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Objectives: This cross‐sectional survey aimed to explore associations between age of menarche, early sexual debut and high‐risk sexual behaviour among urban Tanzanian schoolgirls. Methods: Secondary schoolgirls aged 17–18 years from Mwanza, Tanzania, participated in structured face‐to‐face questionnaire‐based interviews, conducted by nurses and clinicians. Age of menarche was evaluated in categories of 11–12, 13–14, 15–16 or ≥17 years. Primary outcome measures were self‐reported early sexual debut (first vaginal sex at <16 years) and high‐risk sexual behaviour, including non‐use of condoms, having sex for gifts/money, having older sexual partners and/or other risky behaviours. Results: Of 401 girls enrolled, 174 (43.4%) reported prior vaginal sex. Prevalence of early sexual debut was 14.2% but pressured/forced sex and risky sexual behaviours were common. Adjusted for potential confounding, younger age at menarche was associated with early sexual debut (adjusted odds ratio for linear trend: 1.88 per category, 95% confidence interval: 1.21–2.92, p = 0.005). This association remained after excluding girls with first sex at <8 years or experiencing pressure or force at first sex. Further, adjusted for potential confounding (including ever experiencing forced sex), early sexual debut was associated with high‐risk sexual behaviour (adjusted odds ratio: 2.85, 95% confidence interval: 1.38–5.88, p = 0.004). Conclusions: Among urban Tanzanian school girls, younger age of menarche was associated with early sexual debut, and early sexual debut was associated with high‐risk sexual behaviour. Researchers and public health professionals developing and delivering interventions aimed at preventing adverse sexual health outcomes should consider the impact of these early biological and sexual exposures. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa (SSA), hospitalized HIV-infected patients who are discharged home have been shown to experience extremely high mortality rate. Daraja is an individual-level, time-limited, five-session case management intervention aiming to link hospitalized HIV-infected patients to outpatient HIV care upon discharge. A randomized control trial will aim at evaluating the efficacy of Daraja intervention on reducing mortality in hospitalized HIV-infected patients upon discharge from hospital. The study will recruit 500 hospitalized HIV-infected adults who are ART naïve or defaulted for >7 days from hospitals in Mwanza region, Tanzania. Participants will be enrolled during hospitalization and a baseline assessment will be done. Participants will be randomized to receive either the standard of care HIV linkage, or the Daraja intervention a day before the expected hospital discharge date. The Daraja intervention includes five sessions delivered by a social worker over a 3-month period. All participants will complete follow-up assessment at month 12 and 24. Measures will include 1-year survival, HIV care continuum outcomes (linkage, retention, antiretroviral adherence, and viral suppression), and cost (incremental cost of the intervention and cost per life saved). Quality assurance data will be collected, and the feasibility and acceptability of the intervention will be described. Statistical analysis will assess the effectiveness of the Daraja intervention on improving survival and HIV care continuum outcomes. Hospitalized HIV-infected patients who are being discharged home have higher mortality due to poor linkage to primary HIV care. The Daraja intervention has the potential to address barriers that prevent successful transition from hospital to primary HIV care. Trial registration : ClinicalTrials.gov , NCT03858998. Registered on 01 March 2019. [ABSTRACT FROM AUTHOR]