A Massambu (Portuguese Edition)


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A randomized control trial evaluating the educational effectiveness of a rapid HIV posttest counseling video. Many of the individuals most at risk for HIV infection i. Lacking primary care providers, they rely on the Emergency Department ED for their health care needs and education. In this prospective randomized controlled trial, we compared the educational effectiveness of a minute posttest counseling video with the normal practice of a session with an HIV counselor.

The RAs research assistants recruited a convenience sample of stable patients presenting to the walk-in section of an inner-city adult ED for rapid HIV testing. Eligible patients for this study included patients who consented for the rapid HIV test and completed measures on condom intention and condom use self-efficacy. Afterwards, both groups completed an assessment tool concerning HIV prevention and transmission.

Of the participants, 61 and 67 patients were randomized to the video and counselor groups, respectively. The groups were similar with respect to gender, ethnicity and experience with prior HIV testing. Mean knowledge scores were higher in the video group The use of an educational counseling video is a valid alternative for providing posttest education and prevention information during the waiting period associated with the minute HIV rapid test.

Without disruption in clinical flow, both testing and education. Electronic vending machines for dispensing rapid HIV self-testing kits: This short report evaluates the feasibility of using electronic vending machines for dispensing oral, fluid, rapid HIV self-testing kits in Los Angeles County.

Feasibility criteria that needed to be addressed were defined as: To address these issues, we contracted a vending machine company who could supply a customized, Internet-enabled machine that could dispense HIV kits and partnered with a local health center available to host the machine onsite and provide counseling to participants, if needed.

Vending machines appear to be feasible technologies that can be used to distribute HIV testing kits. Triggering HIV polyprotein processing by light using rapid photodegradation of a tight-binding protease inhibitor. The regulation and kinetics of viral polyprotein processing and maturation are currently not understood in detail. Here we design, synthesize, validate and apply a potent, photodegradable HIV PR inhibitor to achieve synchronized induction of proteolysis.

The compound exhibits subnanomolar inhibition in vitro. Its photolabile moiety is released on light irradiation, reducing the inhibitory potential by 4 orders of magnitude. We determine the structure of the PR-inhibitor complex, analyze its photolytic products, and show that the enzymatic activity of inhibited PR can be fully restored on inhibitor photolysis.

We also demonstrate that proteolysis of immature HIV particles produced in the presence of the inhibitor can be rapidly triggered by light enabling thus to analyze the timing, regulation and spatial requirements of viral processing in real time. This short report evaluates the feasibility of using electronic vending machines for dispensing oral, fluid, rapid HIV -self testing kits in Los Angeles County.

HIV rapid diagnostic testing by lay providers in a key population-led health service programme in Thailand. Rapid diagnostic testing RDT for HIV has a quick turn-around time, which increases the proportion of people testing who receive their result. We evaluated the performance of HIV RDT conducted by trained lay providers who were members of, or worked closely with, a group of men who have sex with men MSM and with transgender women TG communities, and compared it to tests conducted by MTs.

Based on the task-shifting concept, this rapid HIV testing performed by lay providers as part of the KPLHS programme has great potential to enhance HIV prevention and treatment programmes among key at-risk populations. We discuss implications of the findings on rapid HIV testing programmes. Following enrolment into the survey, questionnaires were administered to eligible and consenting participants in order to obtain demographic and HIV -related data.

Peripheral blood samples were collected for HIV -related testing. Participants were offered community-based HIV testing in the home by trained field workers using a serial algorithm with two rapid diagnostic tests RDTs in series. In the laboratory, reference HIV testing was conducted using two fourth-generation immunoassays with all positives in the confirmatory test considered true positives.

Accuracy, sensitivity, specificity, positive predictive value, negative predictive value and false-positive and false-negative rates were determined. From those tested, The overall accuracy of the RDT when compared to the fourth-generation immunoassays was The sensitivity, specificity, positive predictive value and negative predictive value were The false-positive and false-negative rates were 0.

