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Youth living with HIV (YLWH) face psychosocial challenges and HIV-related stigma, which impact adherence to antiretroviral therapy (ART). This study was designed to understand better the change in mental health symptoms and experiences with stigma among YLWH in Tanzania who completed the original pilot Sauti ya Vijana (SYV), a mental health and life skills group intervention. YLWH who completed SYV and demonstrated a change of ≥2 points in either direction on their Patient Health Questionnaire PHQ-9 (depression screener) from baseline to 18 months were purposively sampled. HIV Stigma was measured using 10-questions from the Berger HIV Stigma Scale, and findings ranged from 4-16 for internal stigma and 6-24 for external stigma. In-depth interviews (IDI) were conducted in Kiswahili and included topics such as history of mental health challenges, perceptions of stigma, and experiences with the SYV intervention. Interviews were transcribed, translated to English, and analyzed for emergent themes. Ten youth, 18-25 years of age, were interviewed; 70% were male. Mean (SD) PHQ-9 scores were 7.3 (SD = 3.5) at baseline and 5.6 (SD = 5.0) at 18 months. All participants reported experiencing intermittent episodes of mental health challenges due to difficult interpersonal relationships and fear of stigma. Youth relied on peer support and skills from the SYV intervention to cope with mental health challenges and stigma. Participants reported fear of being stigmatized by others, which led to behaviors such as skipping medication or avoiding situations for worry about unintentional disclosure. All participants endorsed experiencing external stigma on the HIV stigma scale; however, only 3 of 10 participants reported experiencing enacted stigma when directly asked to describe an experience during in-depth interviews. Participants described how SYV helped them have "more confidence", accept themselves, and incorporate positive coping skills such as relaxation (deep breathing) when they felt stressed. The findings suggest SYV helped YLWH accept themselves, develop positive coping methods, and identify and form peer social support; but stigma remains common. Descriptions of stigma were not recognized as such; experiences of enacted stigma were acknowledged by some participants. More research is needed to understand and measure mental distress and wellness as well as stigma in this population so that interventions may more accurately detect change in key outcomes. more...

Although 85% of HIV-positive adolescents reside in sub-Saharan Africa, little is known about the psychosocial and mental health factors affecting their daily well-being. Identifying these contextual variables is key to development of culturally appropriate and effective interventions for this understudied and high-risk population. The purpose of this study was to identify salient psychosocial and mental health challenges confronted by HIV-positive youth in a resource-poor Tanzanian setting. A total of 24 qualitative interviews were conducted with a convenience sample of adolescents aged 12-24 receiving outpatient HIV care at a medical center in Moshi, Tanzania. All interviews were audio-recorded, transcribed, and coded using thematic analysis. Psychosocial challenges identified included loss of one or more parents, chronic domestic abuse, financial stressors restricting access to medical care and education, and high levels of internalized and community stigma among peers and other social contacts. Over half of youth (56%) reported difficulties coming to terms with their HIV diagnosis and espoused related feelings of self-blame. These findings highlight the urgent need to develop culturally proficient programs aimed at helping adolescents cope with these manifold challenges. Results from this study guided the development of Sauti ya Vijana (The Voice of Youth), a 10-session group mental health intervention designed to address the psychosocial and mental health needs of HIV-positive Tanzanian youth. more...

Youth living with HIV (YLWH) face psychosocial challenges and HIV-related stigma, which impact adherence to antiretroviral therapy (ART). This study was designed to understand better the change in mental health symptoms and experiences with stigma among YLWH in Tanzania who completed the original pilot Sauti ya Vijana (SYV), a mental health and life skills group intervention. YLWH who completed SYV and demonstrated a change of ≥2 points in either direction on their Patient Health Questionnaire PHQ-9 (depression screener) from baseline to 18 months were purposively sampled. HIV Stigma was measured using 10-questions from the Berger HIV Stigma Scale, and findings ranged from 4–16 for internal stigma and 6–24 for external stigma. In-depth interviews (IDI) were conducted in Kiswahili and included topics such as history of mental health challenges, perceptions of stigma, and experiences with the SYV intervention. Interviews were transcribed, translated to English, and analyzed for emergent themes. Ten youth, 18–25 years of age, were interviewed; 70% were male. Mean (SD) PHQ-9 scores were 7.3 (SD = 3.5) at baseline and 5.6 (SD = 5.0) at 18 months. All participants reported experiencing intermittent episodes of mental health challenges due to difficult interpersonal relationships and fear of stigma. Youth relied on peer support and skills from the SYV intervention to cope with mental health challenges and stigma. Participants reported fear of being stigmatized by others, which led to behaviors such as skipping medication or avoiding situations for worry about unintentional disclosure. All participants endorsed experiencing external stigma on the HIV stigma scale; however, only 3 of 10 participants reported experiencing enacted stigma when directly asked to describe an experience during in-depth interviews. Participants described how SYV helped them have "more confidence", accept themselves, and incorporate positive coping skills such as relaxation (deep breathing) when they felt stressed. The findings suggest SYV helped YLWH accept themselves, develop positive coping methods, and identify and form peer social support; but stigma remains common. Descriptions of stigma were not recognized as such; experiences of enacted stigma were acknowledged by some participants. More research is needed to understand and measure mental distress and wellness as well as stigma in this population so that interventions may more accurately detect change in key outcomes. [ABSTRACT FROM AUTHOR] more...

