Research Interests: Medicine, Logistic Regression, Schools, Library and Information Studies, Faculty, and 15 morePregnancy, Humans, Female, Dar es Salaam, Risk factors, Cervical Cancer, Middle Aged, Adult, Public health systems and services research, Risk Factors, Sexual Partners, Self report, Cross Sectional Studies, Surveys and Questionnaires, and Early detection of cancer
The increasing use of contraception methods worldwide has allowed couples to choose the number and spacing of their children. Despite impressive achievements, contraceptive use remains low while the need for contraception is high in some... more
The increasing use of contraception methods worldwide has allowed couples to choose the number and spacing of their children. Despite impressive achievements, contraceptive use remains low while the need for contraception is high in some of the world's poorest and most populous places. Little is known about the factors contributing to the low utilisation of contraceptives in the Rorya district, particularly among married individuals where the prevalence of contraceptive use was only 28%. A qualitative design was used for six focus group discussions and six in-depth interviews conducted with married individuals to understand the perception of the use of contraceptives in the Rorya District. Respondents believe that contraception is important in reducing the number of pregnancies and improving health, as well as in limiting family size. Interviewees emphasised the need for more accessible outlets for contraceptives. Religious beliefs and myths about contraceptive side effects have...
Research Interests:
Research Interests:
Research Interests:
SUMMARYKnowledge of the factors affecting the presence of Toxoplasma gondii in wildlife is limited. Here we analyse which local landscape characteristics are associated with the presence of toxoplasmosis in wild boar, Sus scrofa, on the... more
SUMMARYKnowledge of the factors affecting the presence of Toxoplasma gondii in wildlife is limited. Here we analyse which local landscape characteristics are associated with the presence of toxoplasmosis in wild boar, Sus scrofa, on the island of Corsica, France. Meat juice samples from 1399 wild boars collected during two hunting seasons were tested for T. gondii antibodies using the modified agglutination test (titre 1:4). The overall seroprevalence was 0·55 (95% CI 0·50–0·59) for the first year and 0·33 (95% CI 0·29–0·35) for the second year. Seroprevalence varied according to age and county. At the county level, seropositivity in adults was related to farm density during year 1, and to habitat fragmentation, farm density and altitude during year 2. The exposure of wild boar to T. gondii is thus variable according to landscape characteristics and probably results in a variable risk of transmission of toxoplasmosis to humans.
Research Interests: Veterinary Medicine, Epidemiology, Biology, Toxoplasma, Landscape, and 15 moreMedicine, France, Toxoplasmosis, Toxoplasma gondii, Cats, Animals, Public health systems and services research, Swine, Mediterranean Climate, Chi Square Distribution, Swine Diseases, Seroprevalence, Sus Scrofa, Hunting Season, and Direct agglutination test
Research Interests:
Research Interests:
Research Interests:
Background: Infection causes immune activation and inflammatory cytokines may be mediators of intrauterine growth restriction (IUGR). While infection and IUGR are common in developing regions, the intrauterine cytokine environment and its... more
Background: Infection causes immune activation and inflammatory cytokines may be mediators of intrauterine growth restriction (IUGR). While infection and IUGR are common in developing regions, the intrauterine cytokine environment and its impact on birth size is undefined. Understanding the fetal environment mediated by multiple cytokines may inform interventions targeting birth anthropometry. Objective: To investigate the relationship between umbilical cord cytokines and birth size. Methods: Umbilical cord cytokines (IFN-γ, IL-1β, IL-2, IL-6, TNF-α, IL-12p70, IL-10, IL-13) were multiplexed from 50 singleton deliveries of women residing in rural Tanzania (38% HIV-positive). Birth weight and length were assessed using linear regression models adjusted for maternal age, nutritional status, HIV, and infant gender. Results: Cord IFN-γ, IL-1β, TNF-α, IL-12p70, and IL-10 were each associated with reduced birth weight (grams; -532, P<0.01; -372, P=0.04; -315, P=0.03; -721, P<0.01; -278, P=0.04; respectively) and...