Compared to true positives. Results From a Nationally Representative Survey. Pereyra, Margaret; Parish, Carrigan L. Oral HIV rapid testing is potentially well suited to the dental setting. Factors associated with no or delayed linkage to care in newly diagnosed human immunodeficiency virus HIV infected patients identified by emergency department-based rapid HIV screening programs in two urban EDs.

The objective was to describe the proportions of successful linkage to care LTC and identify factors associated with LTC among newly diagnosed human immunodeficiency virus HIV -positive patients, from two urban emergency department ED rapid HIV screening programs. This was a retrospective analysis of programmatic data from two established urban ED rapid HIV screening programs between November and October Trained HIV program assistants interviewed all patients tested to gather risk behavior data using a structured data collection instrument.

Reactive results were confirmed by Western blot testing. Patients were provided with scheduled appointments at HIV specialty clinics at the institutions where they tested positive within 30 days of their ED visit. Of the 15, tests administered, 0. Voluntary counseling, testing, and referral opportunities are offered to persons at risk for HIV infection at approximately 11, sites, including dedicated HIV counseling and testing sites, sexually transmitted disease STD clinics, drug-treatment centers, hospitals, and prisons.

This report compares use of CDC-funded counseling, testing, and referral services the week before and the week of June 27 from through and documents the importance of a national public health campaign designed to increase knowledge of HIV serostatus. Sensitivity and specificity of HIV rapid tests used for research and voluntary counselling and testing. To determine the sensitivity and specificity of HIV rapid tests used for research and voluntary counselling and testing at four sites in East Africa.

Six thousands two hundred and fifty five consenting volunteers were enrolled into the study, and prevalent HIV infections were identified. The RT sensitivity tended to be high for all assays at all sites There was a high rate of RT false positives in Uganda positive predictive values ranging from The sensitivity and specificity of the RT varied significantly across sites.

Kit performances were recorded after the reference techniques enzyme-linked immunosorbent assay. These kits were used to establish infection screening strategies. However, the combination with 2 tests appeared to be more onerous than the combination with 3 tests. Cost Analysis at 5 Years.

To conduct a comprehensive cost-minimization analysis to comprehend the financial attributes of the first 5 years of an implementation wherein emergency department ED registered nurses administered HIV oral rapid tests to patients. A health science research implementation team coordinated with ED stakeholders and staff to provide training, implementation guidelines, and support to launch ED registered nurse-administered HIV oral rapid testing.

Deidentified quantitative data were gathered from the electronic medical records detailing quarterly HIV rapid test rates in the ED setting spanning the first 5 years. Comprehensive cost analyses were conducted to evaluate the financial impact of this implementation.

Despite quarterly variability in testing rates, regression analysis revealed an average increase of 3. Over the course of this implementation, Veterans Health Administration policy transitioned from written to verbal consent for HIV testing, serving to reduce the time and cost s associated with the testing process.

Our data indicated salient health outcome benefits for patients with respect to the potential for earlier detection, and associated long-run cost savings. One way to decrease this epidemic is community-based rapid testing with high-risk populations. One high-risk population that has received limited attention is victims of intimate partner violence IPV who seek shelter.

In an effort to gain foundational information to implement rapid HIV testing and counseling services in domestic violence shelters, the current study conducted a series of focus groups with 18 residents and 10 staff of local shelters from October 15th to December 12th, Participants provided valuable insight into how HIV rapid testing and counseling might be best implemented given the resources and constraints of shelter life.

Despite identifying some potential barriers, most believed that the promise of quick results, the convenience and support afforded by the shelter venue, and the timing of the intervention at a point when women are making life changes would render the intervention acceptable to residents. Further insights are discussed in the article. Integrase inhibitors in late pregnancy and rapid HIV viral load reduction. Minimizing time to HIV viral suppression is critical in pregnancy.