ObjectiveWe assessed the relationship of self-reported adherence versus antiretroviral therapy (ART) concentrations in hair with virologic outcomes among young people living with HIV.DesignThis was a cross-sectional study that enrolled young people living with HIV age 11-24 years, who attended a youth HIV clinic in Moshi, Tanzania.MethodsART adherence was assessed by self-report, drug concentration in hair samples, and plasma HIV-1 RNA measurements. Those with virologic failure, defined as plasma HIV-1 RNA more than 400 copies/ml, had genotypic resistance assessed. Receiver operating characteristic curves were used to evaluate ART-concentration threshold cutoffs for virologic suppression, after excluding those with known high-level resistance mutations.ResultsAmong 280 young people enrolled, 227 were included in the final analysis. Seventy-two (32%) self-reported inadequate adherence and 91 (40%) had virologic failure. Hair ART-concentration (P more...

Objective: Young people living with HIV (YPLWH) experience increased morbidity and mortality compared to all other age groups. Adolescence brings unique challenges related to sexual reproductive health, the elevated importance of peer groups, and often, emerging symptoms of emotional distress. Failure to address this unique life stage for YPLWH can lead to worse HIV and mental health outcomes. Herein lies the protocol for a hybrid-type-1 effectiveness-implementation trial designed to evaluate a mental health and life skills intervention that aims to address these needs for YPLWH in Tanzania. Methods: This is an individually randomized group-treatment trial designed to evaluate the effectiveness of Sauti ya Vijana (SYV: The Voice of Youth) toward improving viral suppression (HIV RNA <400 copies/mL) and mental health outcomes and to assess implementation including acceptability, feasibility, fidelity, and cost-effectiveness of the manualized intervention. The trial is being conducted across four geographically distinct regions of Tanzania. Peer group leaders (PGL) with lived HIV experience deliver the 10-session group-based intervention and two individual sessions during which participants describe their disclosure narrative (when they learned they live with HIV) and value-based goal setting. Caregiver or chosen supportive adults are encouraged to attend two specific group sessions with their youth. Participants are 10–24 years of age, prescribed antiretroviral therapy for at least 6 months, fully aware of their HIV status, able to commit to session attendance, and able to understand and meaningfully contribute to group sessions. Participant study visits occur at 5 time points for evaluation: baseline, 4-, 6-, 12-, and 18-months post baseline. A single booster session is conducted before the 12-month visit. Study visits evaluate mental health, adverse childhood events, interpersonal violence, resilience, stigma, HIV knowledge, substance use, sexual relationships, ART adherence, and HIV RNA. Implementation outcomes evaluate feasibility and acceptability through attendance, intervention session notes, focus discussion groups and qualitative interviews. Fidelity to the intervention is measured using fidelity checklists by a PGL observer at each group session. Cost effectiveness is calculated using an incremental cost-effectiveness ratio that utilizes a patient cost questionnaire and financial records of study costs. Significance: Few mental health interventions for YPLWH have demonstrated effectiveness. Results from this study will provide information about effectiveness and implementation of a peer-led intervention for delivering a mental health and life skills intervention in low-income settings. Trial identifier: This trial is registered at clinicaltrials.gov NCT05374109. [ABSTRACT FROM AUTHOR] more...