Research Interests:
Research Interests:
Background Sub-Saharan Africa (SSA) has the highest fertility rates and highest HIV disease burden globally. However, it is not clear how the rapid expansion of anti-retroviral therapy (ART) for HIV has impacted the fertility gap between... more
Background Sub-Saharan Africa (SSA) has the highest fertility rates and highest HIV disease burden globally. However, it is not clear how the rapid expansion of anti-retroviral therapy (ART) for HIV has impacted the fertility gap between HIV-infected and uninfected women. We used data from a Health and Demographic Surveillance System (HDSS) in north-western Tanzania to explore trends in fertility rates and the relationship between HIV and fertility over the 25-year period. Methods From 1994 to 2018, births and population denominators from the HDSS population were used to obtain age-specific fertility rates (ASFRs) and total fertility rates (TFRs). HIV status was extracted from eight rounds of epidemiologic serological surveillances (1994–2017). Fertility rates by HIV status and in different levels of ART availability were compared over time. Independent risk factors for fertility changes were examined using Cox proportional hazard models. Results There were 24,662 births from 36,814...
Research Interests:
Background: Infection causes immune activation and inflammatory cytokines may be mediators of intrauterine growth restriction (IUGR). While infection and IUGR are common in developing regions, the intrauterine cytokine environment and its... more
Background: Infection causes immune activation and inflammatory cytokines may be mediators of intrauterine growth restriction (IUGR). While infection and IUGR are common in developing regions, the intrauterine cytokine environment and its impact on birth size is undefined. Understanding the fetal environment mediated by multiple cytokines may inform interventions targeting birth anthropometry. Objective: To investigate the relationship between umbilical cord cytokines and birth size. Methods: Umbilical cord cytokines (IFN-γ, IL-1β, IL-2, IL-6, TNF-α, IL-12p70, IL-10, IL-13) were multiplexed from 50 singleton deliveries of women residing in rural Tanzania (38% HIV-positive). Birth weight and length were assessed using linear regression models adjusted for maternal age, nutritional status, HIV, and infant gender. Results: Cord IFN-γ, IL-1β, TNF-α, IL-12p70, and IL-10 were each associated with reduced birth weight (grams; -532, P<0.01; -372, P=0.04; -315, P=0.03; -721, P<0.01; -278, P=0.04; respectively) and...
Research Interests:
The impact of voluntary counselling and testing services on sexual behaviour change and HIV among HIV-negative participants, but no impacts among HIV-positive individuals in the context of low overall VCT Cawley et al. BMC Infectious... more
The impact of voluntary counselling and testing services on sexual behaviour change and HIV among HIV-negative participants, but no impacts among HIV-positive individuals in the context of low overall VCT Cawley et al. BMC Infectious Diseases 2014, 14:159
Research Interests:
Effects on mortality of a nutritional intervention cted adults referred for (95 % CI, 4–46) higher in the LNS-VM compared to the LNS arm (P = 0.02). Conclusions: High-dose vitamin and mineral supplementation in LNS, compared to LNS alone,... more
Effects on mortality of a nutritional intervention cted adults referred for (95 % CI, 4–46) higher in the LNS-VM compared to the LNS arm (P = 0.02). Conclusions: High-dose vitamin and mineral supplementation in LNS, compared to LNS alone, did not decrease
Research Interests:
Background Sero-positivity rates of the rubella virus among pregnant women vary widely throughout the world. In Tanzania, rubella vaccination is not included in the national immunization schedule and there is therefore no antenatal... more
Background Sero-positivity rates of the rubella virus among pregnant women vary widely throughout the world. In Tanzania, rubella vaccination is not included in the national immunization schedule and there is therefore no antenatal screening for this viral disease. So far, there are no reports on the sero-prevalence of rubella among pregnant women in Tanzania. As a result, this study was undertaken to establish the sero-positivity rate of rubella and rubella risk factors among pregnant women attending antenatal care clinics in Mwanza, Tanzania. Methods From November 2012 to May 2013 a total of 350 pregnant women were enrolled and their serum samples collected and analyzed using the AXSYM anti-rubella virus IgG/IgM-MEIA test. Demographic and clinical data were collected using a standardized data collection tool. Data analysis was done using STATA version 12. Results Of 342 pregnant women tested for rubella antibodies, 317 (92.6%) were positive for anti-rubella IgG while only 1 (0.3%)...