There are limited data in pregnant women. We conducted a retrospective cohort study of pregnant HIV -infected women in the United States from through National guidelines on management of occupational exposure to HIV. Exposure to blood, semen, vaginal secretions, CSF, synovial, pleural, peritoneal, pericardial fluid, amniotic fluid and other body fluids contaminated with visible blood can lead to infection.

Steps which are to be followed after occupational exposure are: First aid following the exposure. Establish eligibility for postexposure prophylaxis PEP. Follow-up of an exposed person. In order to get timely prophylactic therapy, PEP drugs should be kept available round-the-clock in at least three locations, casualty, ICU and labour room. Every hospital should have a written protocol and SOP for handling occupational exposure. Achieving an HIV vaccine: The development of an effective HIV vaccine has become a crucial national healthcare goal. To develop a worldwide AIDS vaccine, an international collaboration with developing countries is needed.

The global approach rationale is threefold: Although a number of barriers to the successful development of an HIV vaccine exist, the polio vaccine can be used as an example to show researchers how to overcome the obstacles. Jonas Salk, the polio vaccine developer, used killed whole virus in a technique that critics argued would not be fully effective.

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However, the Salk vaccine reduced polio-related paralysis by 72 percent, while the more effective Sabin oral vaccine did not become available until several years later. The lesson to be learned is that any percent of effectiveness is better than nothing, and researchers should not abandon uncertain HIV vaccine development efforts because they believe a better solution may develop in the future.

The existence of traditional research should not preclude the development of new solutions that might prove more effective. For example, in the case of polio, the March of Dimes campaign pushed both the Salk and Sabin vaccines despite the skepticism of many academic research groups. The shortage of health workers impedes universal coverage of quality HIV services, especially in those countries hardest hit by the epidemic. The dramatic increase in international aid to scale-up HIV services, including antiretroviral therapy ART , has highlighted workforce deficiencies and provided an opportunity to strengthen health systems capacity.

In Mozambique, a country with a high HIV burden and a staggering workforce deficit, the Ministry of Health looked to past experience in workforce expansion to rapidly build ART delivery capacity, including reliance on existing non-physician clinicians NPC to prescribe ART and dramatically increasing the output of NPC training.

As a result of responsible task shifting, the number of facilities providing ART tripled during a 6-month period, and patients from disadvantaged areas have access to quality ART services. Because the NPC-driven ART approach is integrated into primary health care, the addition of new clinical staff also promises to improve general health services.

Interpret perceptions of Colombian health professionals concerning factors that obstruct and facilitate the introduction of rapid syphilis and HIV testing in prenatal care services. A qualitative study based on semi-structured interviews was carried out. A convenience sample was selected with 37 participants, who included health professionals involved in prenatal care services, programs for pregnant women, clinical laboratories, and directors of health care units or centers, as well as representatives from regional departments and the Ministry of Health.

Colombia does not do widespread screening with rapid syphilis and HIV tests in prenatal care. The professionals interviewed stated they did not have prior experience in the use of rapid tests-except for laboratory staff-or in the course of action in response to a positive result. The insurance system hinders access to timely diagnosis and treatment. Health authorities perceive a need to review existing standards, strengthen the first level of care, and promote comprehensive prenatal care starting with contracts between insurers and health service institutional providers.

Participants recommended staff training and integration between health-policymaking and academic entities for updating training programs. The market approach and the characteristics of the Colombian health system constitute the main barriers to implementation of rapid testing as a strategy for elimination of mother-to-child transmission of syphilis and HIV. Measures identified include making changes in contracts between insurers and health service institutional providers, adapting the timing and duration of prenatal care procedures, and training physicians and nurses involved in prenatal care.

Lab tests are frequently used in primary care to guide patient care. This is particularly the case when a severe disorder, or one that will affect patients' initial care, needs to be excluded rapidly. This led us to introduce rapid HIV testing which provides results within 30 minutes. Following the first tests the authors discuss the results as well as the benefits of rapid HIV testing in an urban walk-in clinic. Infected macrophages differ from T cells in terms of decreased to absent cytopathicity and for active accumulation of new progeny HIV -1 virions in virus-containing compartments VCC.