1 | INTRODUCTION In 2016, approximately two million adolescents about 10 to 19 years of age were living with HIV worldwide [1,2]. Eighty-four per cent of these adolescents lived in [...], Introduction: Scale up of anti-retroviral therapy has enabled millions of children infected with HIV to survive into adulthood, requiring transition of care to the adult HIV clinic. This transition period is often met with anxiety and reluctance. Youth who fail to transition may create strain on capacity in the pediatric and adolescent clinics or result in individuals dropping out of care entirely. This study examined challenges and facilitators to the transition among young adults living with HIV in Moshi, Tanzania. Methods: From April to June 2017, in-depth interviews were conducted with young adults aged 18 to 27 years living with HIV in order to capture the spectrum of experiences from pre-transitioning youth to those who successfully transitioned to adult care. Young adults were purposively recruited based on prior study enrollees and recommendations from healthcare staff. Recruitment occurred in the adolescent, adult HIV and the prevention of mother to child transition clinics at Kilimanjaro Christian Medical Centre. Two separate in-depth interviews were conducted with eligible participants. Medical records were reviewed retrospectively to collect information on HIV-related outcomes. Results: In-depth interviews were held with 19 young adults. Participants mean age was 23.8 years (interquartile range 22.2 to 26.3 years); 53% were female. Most (78.9%) participants had been receiving anti-retroviral therapy for nearly a decade and 72.2% were virologically suppressed (HIV RNA Conclusions: Transition is a complex process influenced by many factors. As the number of young adults living with HIV continues to grow, it is vital to develop a transition protocol that addresses these challenges and is feasible to implement in low-resource settings. Keywords: Transition of care; young adults; youth; challenges; facilitators; HIV; Tanzania more...

Background: The primary aim of this study was to evaluate the performance of four burn prognostic scores—Abbreviated Burn Severity Index (ABSI), Ryan, Belgium Outcome Burn Injury (BOBI), and revised Baux score (rBaux) in a Croatian burn center. A secondary aim was to compare patient outcomes before and after the organizational and protocol changes. Methods: A retrospective study and comparison of four prediction scores was conducted over a nine-year period in burn patients with ≥20% total body surface area (TBSA) burned. Additionally, outcomes before and after organizational changes were compared. Results: A total of 149 patients were included, with the mean patient age of 54.62 ± 19.38 years, the mean of TBSA of 42.98 ± 19.90, and an overall mortality rate of 48.99%. The area under the ROC curve (AUROC) was 0.79 for the rBaux and ABSI score, 0.77 for the BOBI score, and 0.76 for the Ryan score. The duration of mechanical ventilation and length of stay (LOS) in burn intensive care units (BICU) decreased after the organizational changes, though survival rates remained similar. Conclusions: Prognostic scores are good predictors of mortality but with moderate predictive accuracy. Continuity of care in intensive care could be important for better outcomes. more...

Abstract Background This study aimed to examine the status of performance indicators in hospitals affiliated with Qazvin University of Medical Sciences (QUMS) before and after the implementation of the Health Transformation Plan (HTP). Methods This longitudinal descriptive-analytical study was conducted utilizing hospital data. The study collected data using a checklist that included both general characteristics of the participating hospitals and performance indicators such as “the number of outpatient visits,” “the number of paraclinical patients,” “the number of surgeries,” and “the number of inpatients” on a monthly basis for 2012–2019. The intervention examined in this study was the implementation of the HTP in May 2014. The data collected was analyzed using interrupted time series and STATA statistical software version 15. Results The study examined seven hospitals affiliated with QUMS, including general, trauma, pediatric, gynecology, and psychiatry hospitals. The findings indicated a significant increase in outpatient visits, paraclinical patients, and inpatients in the first month after the intervention. Specifically, there was an increase of 1739 in the number of outpatient visits, an increase of 513 in the number of paraclinical patients, and an increase of 135 in the number of inpatients (p more...

