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Adolescents with Human Immunodeficiency Virus (HIV) are at greater risk for mental health problems than their HIV-negative counterparts. However, there is a dearth of evidence on the need for mental health services, including interventions for depression in adolescents with HIV (AWHIV), in most low- and middle-income countries (LMICs). This study's objective was to explore the unmet mental health needs of AWHIV to inform the development and implementation of a psychological intervention for depression in AWHIV in Dar es Salaam, Tanzania. A descriptive phenomenological qualitative study design was used. Consultative meetings with providers and 45 in-depth interviews were conducted with AWHIV, caregivers, and healthcare providers (HCPs) to explore their experiences and unmet mental health needs for AWHIV. Data from the consultative meetings were triangulated to validate the obtained information with those from interviews. Data were organized and managed with the aid of NVIvo-11. The thematic analysis framework guided data analysis. Five major themes emerged: Experience of complex symptoms, unmet need for services, impact of the unmet needs, ways utilized in managing symptoms, and preferred intervention. Complex depressive symptoms expressed as physical, behavioral, or somatic complaints adversely affected ART adherence and academic performance, led to substance use, and compromised overall quality of life in AWHIV. HIV-Care and Treatment Centers (HIV-CTCs) did not conduct formal mental health screenings. Instead, caregivers and HCPs addressed the symptoms of mental health problems with death threats and corporal punishments. No evidence-based depression interventions existed in HIV-CTCs for observed symptoms. This study reports on unmet mental health needs with a clear impact on the lives of AWHIV, which may have significant implications for treatment adherence. There is an urgent need to develop and implement effective and scalable interventions to address these mental health needs. [ABSTRACT FROM AUTHOR]

The study explores barriers and suggestions for improving viral load testing (VLT) uptake in Tanzania, revealing that only 58% of patients receive VLT annually, contrary to the Tanzanian National Guidelines toward the 95-95-95 UNAIDS targets. Twelve individual interviews and three patient-focus groups were conducted as part of a qualitative study conducted in six human immunodeficiency virus (HIV) clinics in Dar es Salaam to identify potential suggestions for access enhancement, as well as barriers to VLT uptake. Using King's theory of goal attainment, we found that missing appointments was the primary individual barrier to VLT uptake, along with limited knowledge among individuals living with HIV. Participants also face system–level barriers, such as a lack of integrated care and evening service availability. The study suggests that, despite challenges, there is potential for improvement in the uptake and quality of VLT services in Tanzanian public health facilities through a holistic approach. Plain Language Summary: Patients' and care providers' reported barriers and suggestions for improving HIV viral load testing in Tanzania: A qualitative study in Dar es Salaam The study investigates barriers and potential suggestions to improve viral load testing (VLT) uptake in Tanzania, highlighting that only 58% of patients receive VLT annually, contrary to the Tanzanian national guidelines. A qualitative study in six HIV clinics in Dar es Salaam involved 12 in-depth interviews and three patient-focused group discussions to identify facilitators and barriers to VLT uptake, using King's goal attainment theory. Missing appointments is the main barrier to VLT uptake, attributed to distance from care and high transport costs. Healthcare providers and patients also face systemic and structural barriers, such as a lack of integrated care and evening service availability. Patients suggest effective communication, service extension, and knowledge sharing to improve VLT uptake. The study suggests that, despite challenges, there is potential for improvement in the uptake and quality of VLT services in Tanzanian public health facilities through a holistic approach. [ABSTRACT FROM AUTHOR]

Background Perinatal women living with HIV (PWLH) have a greater risk of depression compared to other women; however, there are limited specialized mental health services available to them. We aimed to determine whether a stepped-care intervention facilitated by trained lay providers can improve mental health outcomes postpartum for PWLH. Methods and findings Healthy Options is a cluster-randomized controlled study conducted in 16 government-managed antenatal care clinics that provided HIV care for pregnant women in urban Tanzania. Recruitment occurred from May 2015 through April 2016, with the final round of data collection completed in October 2017. Participants included a consecutive sample of pregnant women under 30 weeks of gestation, living with HIV and depression, and attending the study clinics. Control sites received enhanced usual care for depression (EUDC). Intervention sites received EUDC plus the Healthy Options intervention, which includes prenatal group sessions of problem-solving therapy (PST) plus cognitive behavioral therapy (CBT) sessions for individuals showing depressive symptoms at 6 weeks postdelivery. We assessed depressive symptoms comparable to major depressive disorder (MDD) using the Patient Health Questionnaire-9 (PHQ-9) with a locally validated cutoff at 9 months and 6 weeks postpartum. The primary time point is 9 months postpartum. We examined differences in outcomes using an intent-to-treat analysis with a complete case approach, meaning those with data at the relevant time point were included in the analysis. We used generalized estimating equations accounting for clustering. Of 818 women screened using the PHQ-9, 742 were determined eligible and enrolled (395 intervention; 347 control); 649 women (87.5%) participated in the first follow-up and 641 women (86.4%) in the second. A majority (270, 74.6%) of women in the intervention arm attended 5 or more PST sessions. Women enrolled in Healthy Options demonstrated a 67% (RR 0.33; 95% CI: 0.22, 0.51; p-value: Conclusions The Healthy Options intervention did not demonstrate reduction in depressive symptoms at 9 months postpartum, the primary outcome. Significant reductions were seen in depression symptoms at 6 weeks postpartum, the secondary outcome. Stepped-care interventions may be relevant for improving outcomes in the critical early postpartum window. Trial registration Clinical Trial registration number (closed to new participants) NCT02039973, Author(s): Sylvia Kaaya 1, Hellen Siril 2, Mary C. Smith Fawzi 3, Zenaice Aloyce 2, Ricardo Araya 4, Anna Kaale 2, Muhummed Nadeem Kasmani 3, Amina Komba 2, Anna Minja [...]