Here we explored the hypothesis that extracellular ATP eATP could represent a microenvironmental signal potentially affecting virion release from VCC of infected macrophages. A similar phenomenon was observed in chronically infected promonocytic U1 cells differentiated to macrophage-like cells D-U1 by costimulation with phorbol esters and urokinase-type plasminogen activator. Worthy of note, eATP did not cause necrotic, apoptotic, or pyroptotic cell death, and its effect on HIV -1 release was suppressed by Imipramine an antidepressant agent known to inhibit microvesicle formation by interfering with membrane-associated acid sphingomyelinase.

Thus, eATP triggered the discharge of virions actively accumulating in VCC of infected macrophages via interaction with the P2X7R in the absence of significant cytopathicity. These findings suggest that the microvesicle pathway and P2X7R could represent exploitable targets for interfering with the VCC-associated reservoir of infectious HIV -1 virions in tissue macrophages. For these reasons, infected macrophages are believed to act as "Trojan horses" carrying infectious particles to be released on cell necrosis or functional stimulation.

HIV prevalence and risk behavior results from a nationally representative survey among men who have sex with men. Recent evidence points to the apparent increase of HIV prevalence among men who have sex with men MSM in different settings with concentrated epidemics, including the Latin American region. The program was intended to strengthen the prevention response for the most at risk populations: MSM and injecting drug users. This paper presents the HIV prevalence results of a nationally representative baseline survey in 24 Mexican cities throughout the 5 regions in the country and reports the socio-demographic and sexual risk behaviors that predict the probability of infection.

The survey was implemented in two phases. We first identified and characterized places where MSM gather in each city and then conducted in a second phase, a seroprevalence survey that included rapid HIV testing and a self-administered questionnaire. The prevalence of HIV was estimated by adjusting for positive predicted value. We applied a probit model to estimate the probability of having a positive result from the HIV test as a function of socio-demographic characteristics and self-reported sexual risk behaviors.

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Our regression results suggest that the risk of infection increases with age, with the number of sexual partners, and among those who play a receptive sexual role, and the risk decreases with higher education. Our findings suggest a higher HIV prevalence among MSM than previously acknowledged and that a significant regional variability exist throughout the country.

These two findings combined, signal an important dynamic in the epidemic that should be better understood and promptly addressed with strong prevention efforts targeted at key populations. Bautista-Arredondo, Sergio; Colchero, M. Background Recent evidence points to the apparent increase of HIV prevalence among men who have sex with men MSM in different settings with concentrated epidemics, including the Latin American region.

Methods The survey was implemented in two phases. Discussion Our findings suggest a higher HIV prevalence among MSM than previously acknowledged and that a significant regional variability exist throughout the country. These two findings combined, signal an important dynamic in the epidemic that should be better understood and promptly addressed with strong prevention efforts targeted at key.

Health education specialists, with their training in health program design, implementation, evaluation, and work with vulnerable communities, may have the necessary expertise to conduct rapid HIV testing RHT. The majority were White The majority of respondents had high knowledge of HIV However, training and implementation barriers were identified. Piloting such an approach should be considered to further evaluate the optimum ways in which expanding HIV testing can be achieved.

Evaluation of rapid HIV test kits on whole blood and development of rapid testing algorithm for voluntary testing and counseling centers in Ethiopia. Five simple and rapid HIV antibody detection assays viz. Determine, Capillus, Oraquick, Unigold and Hemastrip were evaluated to examine their performance and to develop an alternative rapid test based testing algorithm for voluntary counseling and testing VCT in Ethiopia.

