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Tan A.X.,The New School | Kapiga S.,Mwanza Intervention Trials Unit | Khoshnood K.,The New School | Bruce R.D.,New Hill | Bruce R.D.,Yale University
PLoS ONE | Year: 2015

Heroin trafficking and consumption has increased steadily over the past decade in Tanzania, but limited information regarding HIV and drug use exists for the city of Mwanza. Our study investigates the epidemiology of drug use, and HIV risk behaviors among drug users in the northwestern city of Mwanza. Using a combination of targeted sampling and participant referral, we recruited 480 participants in Mwanza between June and August 2014. The sample was 92% male. Seventy-nine (16.4%) participants reported injecting heroin, while 434 (90.4%) reported smoking heroin. Unstable housing and cohabitation status were the only socioeconomic characteristics significantly associated with heroin injection. More than half of heroin injectors left syringes in common locations, and half reported sharing needles and syringes. Other risk behaviors such as lack of condom use during sex, and the use of illicit drugs during sex was widely reported as well. Among the study sample, there was poor awareness of health risks posed by needle/syringe sharing and drug use. Our results show that heroin use and HIV risk related behaviors are pressing problems that should not be ignored in Mwanza. Harm reduction programs are urgently needed in this population. © 2015 Tan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source arecredited. Source

Balira R.,National Institute for Medical Research NIMR | Mabey D.,London School of Hygiene and Tropical Medicine | Weiss H.,London School of Hygiene and Tropical Medicine | Ross D.A.,London School of Hygiene and Tropical Medicine | And 3 more authors.
International Journal of Gynecology and Obstetrics | Year: 2015

Abstract Objective To assess the operational integration of maternal HIV testing and syphilis screening in Mwanza, Tanzania. Methods Interviews were conducted with 76 health workers (HW) from three antenatal clinics (ANC) and three maternity wards in 2008-2009 and 1137 consecutive women admitted for delivery. Nine ANC health education sessions and client flow observations were observed. Results Only 25.0% of HWs reported they had received training in both prevention of mother-to-child transmission (PMTCT) and syphilis screening. HIV and syphilis tests were sometimes performed in different rooms and results recorded in separate registers with different formats and the results were not always given by the same person. At delivery, most women had been tested for both HIV (79.4%) and syphilis (88.1%) during pregnancy. Of those not tested antenatally for each infection, 70.1% were tested for HIV at delivery but none for syphilis. Conclusion Integration of maternal HIV and syphilis screening was limited. Integrated care guidelines and related health worker training should address this gap. © 2015 International Federation of Gynecology and Obstetrics. Source

Settumba S.N.,Medical Research Council Uganda Virus Research Institute | Sweeney S.,London School of Hygiene and Tropical Medicine | Seeley J.,Medical Research Council Uganda Virus Research Institute | Seeley J.,London School of Hygiene and Tropical Medicine | And 6 more authors.
Tropical Medicine and International Health | Year: 2015

Objective: To explore the chronic disease services in Uganda: their level of utilisation, the total service costs and unit costs per visit. Methods: Full financial and economic cost data were collected from 12 facilities in two districts, from the provider's perspective. A combination of ingredients-based and step-down allocation costing approaches was used. The diseases under study were diabetes, hypertension, chronic obstructive pulmonary disease (COPD), epilepsy and HIV infection. Data were collected through a review of facility records, direct observation and structured interviews with health workers. Results: Provision of chronic care services was concentrated at higher-level facilities. Excluding drugs, the total costs for NCD care fell below 2% of total facility costs. Unit costs per visit varied widely, both across different levels of the health system, and between facilities of the same level. This variability was driven by differences in clinical and drug prescribing practices. Conclusion: Most patients reported directly to higher-level facilities, bypassing nearby peripheral facilities. NCD services in Uganda are underfunded particularly at peripheral facilities. There is a need to estimate the budget impact of improving NCD care and to standardise treatment guidelines. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd. Source

Hayes R.,London School of Hygiene and Tropical Medicine | Kapiga S.,Mwanza Intervention Trials Unit | Padian N.,London School of Hygiene and Tropical Medicine | Padian N.,University of California at Berkeley | And 3 more authors.
AIDS | Year: 2010

Previous papers in this supplement have reviewed the evidence of the effectiveness of alternative HIV prevention methods from randomized controlled trials and other studies. This paper draws together the main conclusions from these reviews. A conceptual framework is presented that maps the proximal and distal determinants of sexual HIV transmission and helps to identify the stages in the causal pathway at which each intervention approach acts. The advances, gaps and challenges emerging from the reviews of individual intervention methods are summarized and cross-cutting themes identified. Approximately 90% of HIV prevention trials have found no effect on HIV incidence and we explore the alternative explanations for the large number of 'flat' trials. We conclude that there is no single explanation for these flat results, which may be due to interventions that are ineffective or inappropriately targeted or implemented, or to factors related to the design or conduct of trials. We examine the lessons from these flat results and provide recommendations on what should be done differently in future trials. HIV prevention remains of critical importance in an era of expanded delivery of antiretroviral therapy. In future HIV prevention research, it is important that resources are used as efficiently as possible to provide rigorous evidence of the effectiveness of a wider array of complementary prevention tools. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Smit P.W.,Leiden Cytology and Pathology Laboratory | Smit P.W.,London School of Hygiene and Tropical Medicine | van der Vlis T.,Leiden Cytology and Pathology Laboratory | Mabey D.,London School of Hygiene and Tropical Medicine | And 11 more authors.
BMC Infectious Diseases | Year: 2013

Background: Syphilis causes up to 1,500,000 congenital syphilis cases annually. These could be prevented if all pregnant women were screened, and those with syphilis treated with a single dose of penicillin before 28 weeks gestation. In recent years, rapid point-of-care tests have allowed greater access to syphilis screening, especially in rural or remote areas, but the lack of quality assurance of rapid testing has been a concern. We determined the feasibility of using dried blood spots (DBS) as specimens for quality assurance of syphilis serological assays.Methods: We developed DBS extraction protocols for use with Treponema pallidum particle agglutination assay (TPPA), Treponema pallidum haemagglutination assay (TPHA) and an enzyme immunoassay (EIA) and compared the results with those using matching plasma samples from the same patient.Results: Since DBS samples showed poor performance with TPHA and EIA (TPHA sensitivity was 50.5% (95% confidence interval: 39.9-61.2%) and EIA specificity was 50.4% (95% CI: 43.7-57.1%), only the DBS TPPA was used in the final evaluation. DBS TPPA showed an sensitivity of 95.5% (95% CI: 91.3-98.0%) and a specificity of 99.0% (95% CI: 98.1-99.5%) compared to TPPA using plasma samples as a reference.Conclusion: DBS samples can be recommended for use with TPPA, and may be of value for external quality assurance of point-of-care syphilis testing. © 2013 Smit et al; licensee BioMed Central Ltd. Source

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