually active girls and women aged 15-25 years in Bangladesh, Nepal, and Pakistan. Methods Within the Global Burden Estimation of HPV (GLOBE-HPV) project, which aims to estimate HPV prevalence and incidence across eight low- and middle-income countries in South Asia and Sub-Saharan Africa, we analyzed paired SCVS and FVU samples from 753 participants in Bangladesh, Pakistan, and Nepal using standardized protocols. DNA was extracted using the QIAamp DNA Mini Kit, and HPV testing was performed with the Allplex HPV28 Detection PCR assay. We evaluated HPV detection and type-specific concordance using Cohen’s Kappa, McNemar’s test, and a 3×3 agreement table, along with accuracy and positive/negative agreement metrics. Results The overall prevalence of 14 HR-HPV types was 8.6% in SCVS and 7.2% in FVU samples. Detection rates for 7 HR-HPV vaccine types were similar (5.3% in SCVS versus 5.0% in FVU), with nearly identical HPV 16/18 rates (2.3% in SCVS and 2.4% in FVU). Bi-directional type-specific discordance was noted, with each sample type detecting unique types. SCVS demonstrated higher sensitivity for detecting HPV types beyond the 9 vaccine types with McNemar p-values of 0.013 and &lt;0.001 for 14 and 28 types, respectively, while overall concordance remained high (Kappa &gt;0.7). Samples with lower viral load (indicated by higher real-time PCR cycle threshold values) were more likely to yield discordant results. Conclusion SCVS and FVU yielded similar HR-HPV results, including those targeted by the 9-valent HPV vaccine, in sexually active young women. Both non-invasive self-sampling methods have potential for use in large-scale HPV surveillance programs in resource-limited settings.

Intimate partner violence (IPV) starts at a young age. In Tanzania, 32% of adolescent girls and young women report lifetime experience of physical or sexual IPV. Adolescence is a critical developmental period when young people are establishing beliefs around gender equity and violence and when programmes and interventions may be most influential. This study explored adolescent and young adult perspectives on gender equity and gender roles, and their links to IPV to inform the adaptation and implementation of an evidence-based gender empowerment curriculum for young people in Tanzania. We conducted 24 focus group discussions among young people ages 14–24, adult community members, and community and religious leaders. Five major themes were developed: social acceptance of traditional gender roles and male dominated families; generational divide on support for gender equity; a religious lens on gender equity and the tolerance of violence; the normalisation of violence; and recommendations to promote gender equity. Our findings suggest young people, particularly girls and young women, support gender equity concepts. However, pervasive social norms about traditional gender roles, perpetuated by adults and community leaders, inhibit gender equity. Recommen­dations included involving peers, family, and wider community in gender empowerment education; and engaging religious leaders.

BackgroundThe World Health Organisation estimates that worldwide six percent of women aged 15–49 have experienced non-partner sexual violence (NPSV) in their lifetimes. A similar prevalence is found in sub-Saharan Africa. This form of violence is comparatively under-researched, leading to a dearth of knowledge around potential risk factors for male perpetration of NPSV.MethodsWe sought to explore key risk factors for perpetration of non-partner rape, verbal and physical sexual harassment in young Tanzanian men by conducting a cross-sectional survey of 1002 young men aged 18 to 24 living in Mwanza, Tanzania between June 2021 and March 2022. We conducted unadjusted logistic regression for bivariate associations between all three forms of NPSV and risk factors at the sociodemographic, behavioural, and mental health and substance misuse level. The risk factors independently associated with the outcomes were included in three separate multivariable logistic regression models. We then used dominance analysis to determine which factors had the strongest association with all three forms of NPSV perpetration.ResultsAmong the young men in our sample, 9% reported having perpetrated non-partner rape (n = 86), 19% having physically harassed a woman (n = 188) and 33% having verbally harassed a woman (n = 330). After adjustment for the other risk factors in the model, pornography consumption, having multiple sexual partners, gambling, and depressive symptoms remained significantly associated with more than one form of NPSV.ConclusionsThe widespread nature of sexual harassment and rape perpetration among young men in our study and the associated risk factors, which are all tied to notions of masculinity encouraging domination, promiscuity, and risky health behaviours, call for harmful gender norms to be addressed to reduce the incidence of NPSV.