All the kits were tested on whole blood, plasma and serum. The evaluation had three phases: Primary lab review, piloting at point of service and implementation. This report includes the results of the first two phases. A total of 2, specimens both whole blood and plasma were included in the evaluation. Rapid assessment of infant feeding support to HIV -positive women accessing prevention of mother-to-child transmission services in Kenya, Malawi and Zambia.

The possibility of mother-to-child transmission MTCT of HIV through breast-feeding has focused attention on how best to support optimal feeding practices especially in low-resource and high- HIV settings, which characterizes most of sub-Saharan Africa. To identify strategic opportunities to minimize late postnatal HIV transmission, we undertook a review of selected country experiences on HIV and infant feeding, with the aims of documenting progress over the last few years and determining the main challenges and constraints.

Field teams conducted national -level interviews with key informants and visited a total of thirty-six facilities in twenty-one sites across the three countries--eighteen facilities in Malawi, eleven in Kenya and seven in Zambia. During these visits interviews were undertaken with key informants such as the district and facility management teams, programme coordinators and health workers. This is manifest in the lack of resources - human, financial and time--for infant feeding counselling, leading to widespread misunderstanding of the HIV transmission risks from breast-feeding.

It has also resulted in lack of space and time for proper counselling, poor support and supervision, and very weak monitoring and evaluation of infant feeding. Finally, there are very few examples of linkages with community-based infant feeding interventions. However, all three countries have started to revise their feeding policies and strategies and there are signs of increased resources. In order to sustain this momentum it will be necessary to continue the advocacy with the HIV community and stress the importance of child survival--not just minimization of HIV transmission - and hence the need for integrating MTCT.

Usefulness of simultaneous screening for HIV - and HCV- specific antibodies and HBsAg by capillary-based multiplex rapid diagnostic test to strengthen linkage-to-care in sub-Saharan patients attending sexually transmitted infections clinic. This article is protected by copyright. Implementing rapid HIV testing in outreach and community settings: The goals of this project were to assess the feasibility of conducting rapid human immunodeficiency virus HIV testing in outreach and community settings to increase knowledge of HIV serostatus among groups disproportionately affected by HIV and to identify effective nonclinical venues for recruiting people in the targeted populations.

Community-based organizations CBOs in seven U. People with reactive preliminary positive test results received confirmatory testing, and people confirmed to be HIV -positive were referred to health-care and prevention services. A total of 23, people received rapid HIV testing. Of the people 1. Venues with the highest proportion of new HIV diagnoses were bathhouses, social service organizations, and needle-exchange programs.

Findings from this demonstration project indicate that offering rapid HIV testing in outreach and community settings is a feasible approach for reaching members of minority groups and people at high risk for HIV infection. The project identified venues that would be important to target and offered lessons that could be used by other CBOs to design and implement similar programs in the future.

Anonymized data on diagnoses, treatment and laboratory parameters are collected in a standardized format. A total of patients were enrolled in the study by 30 June Of these, patients Evaluation indicators, such as the number of newly enrolled patients per half-year period, loss to follow-up, completeness of data per case, availability of data per possible clinical contact, and internal quality control parameters, show a very stable evolution in the cohort, which although open, can be observed.

Comparison with the national HIV surveillance data suggests a high degree of representativeness according to major demographic variables. Federal Register , , , , Catalog of Federal Domestic Assistance Number: The actions we take now will build upon a legacy of global leadership, national commitment, and Success will require the commitment of all parts of society, including businesses HIV policy and implementation: Malawi is a global leader in the design and implementation of progressive HIV policies.

However, there continues to be substantial attrition of people living with HIV across the "cascade" of HIV services from diagnosis to treatment, and program outcomes could improve further. Ability to successfully implement national HIV policy, especially in rural areas, may have an impact on consistency of service uptake. We reviewed Malawian policies and guidelines published between and relating to accessibility of adult HIV testing, prevention of mother-to-child transmission and HIV care and treatment services using a policy extraction tool, with gaps completed through key informant interviews.