Research Interests: Nursing, Obstetrics, Risk assessment, Adolescent, Medicine, and 15 morePregnancy, Humans, Female, Incidence, Adult, Public health systems and services research, Retrospective Studies, Prognosis, Risk Factors, Risk Assessment, Cross Sectional Studies, Prenatal Care, immunoglobulin G, Congenital Rubella Syndrome, and Paediatrics and reproductive medicine
BACKGROUND In sub-Saharan Africa, the estimated burden of hypertension is increasing. Innovative strategies are neededto ensure that people can regularly check their blood pressure. This qualitative study aimed to understandparticipants’... more
BACKGROUND In sub-Saharan Africa, the estimated burden of hypertension is increasing. Innovative strategies are neededto ensure that people can regularly check their blood pressure. This qualitative study aimed to understandparticipants’ knowledge of hypertension, explore the acceptability of self-screening blood pressure testing atprivate drug shops, and understand motivations and barriers for attending referral services after a high bloodpressure reading. METHODS The study took place between October 2013 and January 2014 in Mwanza region, Tanzania. In-depthinterviews were conducted with eight service providers and 14 service users. Two focus group discussionswere conducted with 24 community members. RESULTS Private drug shop attendants liked the opportunity to offer blood pressure testing, and their clientsappreciated the self-testing of their blood pressure. Some service users, whose screening suggested a raisedblood pressure, attended health facilities for further follow-up, dri...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Background Immune activation and inflammation are common symptoms throughout HIV infection and lead to elevated circulating concentrations of cachectic cytokines. Aims To evaluate cachexia-like symptoms among HIV-positive and HIV-negative... more
Background Immune activation and inflammation are common symptoms throughout HIV infection and lead to elevated circulating concentrations of cachectic cytokines. Aims To evaluate cachexia-like symptoms among HIV-positive and HIV-negative pregnant women, and investigate whether cachexic mechanisms may contribute to impaired HIV-exposed fetal and infant growth. Methods Pregnant women (n=114; 39% HIV-positive) were prospectively enrolled from an antenatal clinic in semi-rural Tanzania. Maternal cachexia-associated plasma cytokines and hormones, and clinical and anthropometric data were assessed. Cachexia scores were quantified using a novel adaptation of a validated cachexia scoring system. Infant growth anthropometry was measured at birth and after 6 months. Results Maternal cachexia score was inversely associated with infant birth weight, birth length, and weight-for-age z-score at 6 months. Conclusions Symptoms consistent with a mild cachectic state were associated with poorer infa...
Research Interests:
IntroductionExtrapulmonary tuberculosis (EPTB) is difficult to confirm bacteriologically and requires specific diagnostic capacities. Diagnosis can be especially challenging in under‐resourced settings. We studied diagnostic modalities... more
IntroductionExtrapulmonary tuberculosis (EPTB) is difficult to confirm bacteriologically and requires specific diagnostic capacities. Diagnosis can be especially challenging in under‐resourced settings. We studied diagnostic modalities and clinical outcomes of EPTB compared to pulmonary tuberculosis (PTB) among HIV‐positive adults in antiretroviral therapy (ART) programmes in low‐ and middle‐income countries (LMIC).MethodsWe collected data from HIV‐positive TB patients (≥16 years) in 22 ART programmes participating in the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium in sub‐Saharan Africa, Asia‐Pacific, and Caribbean, Central and South America regions between 2012 and 2014. We categorized TB as PTB or EPTB (EPTB included mixed PTB/EPTB). We used multivariable logistic regression to assess associations with clinical outcomes.Results and DiscussionWe analysed 2695 HIV‐positive TB patients. Median age was 36 years (interquartile range (IQR) 30 to 43), 1102 we...