Background: There is a treatment gap for those living with severe mental illnesses in low- and middle-income countries, yet not enough is known about those who are currently accessing clinical services. A better understanding of potentially modifiable factors associated with functioning and quality of life will help inform policies and programming. Aims: To describe the functioning and quality of life for a psychiatric treatment-engaged population living with psychotic disorders in two urban areas of Tanzania, and to explore their respective correlates. Methods: This study analyzed cross-sectional data from 66 individuals enrolled in the Kuwezeshana Kupata Uzima (KUPAA) pilot clinical trial who had a diagnosis of schizophrenia or schizoaffective disorder, recent relapse, and who were receiving outpatient treatment. Baseline functioning (WHO Disability Assessment Schedule 2.0) and quality of life (WHO Quality of Life BREF scale) were measured. Univariable and multivariable regression analyses were conducted to determine correlates of functioning and quality of life. Results: Adjusted analyses indicated that higher disability was associated with higher food insecurity, more symptomatology, more self-stigma, less instrumental support, less hope, lower self-efficacy, and/or lower levels of family functioning. Higher quality of life was associated with higher levels of self-efficacy, more hopefulness, more instrumental support, less self-stigma, and better family functioning. Conclusions: Identification of factors associated with disability and quality of life can help clinicians and policymakers, as well as consumers of mental health services, to better co-design and target psychosocial interventions to optimize their impact in low-resource settings. Trial registration: Trial registration: ClinicalTrials.gov # NCT04013932, July 10, 2019. [ABSTRACT FROM AUTHOR]

Purpose Clinical trials are necessary to test HIV-prevention strategies among adolescent girls and young women in sub-Saharan Africa. Psychosocial risk factors that increase girls' and young women's vulnerability for HIV may also impact their experiences in clinical trials. A better understanding of psychosocial risks among girls and young women enrolled in HIV-prevention research is needed. This analysis explores depression and sexual trauma among adolescent girls and young women enrolled in a mock microbicide trial in Tanzania. Methods We collected cross-sectional data from 135 HIV-negative adolescent girls and young women between 15 and 21 in Dar es Salaam, Tanzania enrolled in a mock microbicide trial. Depression, sexual behavior, and sexual trauma were measured. Sexual trauma and demographic variables were entered into a multivariate binomial logistic regression model predicting depression. Findings Overall, 27% of participants had moderate-to-severe depression. The most commonly endorsed items were anhedonia (lack of interest/pleasure) and low mood, which were reported by 78% of participants. Thoughts of suicide or self-harm were endorsed by 17% of participants. Coerced/forced first sex was reported by 42% of participants. Participants reporting coerced/forced first sex had 3.16 times the likelihood of moderate-to-severe depression. Conclusions Depression and coerced/forced sex were common among participants in an HIV-prevention mock clinical trial in Tanzania. When enrolling adolescent girls and young women in HIV-prevention trials in sub-Saharan Africa, our research suggests the need for a trauma-informed approach, referrals for trauma and depression, and interventions that address the impact of depression and trauma on HIV prevention, clinical trial adherence, and clinical outcomes., Author(s): Emily M. Cherenack [sup.1] , Elizabeth E. Tolley [sup.2] , Sylvia Kaaya [sup.3] , Jennifer Headley [sup.4] , Joy Noel Baumgartner [sup.4] Author Affiliations: (1) grid.26009.3d, 0000 0004 1936 [...]