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A health facility survey was conducted in six facilities serving the population of a demographic surveillance site in rural northern Malawi to investigate service-level policy implementation. Survey data were analyzed using descriptive statistics. Policy implementation was assessed by comparing policy content and facility practice using pre-defined indicators covering service access: ART was rolled out in Malawi in and became available in the study area in In most areas, practices in the surveyed health facilities complied with or exceeded national policy, including those designed to promote rapid initiation onto treatment, such as free services and task-shifting for treatment initiation.

In some instances, though, facilities implemented alternative progressive practices aimed at improving quality of care and encouraging adherence. While Malawi has formulated a range of progressive policies aiming to promote rapid initiation onto ART, increased investment in policy implementation. Burns, Fiona; Edwards, Simon G. Our aim was to determine whether a dedicated staff member using a multimedia tool, a model found to be effective in the USA, is an acceptable, feasible, and cost-effective model when translated to a UK setting.

Patients with negative results had the option to watch a post-test video providing risk-reduction information. For reactive results the HA arranged a confirmatory test, and ensured linkage into HIV specialist care. Feasibility and acceptability were assessed through surveys and uptake rates.

Costs per case of HIV identified were established. Results Of the eligible people admitted during the pilot period, Of the patients who watched the video and had not recently tested for HIV , Discussion Universal POCT HIV testing in an acute medical setting, facilitated by an educational video and dedicated staff appears to be acceptable, feasible, effective, and low cost. These findings support the recommendation of HIV testing all admissions to AAU in high prevalence settings, although with the model used a significant proportion remained untested.

Results of a Randomized Trial. We examined the effectiveness of risk reduction counseling and the role of on-site HIV testing in drug treatment. We defined 2 primary self-reported outcomes a priori: Assessing patients' attitudes to opt-out HIV rapid screening in community dental clinics: As a public health initiative, provided-initiated HIV screening test in dental settings has long been available in the U.

The objective of this paper was to assess patients' response to, and attitudes towards, an opt-out rapid HIV screening test in a dental setting in Vancouver, Canada. A cross-sectional evaluation design using a self-complete survey questionnaire on self-perceived values and benefits of an opt-out rapid HIV screening was employed.

An anonymous item questionnaire was developed to explore reasons for accepting or declining the HIV rapid screening test, and barriers and facilitators for the HIV screening in dental settings. Convenience, cost-free and readily available results are factors influencing rapid HIV screening uptake. Although dental settings remain an alternative venue for HIV screening from the patients' perspectives, dental hygiene settings might offer a better option.

Of those reporting HIV testing history, This venue-based HIV testing approach at nonclinical sociocultural events is an additional strategy for HIV prevention goals to increase the number of people aware of their HIV infection with subsequent linkage to HIV care. Methods A total of people were recruited in Santiago, Chile: The ORT showed a sensitivity of Participants positively perceived ORT as having reduced both waiting time and anxiety over obtaining their test results.

ORT provides quicker results, potentially ensuring that more people receive them, and does not require handling of or exposure to potentially hazardous blood products. Vietnam achieved rapid scale-up of antiretroviral therapy ART , although external funds are declining sharply. To achieve and sustain universal access to HIV services, evidence-based planning is essential. To date, there had been limited HIV treatment and care cost data available in Vietnam.

Portuguese dialects

Cost data of outpatient and inpatient HIV care were extracted at 21 sentinel facilities 17 adult and 4 pediatric that epitomize the national program. Step-down costing for administration costs and bottom-up resource costing for drugs, diagnostics, and labor were used. Records of adults and pediatric patients were reviewed. The study found that HIV treatment and care costs in Vietnam are economical, yet there is potential to further promote efficiency through strengthening competitive procurement, integrating HIV services, and promoting earlier ART initiation.

Rapid spread of HIV among injecting drug users in north-eastern states of India. Manipur, a north-eastern state of India bordering Myanmar, has experienced very rapid transmission of the human immunodeficiency virus HIV among its vast drug-injecting population. Seroprevalence among intravenous drug users increased from 0 per cent in September to 50 per cent within six months. With a minimum injecting population of 15, and seropositivity of over 50 per cent, the infection quickly spread to the population at large.