Research Interests:
IntroductionSince 2015, the World Health Organization (WHO) has recommended that all people living with HIV (PLHIV) initiate antiretroviral treatment (ART), irrespective of CD4+ count or clinical stage. National adoption of universal... more
IntroductionSince 2015, the World Health Organization (WHO) has recommended that all people living with HIV (PLHIV) initiate antiretroviral treatment (ART), irrespective of CD4+ count or clinical stage. National adoption of universal treatment has accelerated since WHO's 2015 “Treat All” recommendation; however, little is known about the translation of this guidance into practice. This study aimed to assess the status of Treat All implementation across regions, countries, and levels of the health care delivery system.MethodsBetween June and December 2017, 201/221 (91%) adult HIV treatment sites that participate in the global IeDEA research consortium completed a survey on capacity and practices related to HIV care. Located in 41 countries across seven geographic regions, sites provided information on the status and timing of site‐level introduction of Treat All, as well as site‐level practices related to ART initiation.ResultsAlmost all sites (93%) reported that they had begun i...
Research Interests: Global Health, Medicine, HIV, Humans, Female, and 13 moreMale, Clinical Sciences, Adult, Public health systems and services research, Time Factors, HIV Care, World Health Organization, Medicine and Health Sciences, Surveys and Questionnaires, Delivery of Health Care, Health facilities, antiretroviral treatment, and HIV infections
IntroductionHealth and demographic surveillance systems (HDSS) have been an invaluable resource for monitoring the health status of populations, but often contain self-reported health service utilisation, which are subject to reporting... more
IntroductionHealth and demographic surveillance systems (HDSS) have been an invaluable resource for monitoring the health status of populations, but often contain self-reported health service utilisation, which are subject to reporting bias. ObjectivesTo implement point-of-contact interactive record linkage (PIRL) between demographic and health facility systems data, characterise attributes associated with (un)successful record linkage, and compare findings with a fully automated retrospective linkage approach. MethodsIndividuals visiting the Kisesa Health Centre were matched to their HDSS records during a short uptake interview in the waiting area of the health facility. The search algorithm was used to rank potential matches, from which the true match(es) were selected after consultation with the patient. Multivariable logistic regression models were used to identify characteristics associated with being matched to an HDSS record. Records matched based on respondent’s clarificatio...
Research Interests:
IntroductionStudies based on high-quality linked data in developed countries show that residual linkage errors impact the bias and precision of subsequent analyses. Since 2015, we conducted point-of-contact interactive record linkage... more
IntroductionStudies based on high-quality linked data in developed countries show that residual linkage errors impact the bias and precision of subsequent analyses. Since 2015, we conducted point-of-contact interactive record linkage (PIRL) between serological survey data and manually digitised medical records with low data quality from three clinics in rural Tanzania. Objectives and ApproachWe sought to determine the impact of the substantial linkage errors made by automated probabilistic linkage (a commonly used, less accurate, but much cheaper alternative to PIRL) on the bias and precision of inferences drawn from Cox regression analyses, comparing time from a positive HIV diagnostic test to registration at a local HIV care and treatment clinic (CTC) by testing modality (sero-survey vs. clinic). Using PIRL links as the gold standard, we quantified false/missed matches, compared characteristics between linked and unlinked data, and evaluated regression estimates at low, medium, an...