Abstract Background Despite the decreased incidence of the human immunodeficiency virus (HIV) in Tanzania, the number of adolescents living with HIV is increasing. This study aimed to describe factors independently associated with viral load non-suppression among adolescents living with HIV (ALHIV) on ART in the Tanga region. Methods We conducted a retrospective study of routinely collected data from ALHIV on ART from October 2018 to April 2022. We extracted data from the Care and Treatment Clinics form number 2 (CTC2) database that included age, sex, BMI, World Health Organization HIV clinical disease stage, marital status, ART duration, viral load suppression, facility level, and Dolutegravir (DTG)-based regimen. We did descriptive analysis using frequencies to describe the study participants’ socio-demographic and clinical characteristics. The Cox proportional hazard regression model was used to identify factors associated with viral load non-suppression (VLS). Viral load non-suppression was defined as viral load ≥ 1000 copies/ml. A total of 4735 ALHIV on ART were extracted from CTC2, then 2485 were excluded (2186 missed viral load results, 246 were lost to follow-up, and 53 deaths). Results 2250 ALHIV on ART were tested for viral load, of whom 2216 (98.62%) adolescents were on first-line ART, and 2024 (89.96%) participants were virally suppressed, while 226 (10.04%) were virally non-suppressed. In addition, 2131 (94.71%) of participants were using a DTG-based regimen; of them, 1969 (92.40%) were virally suppressed. Not using a DTG-based regimen (HR: 9.36, 95% CI 3.41–15.31) and dispensary facility level (HR: 3.61, 95% CI 1.44–7.03) were independently associated with increased hazard for viral load non-suppression. In addition, adolescents aged between 15 and 19 years are less likely to be virally suppressed (HR: 0.55, 95% CI 0.30–0.99). Conclusions The dispensary facility level and not using a DTG-based regimen were significantly associated with viral load non-suppression. HIV intervention strategies should ensure a DTG-based regimen utilization in all adolescents living with HIV, and techniques used by higher-level health facilities should be disseminated to lower-level facilities. more...

Abstract Background Availability and accessibility of Antiretroviral drugs (ARV’s) improve the lives of People living with HIV (PLHIV) by improving client’s immune system to overcome infections and prevent the development of AIDS and other HIV complications. Combination therapy, early initiation of ART, newer ART drugs, single dosage and drug affordability significantly contribute in the reduction of viral multiplication and suppression of HIV to undetectable plasma levels. Methods A retrospective longitudinal study design study was conducted from 1st October, 2018 to 30th June 2022 in all supported HIV care and treatment health facilities in Tanga region which were supported by Amref Health Africa, Tanzania. The participants were HIV adult patients aged 15 years and above on ART and attended the clinic at least once after ART initiation. Viral load suppression levels are defined with viral load 15 years whom were on ART were included in the analysis to determine the level of plasma Viral Load suppression after being on ART. Female 41,304 (69.4%) and male 18,199 (30.6%). Only four percent (2,290) were found to be unsuppressed i.e having plasma Viral Load >1,000cp/ml while 96% (57,213) were virally suppressed. Several factors were independently associated with virologic failure that included; age between 15 - more...

Background and Purpose: Organizational commitment among nurses, a critical aspect of hospital workforce management, is influenced by various factors, including job attachment. This attachment fosters motivation and commitment, which ultimately enhances the quality of healthcare services. This study investigates the relationship between organizational commitment and job attachment among nurses working in selected teaching hospitals affiliated with Shahid Sadoughi University of Medical Sciences in Yazd in 2022. Methods: This descriptive-analytical study involved all nurses at Shahid Sadoughi Hospital in Yazd. A sample size of 298 nurses was determined using Cochran's formula. Data collection was conducted using the Job Descriptive Index (JDI) by Edwards and Kilpatrick (1984) and the Organizational Commitment Questionnaire (OCQ) by Allen and Meyer (1990). The data were analyzed using the Chi-square test with SPSS version 21 software and structural equation modeling via LISREL software. Results: Among the nurses surveyed, 43.17% reported being satisfied with their jobs, while 40.17% exhibited organizational commitment. The findings revealed a significant relationship between job attachment and organizational commitment (P more...

Abstract Background Breast self-examination is a simple, painless, confidential and inexpensive screening method for early diagnosis that does not require specialized tools and equipment. In this study, we have estimated the pooled percentage of breast self-examination (BSE) in Iranian women. Methods All the published literatures between 2012 and 2022 have been reviewed. Searches were performed in PubMed, Web of Science, ProQuest, Science Direct, Google Scholar, Scientific Information and Magiran databases. The effect size was the pooled percentage of breast self-examination (BSE). In order to check the heterogeneity, the estimation of the I2 index and extraction of the Galbraith plot were used, and the drivers of heterogeneity have been identified through meta-regression and estimates were made based on subgroups. All the analysis was done in STATA 15. Results From the initial 294 records, 38 were included in the final analysis in which 9960 women have been studied. The heterogeneity of the studies was high based on the variation in OR (I2 = 98.4%, heterogeneity X2 = 2278.21 (d.f. = 37), p more...