One per cent of antenatal mothers tested seropositive by Forming part of the area of South-East Asia known as the Golden Triangle, and producing opium and its derivatives, Myanmar shares a long international border with four States of the region, and populations with a common language and culture move freely across borders. Two other north-eastern states of India bordering Myanmar have faced a similar epidemic within a short period of time. As a result of serosurveillance for HIV since , the epidemic could be detected at an early stage.

The present paper provides an account of the results of ongoing comprehensive studies conducted in the north-eastern states of India on drug-related HIV infection, already a serious problem, but possibly still restricted to that region of the country. The prevalence of intravenous drug users, their HIV serological status, the demographic profile, risk behaviour, the spread of the infection to other groups and the problems of harm minimization are also covered. NYC pharmacies were stratified into high, moderate and low morbidity neighborhoods by the HIV diagnosis rate of the neighborhood in which the pharmacy was located.

A random sample of pharmacies was taken [ from high morbidity neighborhoods HighMN and from low morbidity neighborhoods LowMN ]. Pharmacies were excluded if: The rapid HIV self-test had limited availability and access in retail pharmacies. The high median price measured suggests that cost remained a barrier. Publications on diagnosed HIV infection among transgender people have been limited to state- or local-level data. We analyzed data from the National HIV Surveillance System and present results from the first national -level analysis of transgender people with diagnosed HIV infection.

From to , HIV surveillance jurisdictions from 45 states plus the District of Columbia identified and reported at least one case of newly diagnosed HIV infection for transgender people; jurisdictions from 5 states reported no cases for transgender people. Of transgender people with newly diagnosed HIV infection during —, Over half of both transgender women Improvements in data collection methods and quality are needed to gain a better understanding of HIV burden among transgender people.

Of transgender people with newly diagnosed HIV infection during , Routine monitoring and assessment of adults living with HIV: The clinical care of people living with HIV changed fundamentally as a result of the development of effective antiretroviral therapy ART. HIV infection is now a long-term treatable condition. We report a national audit to assess adherence to British HIV Association guidelines for the routine investigation and monitoring of adult HIV infected individuals.

All UK sites known as providers of adult HIV outpatient services were invited to complete a case-note review and a brief survey of local clinic practices. Each site collected data electronically using a self-audit spreadsheet tool. This included demographic details gender, ethnicity, HIV exposure, and age and whether 22 standardised and pre-defined clinical audited outcomes had been recorded.

Sexual health screening was provided within There was wide variation in resistance testing across sites. There was high participation in the national audit and good practice was identified in some areas. However improvements can be made in monitoring of cardiovascular risk, bone and sexual health. The differences between the various spoken Portuguese dialects are mostly in phonology, in the frequency of usage of certain grammatical forms, and especially in the distance between the formal and informal levels of speech.

Lexical differences are numerous but largely confined to "peripheral" words, such as plants, animals, and other local items, with little impact in the core lexicon. Dialectal deviations from the official grammar are relatively few. As a consequence, all Portuguese dialects are mutually intelligible although for some of the most extremely divergent pairs, the phonological changes may make it difficult for speakers to understand rapid speech.

Within each of these regions, however, is further variation, especially in pronunciation. It is usually believed that the dialects of Brazil , Africa , and Asia derived mostly from those of central and southern Portugal. In the Portuguese town of Barrancos in the border between Extremadura , Andalucia and Portugal , a dialect of Portuguese heavily influenced by Southern Spanish dialects is spoken, known as barranquenho.

Brazilian dialects are divided into northern and southern groups, the northern dialects tending to slightly more open pre- stressed vowels.