Research Interests:
Linking a health and demographic surveillance system (HDSS) to data from a health facility that serves the HDSS population generates a research infrastructure for directly observed data on access to and utilization of health facility... more
Linking a health and demographic surveillance system (HDSS) to data from a health facility that serves the HDSS population generates a research infrastructure for directly observed data on access to and utilization of health facility services. Many HDSS sites, however, are in areas that lack unique national identifiers or suffer from data quality issues, such as incomplete records, spelling errors, and name and residence changes, all of which complicate record linkage approaches when applied retrospectively. We developed Point-of-contact Interactive Record Linkage (PIRL) software that is used to prospectively link health records from a local health facility to an HDSS in rural Tanzania. This prospective approach to record linkage is carried out in the presence of the individual whose records are being linked, which has the advantage that any uncertainty surrounding their identity can be resolved during a brief interaction, whereby extraneous information (e.g., household membership) ...
Research Interests:
Timely progression of people living with HIV (PLHIV) from the point of infection through the pathway from diagnosis to treatment is important in ensuring effective care and treatment of HIV and preventing HIV-related deaths and onwards... more
Timely progression of people living with HIV (PLHIV) from the point of infection through the pathway from diagnosis to treatment is important in ensuring effective care and treatment of HIV and preventing HIV-related deaths and onwards transmission of infection. Reliable, population-based estimates of new infections are difficult to obtain for the generalised epidemics in sub-Saharan Africa. Mortality data indicate disease burden and, if disaggregated along the continuum from diagnosis to treatment, can also reflect the coverage and quality of different HIV services. Neither routine statistics nor observational clinical studies can estimate mortality prior to linkage to care nor following disengagement from care. For this, population-based data are required. The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa brings together studies in Kenya, Malawi, South Africa, Tanzania, Uganda, and Zimbabwe. Eight studies have the necessary data to estimate morta...
Research Interests:
To estimate the relationship between HIV natural history and fertility by duration of infection in East and Southern Africa before the availability of antiretroviral therapy, and assess potential biases in estimates of age-specific... more
To estimate the relationship between HIV natural history and fertility by duration of infection in East and Southern Africa before the availability of antiretroviral therapy, and assess potential biases in estimates of age-specific sub-fertility when using retrospective birth histories in cross-sectional studies. Pooled analysis of prospective population-based HIV cohort studies in Masaka (Uganda) Kisesa (Tanzania), and Manicaland (Zimbabwe). Women aged 15-49 who had ever tested for HIV were included. Analyses were censored at antiretroviral treatment roll out. Fertility rate ratios were calculated to see the relationship of duration of HIV infection on fertility, adjusting for background characteristics. Survivorship and misclassification biases on age-specific subfertility estimates from cross-sectional surveys were estimated by reclassifying person time from the cohort data to simulate cross-sectional surveys and comparing fertility rate ratios to true cohort results. HIV negativ...
Research Interests: Demography, Fertility, Adolescent, Tanzania, Medicine, and 15 moreBiological Sciences, Population, Humans, Female, Cohort Study, AIDS, Middle Aged, Adult, Birth Rate, Retrospective Studies, Cross Sectional Studies, Confidence Interval, Psychology and Cognitive Sciences, Medical and Health Sciences, and HIV infections
Xpert MTB/RIF is recommended by the World Health Organization (WHO) as the initial tuberculosis (TB) diagnostic test in individuals suspected of HIV-associated TB. We sought to evaluate field implementation of Xpert among a cohort of... more
Xpert MTB/RIF is recommended by the World Health Organization (WHO) as the initial tuberculosis (TB) diagnostic test in individuals suspected of HIV-associated TB. We sought to evaluate field implementation of Xpert among a cohort of HIV/TB co-infected individuals, including availability, utilization and outcomes. Observational cohort study (patient-level data) and cross-sectional study (site-level Xpert availability data). Data were collected at 30 participating International epidemiologic Databases to Evaluate AIDS (IeDEA) sites in 18 countries from January 2012-January 2016. All patients were HIV-infected and diagnosed with TB, either bacteriologically or clinically, and followed until a determination of TB treatment outcome. We used multivariable modified Poisson regression to estimate adjusted relative risk (RR) and 95% confidence intervals for unfavorable TB treatment outcomes. Most sites (63%) had access to Xpert, either in the clinic (13%), in the same facility (20%) or offs...