For refugee children, there are a number of risk factors for poor mental health and psychosocial well-being, many of them exacerbated for those refugee children living in low-resource settings. There is some evidence that caregiver warmth, parenting self-efficacy and positive relationships between caregivers and children can act as protective factors against poor mental health outcomes for children and adolescents. This study sought to assess if caregiver-level factors (parental warmth and affection, positive child-caregiver interaction and parenting self-efficacy) are protective for symptoms of child depression. To address these questions, a quantitative survey was implemented (n = 501) in the Imvepi refugee settlement in Uganda. Results indicated bivariate associations between several caregiver-level factors and child depression. However, in multivariate models, which included measures of economic stress, both parental warmth and affection and child-caregiver interaction were no longer significantly associated with child-reported depression. Parenting self-efficacy was found to be significantly associated with lower child-reported depression. These findings indicate the need to examine and explore how or if caregiver-level factors, such as warmth and parenting self-efficacy, as well as child-caregiver relationships overall, operate in the context of chronic stress. Whereas caregiver-level factors are potentially protective against poor mental health for refugee children, contextual factors, such as poverty and livelihood opportunities, may constrain the positive impacts of parenting.

Suicidal ideation and depression are common in people living with HIV (PLWH) in sub-Saharan Africa, but longitudinal data on their persistence in the modern antiretroviral therapy era are lacking. We examined the prevalence of persistent suicidal ideation and depression symptoms using the PHQ-9 in a well-characterized cohort of PLWH and HIV-uninfected community controls. Multivariable logistic regression models were used to determine the relationship between HIV and persistent depression and suicidal ideation. Persistent suicidal ideation was more common in PLWH but there was no difference in persistent depression by HIV status. Approximately one out of five participants with depression at baseline had persistent depression after 12-24 months and only about one out of four participants reporting suicidal ideation at baseline had persistent suicidal ideation after 12-24 months. HIV was associated with suicidal ideation at baseline. Persistent suicidal ideation was significantly associated with HIV immune non-response (p = 0.022). These findings highlight the need for integration of mental health services into HIV care in sub-Saharan Africa with a focus on suicide prevention.

Half of the world's children experience violence every year, but the meaning of violence is not universally agreed. We may therefore risk failing to measure, and address, the acts that matter most to children and adolescents. In this paper, we describe and synthesise evidence on how children and adolescents in sub-Saharan Africa conceptualise different behavioural acts which are deemed violence in childhood under WHO and UN CRC definitions. We conducted a systematic review of qualitative studies. We searched PsychINFO, CINAHL, Embase, Global Health, Medline and ERIC for all publications released prior to March 2023. 30 papers met inclusion criteria. We synthesised primary data from children and adolescents and drew upon theoretical and contextual interpretations of authors of included studies. Only 12 of more than 45 sub-Saharan African countries were represented with relevant research. Of the 30 included papers, 25 came from three countries: South Africa, Uganda and Ghana. Only 10 of 30 papers reported data from young children (pre-adolescence), and 18 of 30 papers primarily focused on sexual violence. 14 studies used child friendly and/or participatory methods. From this limited evidence, we identified six overarching themes in how children and adolescents conceptualised their experiences of acts internationally recognised as violence: 1) adults abusing or neglecting responsibility; 2) sexual violence from peers, family and community members; 3) violence in established intimate relationships; 4) emotional violence surrounding sex from peers and community members; 5) fighting and beating between peers; 6) street and community dangers. No studies meeting our inclusion criteria specifically examined children or adolescents' conceptualisations of homophobic or transphobic violence; violence against children with disabilities; boys' experiences of sexual violence from male perpetrators; trafficking, modern slavery or conflict; child labour; or female genital mutilation. We found that three dimensions were important in how children and adolescents constructed conceptualisations of violence: their age, relationship to the perpetrator, and the physical location of acts they had experienced. These dimensions were interrelated and gendered. The current limited evidence base suggests children and adolescents' conceptualisations of violence overlapped with, but were also distinct from, the WHO and UNCRC definitions of violence. Currently international survey tools focus on measuring types and frequencies of particular acts and neglect to focus on children's understandings of those acts. Relationship to perpetrator, age of child, physical location are all important in how children conceptualise their experiences of acts internationally recognised as violence, and therefore might be important for their health and social outcomes. Those developing measures should account for these dimensions when developing items for testing.

