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Retention in methadone maintenance treatment is instrumental in achieving better treatment outcomes. In this study, we compared 2 medication-assisted treatment (MAT) clinics in Dar es Salaam, Tanzania with respect to patient characteristics, outcomes, and factors that predict 12-month treatment retention.This retrospective registry-based cohort study utilized data collected for routine clinical and program monitoring at 2 sites, Mwananyamala and Muhimbili MAT clinics. Cumulative retention in treatment was calculated using life tables. The analysis of treatment retention predictor variables used both Kaplan-Meier and Cox proportional hazard analyses.We examined the socio-demographic and program-related characteristics of 362 (181 from each clinic) patients. Twelve-month treatment retention was higher at Mwananyamala (73%) than Muhimbili (64%) MAT clinic, but the difference was not significant. In both clinics, a higher methadone dose (gt;60mg) significantly predicted treatment retention ( Plt; 0.05). Being employed and traveling an average short distance (lt;5 km) from home to clinic significantly increased the likelihood of remaining in treatment in Muhimbili MAT clinic (Plt; 0.05) only.A methadone dose of 60 mg and above was associated with longer retention in treatment. At 1 clinic in a denser and more central location, employment and a short travel distance from home to clinic were associated with longer tenure in treatment. These findings have potential implications for clinical practice, research, and scaling up MAT services in Tanzania.

Women with disabilities are at risk of experiencing multiple forms of severe and prolonged violence, yet guidelines for screening this population are unclear, screening rates are historically low, and screening tools may be inadequate to capture disability-related aspects of abuse. We conducted qualitative in-depth interviews with 33 rural women in the United States with diverse disabilities and experiences of violence. They described overarching healthcare provider and system factors that influenced their trust and confidence in healthcare delivery as an avenue to support their safety. Women described interactions with the healthcare system during their experience of violence as a missed opportunity for identifying and responding to their abuse and connecting them with resources. We conclude with policy and practice recommendations based on women with disabilities’ perspectives and insights.

As human genomics research in Africa continues to generate large amounts of data, ethical issues arise regarding how actionable genetic information is shared with research participants. The Human Heredity and Health in Africa Consortium (H3Africa) Ethics and Community Engagement Working group acknowledged the need for such guidance, identified key issues and principles relevant to genomics research in Africa and developed a practical guideline for consideration of feeding back individual genetic results of health importance in African research projects. This included a decision flowchart, providing a logical framework to assist in decision-making and planning for human genomics research projects. Although presented in the context of the H3Africa Consortium, we believe the principles described, and the decision flowchart presented here is applicable more broadly in African genomics research.

Background: Low literacy of study participants in Sub Saharan Africa has been associated with poor comprehension during consenting process in research participation. The concerns in comprehension are far greater when consenting to participate in genomic studies due to the complexity of the science involved. While efforts are made to explore possibilities of applying genomic technologies in diseases prevalent in Sub Saharan Africa, we ought to develop methods to improve participants’ comprehension for genomic studies. Aim: The aim of this study was to understand different approaches that can be used to seek consent from individuals with low literacy in Sub-Saharan African countries in genomic research to improve comprehension. Methods: Using qualitative study design, we conducted focus-group discussions, in-depth interviews and participant observations as data collection methods. This study was embedded in a hospital based genomic study on Sickle Cell Disease at Muhimbili National Hospital in Tanzania. Thematic content analysis was used to analyse the transcripts and field notes. Results: Findings from this study show that literacy level has little influence on understanding the research details. According to the participants of this study, the methods used to provide information, the language, and time spent with the study participants were the key factors influencing understanding. The availability of group sessions held before individual consent to allow for a detailed questions and answers format was agreed to be the best method to facilitate the comprehension. Conclusion: The quality of the consenting process of participants will be influence by a number of factors. The type of research consented for, where the research will be implemented and who are the potential study participants are amongst the factors that need to be assessed during the consenting. Measures to improve participants’ comprehension need to be developed when consenting participants with low literacy level in genomic studies.

Advances in omics technologies alone are not a guarantee that science will translate to robust responsible innovation that is firmly grounded in societal values. This study aimed to identify best practices for Ethical, Legal, and Social Implications (ELSI) research in Africa that allows for optimal integration of community perspectives into the design and implementation of genomics research. In a large sample of 346 stakeholders in Cameroon, Ghana, and Tanzania (59% women), we used a qualitative study design with a phenomenological approach and conducted 32 group and 74 individual interviews (25% rural). We imported interview recordings into NVivo software for analysis. We created a “concept map” to organize the coded information, with Perspectives on Genomics and Sickle Cell Disease (SCD) Public Health Interventions as the central themes. We found that (1) analyses of major subthemes across and within countries revealed differential knowledge and experiences of SCD, and perspectives on various aspects of research and genomics; (2) we were able to gather empirical data efficiently from urban and rural stakeholders, to study the issues related to sample sharing, consent processes, and return of clinical and genomic study results; (3) the concept of nondirectiveness in modern genetic medicine practice can be challenged by the views of stakeholders in the context of a high-burden disease such as SCD; and (4) linking community views to current and proposed public health interventions could be understood within the context of each specific country. Our work informs future qualitative social science and technology policy research designs on genomics applications in Africa.