Research Interests:
Hypertension is a major contributor to ill health in sub-Saharan Africa. Developing countries need to increase access for screening. This study assesses the feasibility and acceptability of using private sector drug retail outlets to... more
Hypertension is a major contributor to ill health in sub-Saharan Africa. Developing countries need to increase access for screening. This study assesses the feasibility and acceptability of using private sector drug retail outlets to screen for hypertension in Mwanza region, Tanzania. A pilot study took place in eight drug retail outlets from August 2013 to February 2014. Customers ≥18 years were invited for screening. Socio-demographic characteristics, hypertension knowledge, hypertension screening and treatment history were collected. Subjects with systolic blood pressure over 140 mmHg were referred for follow up. Referral slips captured attendance. Mystery client visits and follow up phone calls were conducted to assess service quality. A total of 971 customers were screened, one person refused; 109 (11.2%) had blood pressure over 140/90 mmHg and were referred for ongoing assessment; 85/109 (78.0%) were newly diagnosed. Customers reported that the service was acceptable. Service ...
Research Interests:
Research Interests:
Routinely collected clinic data have the potential to provide much needed information on the uptake of services to prevent mother-to-child transmission (PMTCT) of HIV, and to measure HIV prevalence in pregnant women. This article... more
Routinely collected clinic data have the potential to provide much needed information on the uptake of services to prevent mother-to-child transmission (PMTCT) of HIV, and to measure HIV prevalence in pregnant women. This article describes the methodological challenges associated with using such data, based on the experiences of researchers and programme implementers in Tanzania and drawing from other examples from East Africa. PMTCT data are routinely collected in maternal and child health (MCH) clinics in East Africa using paper-based registers corresponding to distinct services within the PMTCT service continuum. This format has inherent limitations with respect to maintaining and accurately recording unique identifiers that can link patients across the different clinics (antenatal, delivery, child), and also poses challenges when compiling aggregate data. Recent improvements to recording systems include assigning unique identifiers to HIV-positive pregnant women in MCH clinics, ...
Research Interests:
Estimates of population-level coverage with prevention of mother-to-child transmission (PMTCT) services are vital for monitoring programmes but are rarely undertaken. This study describes uptake of PMTCT services among HIV-positive... more
Estimates of population-level coverage with prevention of mother-to-child transmission (PMTCT) services are vital for monitoring programmes but are rarely undertaken. This study describes uptake of PMTCT services among HIV-positive pregnant women in a community cohort in rural Tanzania. Kisesa cohort incorporates demographic and HIV sero-surveillance rounds since 1994. Cohort data were linked retrospectively to records from four Kisesa clinics with PMTCT services from 2009 (HIV care and treatment clinic (CTC) available in one facility from 2008; referrals to city hospitals for PMTCT and antiretroviral treatment (ART) from 2005). The proportion of HIV-positive pregnant women residing in Kisesa in 2005-2012 who accessed PMTCT service components (based on linkage to facility records) was calculated per HIV-positive pregnancy and by year, with adjustments made to account for the sensitivity of the linkage algorithm. Out of 1497 HIV-positive pregnancies overall (to 849 women), 26 % (n = ...