Objective To determine the impact of intimate partner violence against women on children's growth and nutritional status in low- and middle-income countries. Methods We pooled records from 42 demographic and health surveys in 29 countries. Data on maternal lifetime exposure to physical or sexual violence by an intimate partner, socioeconomic and demographic characteristics were collected. We used logistic regression models to determine the association between intimate partner violence and child stunting and wasting. Findings Prior exposure to intimate partner violence was reported by 69652 (34.1%) of the 204159 ever-married women included in our analysis. After adjusting for a range of characteristics, stunting in children was found to be positively associated with maternal lifetime exposure to only physical (adjusted odds ratio, aOR: 1.11; 95% confidence interval, CI: 1.09-1.14) or sexual intimate partner violence (aOR: 1.09; 95% CI: 1.05-1.13) and to both forms of such violence (aOR: 1.10; 95% CI: 1.05-1.14). The associations between stunting and intimate partner violence were stronger in urban areas than in rural ones, for mothers who had low levels of education than for women with higher levels of education, and in middle-income countries than in low-income countries. We also found a small negative association between wasting and intimate partner violence (aOR: 0.94; 95%CI: 0.90-0.98). Conclusion Intimate partner violence against women remains common In low- and middle-income countries and is highly detrimental to women and to the growth of the affected women's children. Policy and programme efforts are needed to reduce the prevalence and impact of such violence. Objectif Determiner l'impact de la violence conjugale envers les femmes sur la croissance et l'etat nutritionnel des enfants dans les pays a revenu faible et intermediaire. Methodes Nous avons regroupe les notes de 42 enquetes demographiques et sanitaires menees dans 29 pays. Nous avons recueilli des donnees sur l'exposition des meres a des violences physiques ou sexuelles de la part du conjoint ainsi que sur les caracteristiques socioeconomiques et demographiques. Nous avons utilise des modeles de regression logistique pour determiner l'association entre violence conjugale et retard de croissance ou emaciation des enfants. Resultats Une exposition a des violences conjugales a ete signalee par 69652 (34,1%) des 204159 femmes ayant deja ete mariees qui etaient Incluses dans notre analyse. Apres ajustement en fonction d'un ensemble de caracteristiques, nous avons observe une association positive entre le retard de croissance chez l'enfant et l'exposition des meres a des violences conjugales de nature physique (rapport des cotes ajuste (RCa): 1,11; intervalle de confiance (IC) de 95%: 1,09-1,14), sexuelle (RCa: 1,09; IC 95%: 1,05-1,13) ou a ces deux formes de violence (RCa: 1,10; IC 95%: 1,05-1,14). L'association entre retard de croissance et violence conjugale etait plus marquee en zone urbaine qu'en zone rurale; elle l'etait egalement davantage pour les meres ayant un faible niveau d'education que pour celles ayant un niveau d'education plus eleve et apparaissait aussi plus importante dans les pays a revenu intermediaire que dans ceux a revenu faible. Nous avons egalement observe une legere association negative entre l'emaciation et la violence conjugale (RCa: 0,94; IC 95%: 0,90-0,98). Conclusion La violence conjugale exercee contre les femmes reste courante dans les pays a revenu faible et intermediaire, au grand detriment des femmes et de la croissance de leurs enfants. Des efforts sont necessaires en matiere de politiques et de programmes afin de reduire la prevalence et l'Impact de cette forme de violence. Objetivo Determinar el impacto de la violencia de pareja contra las mujeres en el crecimiento y el nivel de nutricion infantil en paises con ingresos bajos y medios. Metodos Se recopilaron los resultados de 42 encuestas de demografia y salud en 29 paises. Se recogieron datos sobre las caracteristicas socioeconomicas y demograficas en cuanto a la exposicion constante de una madre a violencia fisica o sexual por parte de su pareja. Se utilizaron modelos de regresion logistica para determinar la relacion entre la violencia de pareja y el retraso y la insuficiencia del crecimiento infantil. Resultados Se registro exposicion previa a violencia de pareja en 69 652 (34,1 %) de las 204159 mujeres casadas incluidas en nuestro analisis.Tras fijar una serle de caracteristicas, se observo que el retraso del crecimiento Infantil estaba relacionado con la exposicion constante de la madre solamente a violencia de pareja fisica (coeficiente de posibilidades ajustado, CPa: 1,11; intervalo de confianza, IC, del 95%: 1,09-1,14) o solamente a violencia de pareja sexual (CPa: 1,09; IC del 95%: 1,05-1,13) y a ambas formas de violencia (CPa: 1,10; IC del 95%: 1,05-1,14). La relacion entre la deficiencia del crecimiento y la violencia de pareja era mayor en zonas urbanas que en rurales, en madres con niveles bajos de educacion que en mujeres con niveles altos de educacion, y en paises con ingresos medios que en paises con ingresos bajos.Tambien se observo una pequena relacion negativa entre la insuficiencia del crecimiento y la violencia de pareja (CPa: 0,94; IC del 95%: 0,90-0,98). Conclusion La violencia de pareja contra las mujeres sigue siendo un problema habitual en paises con ingresos bajos y medios y es altamente perjudicial para las mujeres y para el crecimiento de los hijos de las mujeres afectadas. Es necesario que las politicas y los programas se esfuercen por reducir la frecuencia y el impacto de este tipo de violencia., Introduction Intimate partner violence constitutes a major threat to the health and rights of women globally. (1) According to a 2013 multi-country study by the World Health Organization (WHO), almost [...]