Background: Scene management in accidents reduces losses, speeds treatment, and facilitates immediate victim transfer. Learning the related skills through theory-based educational intervention makes this task possible. This study aimed to determine the effect of theory-based educational intervention on emergency medical personnel skills to manage the scene in chemical accidents. Materials and Methods: The present study employed a quasi-experimental design with pre- and post-intervention measurements. Using the random sampling method, 70 emergency medical technicians working in Qazvin Province, Iran, were selected and assigned to experimental and control groups. The data collection tools included demographic questions and scales to assess the theory of planned behavior. The intervention program consisted of 4 sessions. Data were analyzed by SPSS software, version 23 using descriptive statistics and analysis of covariance. Results: The Mean±SD age of the participants was 35.03±5.57 years, and 82.6% (57 people) were married. After the intervention, the Mean±SD scores of attitudes (40.11±4.77), subjective norms (15.06±4.27), perceived behavior control (18.53±2.55), and behavioral intention (8.49±2.27) increased significantly in the experimental group (P more...

Various interventions have been investigated to improve the uptake of colorectal cancer screening. In this paper, the authors have attempted to provide a pooled estimate of the effect size of the BE interventions running a systematic review based meta-analysis. In this study, all the published literatures between 2000 and 2022 have been reviewed. Searches were performed in PubMed, Scopus and Cochrane databases. The main outcome was the demanding the one of the colorectal cancer screening tests. The quality assessment was done by two people so that each person evaluated the studies separately and independently based on the individual participant data the modified Jadad scale. Pooled effect size (odds ratio) was estimated using random effects model at 95% confidence interval. Galbraith, Forrest and Funnel plots were used in data analysis. Publication bias was also investigated through Egger's test. All the analysis was done in STATA 15. From the initial 1966 records, 38 were included in the final analysis in which 72612 cases and 71493 controls have been studied. About 72% have been conducted in the USA. The heterogeneity of the studies was high based on the variation in OR (I2 = 94.6%, heterogeneity X2 = 670.01 (d.f. = 36), p < 0.01). The random effect pooled odds ratio (POR) of behavioral economics (BE) interventions was calculated as 1.26 (95% CI: 1.26 to 1.43). The bias coefficient is noteworthy (3.15) and statistically significant (p< 0.01). According to the results of this meta-analysis, health policy and decision makers can improve the efficiency and cost effectiveness of policies to control this type of cancer by using various behavioral economics interventions. It's noteworthy that due to the impossibility of categorizing behavioral economics interventions; we could not perform by group analysis. more...

Introduction and purpose: In order to have more effective programs and social interventions controlling the burden of diseases, it is necessary for policy makers to have valid evidence about the role of socioeconomic determinants. The present study aimed to provide empirical evidence about the relationship of socioeconomic inequalities and the availability of resources with the burden of diseases among the provinces of the country in 2019. Methods: This descriptive and analytical research was carried out using the provincial data of 2019. The required provincial data were extracted from the Statistical Yearbook Report and the Household Income Expenditure Report of the Statistics Center and the data related to adjusted years with disability and early death (DALI) from the 2019 disease burden estimates. DALY's inequality was investigated by estimating the concentration index and extracting the concentration curve at a 95% confidence interval. The analyses were carried out in the Stata software (version 15). Results: In 2019, the average per capita DALY was 18.33±3.98. The average socio-economic index and resource availability index for 31 provinces were obtained at 0.37±0.21 and 0.64±0.20, respectively. Considering the difference in the available resources (covariate), there was a statistically significant difference between the socio-economic quartiles in terms of the distribution of per capita DALY (P more...

Abstract Background Interruption in Treatment (IIT) is a challenge in HIV care and treatment programs in sub- Saharan Africa. High IIT among HIV adolescents has both individual and potential public health consequences including discontinuation of treatment, increased HIV transmission and risk of death. In this era of test and treat policy it is important to ensure that patients remain connected to HIV clinics to enable achieve UNAIDS 95-95-95 targets timely. This study aimed to assess risk factors for IIT among HIV-positive adolescence in Tanzania. Methods We conducted retrospective longitudinal cohort study using secondary data of adolescent patients enrolled in care and treatment clinics in Tanga from October 2018 to December 2020. We defined Interuption in Treatment as missing clinic visits for 90 consecutive days after the last scheduled appointment date on anti-retroviral therapy (ART). Cox proportional hazard regression models were employed to identify risk factors of the outcome variable. Results Among 2,084 adolescents of age between 15 and 19 years were followed for two years, whereby 546 (26.2%) had interrupted treatment. The median age of the participants was 14.6 years (interquartile range, IQR: 12.6–16.6 years), with age between 15 and 19 years, male sex, with advanced HIV disease and were not on Dolutegravir (DTG) related regimens were associated with interruption in treatment; (Hazard ratio (HR) 1.43, 95% CI: 1.23–1.66, p more...