Research Interests: Tanzania, Medicine, Library and Information Studies, Pregnancy, Population, and 13 moreHumans, Child, Female, Young Adult, Cohort, Adult, Public health systems and services research, Retrospective Studies, Pregnant Women, Rural Population, Community health services, HIV infections, and Referral and consultation
Research Interests: Nursing, Obstetrics, Pediatrics, Child Development, Anthropometry, and 15 moreMedicine, Linear models, Fetal development, Birth Weight, Pregnancy, Humans, Female, Infant, Adult, Body Weight, Gestational Age, Pregnancy Outcome, Paediatrics and reproductive medicine, HIV infections, and Infant nutritional physiological phenomena
Research Interests: Medical Microbiology, Adolescent, Tanzania, Medicine, Logistic Regression, and 15 morePregnancy, Humans, Female, Sexually transmitted infections, Male, Infant, Cohort, Clinical Sciences, Newborn Infant, Adult, Public health systems and services research, Cohort Studies, Health Services Accessibility, Rural Population, and HIV infections
Research Interests:
Research Interests:
Research Interests: Medicine, Breastfeeding, Biological Sciences, Prospective studies, Humans, and 15 moreFemale, Animals, Male, Infant, Mothers, Newborn Infant, Prevalence, Odds ratio, Breast feeding, Cryptosporidium, Cryptosporidiosis, Cohort Studies, Prospective Cohort Study, Medical and Health Sciences, and HIV infections
Reliable population-based data on HIV infection and AIDS mortality in sub-Saharan Africa are scanty, even though that is the region where most of the world's AIDS deaths occur. There is therefore a great need for reliable and valid... more
Reliable population-based data on HIV infection and AIDS mortality in sub-Saharan Africa are scanty, even though that is the region where most of the world's AIDS deaths occur. There is therefore a great need for reliable and valid public health tools for assessing AIDS mortality. The aim of this article is to validate the InterVA-4 verbal autopsy (VA) interpretative model within African populations where HIV sero-status is recorded on a prospective basis, and examine the distribution of cause-specific mortality among HIV-positive and HIV-negative people. Data from six sites of the Alpha Network, including HIV sero-status and VA interviews, were pooled. VA data according to the 2012 WHO format were extracted, and processed using the InterVA-4 model into likely causes of death. The model was blinded to the sero-status data. Cases with known pre-mortem HIV infection status were used to determine the specificity with which InterVA-4 could attribute HIV/AIDS as a cause of death. Cau...
Research Interests:
The rollout of antiretroviral therapy (ART) is one of the largest public health interventions in Eastern and Southern Africa of recent years. Its impact is well described in clinical cohort studies, but population-based evidence is rare.... more
The rollout of antiretroviral therapy (ART) is one of the largest public health interventions in Eastern and Southern Africa of recent years. Its impact is well described in clinical cohort studies, but population-based evidence is rare. We use data from seven demographic surveillance sites that also conduct community-based HIV testing and collect information on the uptake of HIV services. We present crude death rates of adults (aged 15-64) for the period 2000-2011 by sex, HIV status, and treatment status. Parametric survival models are used to estimate age-adjusted trends in the mortality rates of people living with HIV (PLHIV) before and after the introduction of ART. The pooled ALPHA Network dataset contains 2.4 million person-years of follow-up time, and 39114 deaths (6893 to PLHIV). The mortality rates of PLHIV have been relatively static before the availability of ART. Mortality declined rapidly thereafter, with typical declines between 10 and 20% per annum. Compared with the ...
Research Interests: Demography, Africa, Adolescent, Medicine, Biological Sciences, and 15 morePopulation, Humans, Female, Male, Psychological Intervention, AIDS, Incidence, Middle Aged, Adult, Highly Active Antiretroviral Therapy, Drug Utilization, Mortality rate, Psychology and Cognitive Sciences, Medical and Health Sciences, and HIV infections
Research Interests:
Research Interests:
Objective To describe the impact of antiretroviral therapy (ART) on mortality rates among adults participating in an HIV community cohort study in north‐west Tanzania.Methods Serological and demographic surveillance rounds have been... more
Objective To describe the impact of antiretroviral therapy (ART) on mortality rates among adults participating in an HIV community cohort study in north‐west Tanzania.Methods Serological and demographic surveillance rounds have been undertaken in a population of approximately 30 000 people since 1994. Free HIV care including ART has been available since 2005. Event history analysis was used to compare mortality rates among HIV‐negative and HIV‐positive adults in the 5‐year period before and after the introduction of ART. Crude and adjusted hazard ratios were calculated using exponential regression models. Interaction between time period and HIV status was assessed to investigate whether there was a non‐linear relationship between these two variables.Results Male and female mortality patterns varied over the pre‐ and post‐ART period. In women, the crude death rate fell for both HIV negatives and HIV positives hazard rate ratio (HRR = 0.71; 95%CI 0.51–0.99 and HRR = 0.68; 95%CI: 0....