Interviews were conducted with 203 male and 95 female heroin injectors aged 17 to 25 in Dar es Salaam, Tanzania. Nearly one-quarter of participants reported injecting with needles used by someone else. Few reported cleaning needles with bleach. Multiple sexual partnerships, unprotected sex, and trading sex for money were especially present among women, the majority (55%) of whom was HIV seropositive. Self reports suggest the presence of heroin dependence among users. While most participants expressed a desire to quit their use, only 14 (5%) had been in treatment. There appears to be a large unmet need for heroin use treatment. These findings need to be considered in light of a potential forthcoming wave of heroin injection in sub-Saharan Africa.

The Internet has developed as a major site for sexual activity, both cybersex and for making contacts for sex in real life (IRL). As part of a major study of HIV-risk behavior on the Internet and IRL , we obtained on-line responses from 1,017 Latino men who have sex with men (MSM) in the U.S. Open-ended questions solicited responses regarding whether respondents preferred to meet sexual partners first IRL (48.4%), on the Internet (31.6%), or "it depends" (20%), and "why?". Data were analyzed by theme, with themes grouped into overarching domains. Data indicate that for those preferring the Internet, themes represented were ease of Internet use, its advantages for people who were shy, and its anonymity, safety, the excitement and opportunity for experimentation of Internet contact, ability to avoid interpersonal contact, and control of visuals and the environment. Reasons for preferring meeting IRL included some of the same themes, but emphasizing the importance of a "real presence" and the possibility to build a relationship. Where "it depends", key themes were contextual: mood, time, setting, alcohol and drug use, sexual needs and urgency, and relationship intentions. Antagonistic advantages were often noted for cybersex and IRL. These data suggest that motivations for making Internet sexual contact in MSM are complex, depend on the context and nature of the relationship sought, and that the Internet has allowed the development of a class of sexual contacts located between IRL and fantasy.

Introduction - "wicked" women and the reconfiguration of gender in Africa, Dorothy L. Hodgson and Sheryl McCurdy. Part 1 Contesting conjugality: women, marriage, divorce and the emerging colonial state in Abeokuta (Nigeria) 1892-1904, Judith Byfield "she thinks she's like a man" - marriage and deconstructing gender identity in colonial Buha, Western Tanzania, 1943-1960, Margot Lovett wayward women and useless men - contest and change in gender relations in Ado-Odo, South West Nigeria, Andrea Cornwall "gone to their second husbands" - marital metaphors and conjugal contracts in The Gambia's female garden sector, Richard A. Schroeder II. Part 2 Confronting authority: dancing women and colonial men - the "Nwaobiala" of 1925, Misty L. Bastian rounding up spinsters - gender chaos and unmarried women in colonial Asante, Jean Allman "my daughter ... belongs to the government now" - marriage, Maasai and the Tanzania state, Dorothy L. Hodgson. Part 3 Taking spaces/making spaces: gender and the cultural construction of "bad women" in the development of Kampala-Kibuga, 1900-62, Nakanyike B. Musisi you have left me wandering about - Basotho women and the culture of mobility, David B. Coplan urban threats - Manyema women, low fertility and venereal diseases in British colonial Tanganyika, 1926-36, Sheryl McCurdy negotiating social independence - the challenges of career pursuits for Igbo women in post-colonial Nigeria, Philomena E. Okeke. Part 4 Negotiating difference: the politics of difference and women's associations in Niger - of "prostitutes", the public and politics, Barbara M. Cooper "wicked women" and "respectable ladies" - reconfiguring gender on the Zambian copperbelt, 1936-64, Jane L. Parpat gender and profiteering -Ghana's market women as devoted mothers and "human vampire bats", Gracia Clark.

Interviews were conducted with 203 male and 95 female heroin injectors aged 17 to 25 in Dar es Salaam, Tanzania. Nearly one-quarter of participants reported injecting with needles used by someone else. Few reported cleaning needles with bleach. Multiple sexual partnerships, unprotected sex, and trading sex for money were especially present among women, the majority (55%) of whom was HIV seropositive. Self reports suggest the presence of heroin dependence among users. While most participants expressed a desire to quit their use, only 14 (5%) had been in treatment. There appears to be a large unmet need for heroin use treatment. These findings need to be considered in light of a potential forthcoming wave of heroin injection in sub-Saharan Africa.Key Words: HIV, injection drug use, Africa, heroin, drug dependence treatment