ObjectivesThis study systematically reviewed the published literature from clinical trials on the efficacy and immunogenicity of single-dose HPV vaccination compared to multidose schedules or no HPV vaccination. MethodsFour databases were searched for relevant articles published from Jan-1999 to Feb-2023. Articles were assessed for eligibility for inclusion using pre-defined criteria. Relevant data were extracted from eligible articles and a descriptive quality assessment was performed for each study. A narrative data synthesis was conducted, examining HPV infection, other clinical outcomes and immunogenicity responses by dose schedule. ResultsFifteen articles reporting data from six studies (all in healthy young females) were included. One article was included from each of three studies that prospectively randomised participants to receive a single HPV vaccine dose versus one or more comparator schedule(s). The other 12 articles reported data from three studies that randomised participants to receive multidose HPV vaccine (or control vaccine) schedules; in those studies, some participants failed to complete their allocated schedule, and evaluations were conducted to compare participants who actually received one, two or three doses. Across all efficacy studies, the incidence or prevalence of HPV16/18 infection was very low among HPV-vaccinated participants, regardless of the number of doses received; with no evidence for a difference between dose groups. In immunogenicity studies, HPV16/18 antibody seropositivity rates were high among all HPV-vaccinated participants. Antibody levels were significantly lower with one dose compared to two or three doses, but levels with one dose were stable and sustained to 11 years post-vaccination. ConclusionsResults from this review support recent World Health Organization recommendations allowing either one- or two-dose HPV vaccination in healthy young females. Longer-term efficacy and immunogenicity data from ongoing studies are awaited. Randomised trials of single-dose HPV-vaccination are urgently needed in other populations, e.g. boys, older females and people with HIV.

Despite the widespread availability of antiretroviral therapy (ART), people with HIV still experience high mortality after hospital admission. To determine whether a linkage case management intervention (named "Daraja" ["bridge" in Kiswahili]) that was designed to address barriers to HIV care engagement could improve posthospital outcomes. Single-blind, individually randomized clinical trial to evaluate the effectiveness of the Daraja intervention. The study was conducted in 20 hospitals in Northwestern Tanzania. Five hundred people with HIV who were either not treated (ART-naive) or had discontinued ART and were hospitalized for any reason were enrolled between March 2019 and February 2022. Participants were randomly assigned 1:1 to receive either the Daraja intervention or enhanced standard care and were followed up for 12 months through March 2023. The Daraja intervention group (n = 250) received up to 5 sessions conducted by a social worker at the hospital, in the home, and in the HIV clinic over a 3-month period. The enhanced standard care group (n = 250) received predischarge HIV counseling and assistance in scheduling an HIV clinic appointment. The primary outcome was all-cause mortality at 12 months after enrollment. Secondary outcomes related to HIV clinic attendance, ART use, and viral load suppression were extracted from HIV medical records. Antiretroviral therapy adherence was self-reported and pharmacy records confirmed perfect adherence. The mean age was 37 (SD, 12) years, 76.8% were female, 35.0% had CD4 cell counts of less than 100/μL, and 80.4% were ART-naive. Intervention fidelity and uptake were high. A total of 85 participants (17.0%) died (43 in the intervention group; 42 in the enhanced standard care group); mortality did not differ by trial group (17.2% with intervention vs 16.8% with standard care; hazard ratio [HR], 1.01; 95% CI, 0.66-1.55; P = .96). The intervention, compared with enhanced standard care, reduced time to HIV clinic linkage (HR, 1.50; 95% CI, 1.24-1.82; P < .001) and ART initiation (HR, 1.56; 95% CI, 1.28-1.89; P < .001). Intervention participants also achieved higher rates of HIV clinic retention (87.4% vs 76.3%; P = .005), ART adherence (81.1% vs 67.6%; P = .002), and HIV viral load suppression (78.6% vs 67.1%; P = .01) at 12 months. The mean cost of the Daraja intervention was about US $22 per participant including startup costs. Among hospitalized people with HIV, a linkage case management intervention did not reduce 12-month mortality outcomes. These findings may help inform decisions about the potential role of linkage case management among hospitalized people with HIV. ClinicalTrials.gov Identifier: NCT03858998.