Research Interests:
Research Interests: Demography, Family Medicine, Cancer, Logistic Regression, Library and Information Studies, and 15 moreFaculty, Humans, Embarrassment, Female, Cervical Cancer, Cervical Cancer Screening, Adult, Hiv seropositivity, Cross sectional Study, Cross Sectional Studies, Logistic Models, Cervix, Confidence Interval, Acquired immunodeficiency syndrome, and Early detection of cancer
Research Interests:
antiretroviral therapy on adult mortality in rural Tanzania
Research Interests: Environmental Health, Tanzania, Medicine, Counseling, Humans, and 11 morePsychological Intervention, Health surveys, Prenatal Care, Health Facility, Surveys and Questionnaires, Health Services Accessibility, Delivery of Health Care, Health facilities, HIV infections, Referral and consultation, and Referral
Substantial falls in the mortality of people living with HIV (PLWH) have been observed since the introduction of antiretroviral therapy (ART) in sub-Saharan Africa. However, access and uptake of ART have been variable in many countries.... more
Substantial falls in the mortality of people living with HIV (PLWH) have been observed since the introduction of antiretroviral therapy (ART) in sub-Saharan Africa. However, access and uptake of ART have been variable in many countries. We report the excess deaths observed in PLWH before and after the introduction of ART. We use data from five longitudinal studies in Malawi, South Africa, Tanzania, and Uganda, members of the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). Individual data from five demographic surveillance sites that conduct HIV testing were used to estimate mortality attributable to HIV, calculated as the difference between the mortality rates in PLWH and HIV-negative people. Excess deaths in PLWH were standardized for age and sex differences and summarized over periods before and after ART became generally available. An exponential regression model was used to explore differences in the impact of ART over the different sites. 12...
Research Interests:
The Tanzanian national HIV care and treatment programme has provided free antiretroviral therapy (ART) to HIV-positive persons since 2004. ART has been available to participants of the Kisesa open cohort study since 2005, but data to 2007... more
The Tanzanian national HIV care and treatment programme has provided free antiretroviral therapy (ART) to HIV-positive persons since 2004. ART has been available to participants of the Kisesa open cohort study since 2005, but data to 2007 showed a slow uptake of ART and a modest impact on mortality. Additional data from the 2010 HIV serological survey provide an opportunity to update the estimated impact of ART in this setting. The Kisesa Health and Demographic Surveillance Site (HDSS) has collected HIV serological data and demographic data, including verbal autopsy (VA) interviews since 1994. Serological data to the end of 2010 were used to make two estimates of HIV-attributable mortality, the first among HIV positives using the difference in mortality between HIV positives and HIV negatives, and the second in the population using the difference between the observed mortality rate in the whole population and the mortality rate among the HIV negatives. Four time periods (1994-1999, ...
Research Interests:
Interactions between patients and service providers frequently influence uptake of prevention of mother-to-child transmission (PMTCT) HIV services in sub-Saharan Africa, but this process has not been examined in depth. This study explores... more
Interactions between patients and service providers frequently influence uptake of prevention of mother-to-child transmission (PMTCT) HIV services in sub-Saharan Africa, but this process has not been examined in depth. This study explores how patient-provider relations influence PMTCT service use in four government facilities in Kisesa, Tanzania. Qualitative data were collected in 2012 through participatory group activities with community members (3 male, 3 female groups), in-depth interviews with 21 women who delivered recently (16 HIV-positive), 9 health providers, and observations in antenatal clinics. Data were transcribed, translated into English and analysed with NVIVO9 using an adapted theoretical model of patient-centred care. Three themes emerged: decision-making processes, trust, and features of care. There were few examples of shared decision-making, with a power imbalance in favour of providers, although they offered substantial psycho-social support. Unclear communicati...