However, migration from the Northern states to the Southern states cause the influence to be a two-way phenomenon. Cultural issues also play their roles. Also, people of inner cities of the three southern states usually speak with a very notable German, Italian or Polish accent, and among the inhabitants of the Santa Catarina Island i. Between Brazilian Portuguese, particularly in its most informal varieties, and European Portuguese, there can be considerable differences in grammar, aside from the differences in pronunciation and vocabulary.

The most prominent ones concern the placement of clitic pronouns, and the use of subject pronouns as objects in the third person. Non-standard inflections are also common in colloquial Brazilian Portuguese. For historical reasons, the dialects of Africa are generally closer to those of Portugal than the Brazilian dialects, but in some aspects of their phonology, especially the pronunciation of unstressed vowels, they resemble Brazilian Portuguese more than European Portuguese.

They have not been studied as exhaustively as European and Brazilian Portuguese. Asian Portuguese dialects are similar to the African ones and so are generally close to those of Portugal. Many dialects have special characteristics. Most of the differences are seen in phonetics and phonology, and here are some of the more prominent:.

Both mean bad , but mau is an adjective, mal an adverb. In most parts of Brazil, the l before consonants and ending words, which represents a velarized alveolar lateral approximant in differing dialects, became a labio-velar approximant , making both words homophones. Comprimento means "length", and cumprimento means "greeting".

Hispanic influence makes it never represent that sound in some Southern Brazilian. Unlike most of the West Iberian languages , Portuguese usually differs between the voiced bilabial plosive and the voiced labiodental fricative , but the distinction used to be absent in the dialects of the northern half of Portugal, and in some dialects spoken in the border of Brazil or Portugal and Spanish-speaking countries. Both are realized indistinctly as a voiced bilabial plosive or a voiced bilabial fricative , like in Spanish.

In Northeastern Brazil and the metropolitan area of Rio de Janeiro , the vowels followed by coronal fricatives in the same syllable have a palatal approximant pronounced between both. The feature is very distinguishable since this combination appears in the plural forms. The sound happens in other cases in Southeastern Brazil but disappeared in the rest of the Portuguese-speaking world. Guidance on diabetes service provision and human resource management need strengthening and policies related to task-shifting need adjustment to improve quality of service provision for diabetes patients in rural settings.

Induced abortion, pregnancy loss and intimate partner violence in Tanzania: Background Violence by an intimate partner is increasingly recognized as an important public and reproductive health issue. All women who answered positively to at least one of the questions about specific acts of physical or sexual violence committed by a partner towards her at any point in her life were considered to have experienced intimate partner violence. Associations between self reported induced abortion and pregnancy loss with intimate partner violence were analysed using multiple regression models.

Even after adjusting for other explanatory factors, women who experienced intimate partner violence were 1. Intimate partner violence had a stronger influence on induced abortion and pregnancy loss than women's age, socio-economic status, and number of live born children. Conclusions Intimate partner violence is likely to be an important influence on levels of induced abortion and pregnancy loss in Tanzania. Preventing intimate partner violence may therefore be beneficial for maternal health and. Livelihood Diversification through Migration among a Pastoral People: This paper brings together over two decades of research concerning the patterns and processes of livelihood diversification through migration among Maasai pastoralists and agro-pastoralists of northern Tanzania.

Two case studies , one from the Ngorongoro Conservation Area and the other from the Simanjiro plains, jointly demonstrate the complexity of migration within a single ethnic group.

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We analyze the relationship between wealth and migration and examine some of the consequences of migration for building herds, expanding cultivation, and influencing political leadership. We further argue that migration in Maasai communities is becoming a cultural norm and not only a response to economic conditions. Costing maternal health services in South Tanzania: The following paper presents the methodology and results of a costing exercise of maternal health services in Tanzania. The main objective of this study was to determine the actual costs of antenatal and obstetric care in different health institutions in a district in Tanzania as a basis of more efficient resource allocation.

A costing tool was developed that allows the calculation of costs of service units, such as deliveries and antenatal care, and separates these costs from the costs of other services. Time consumed by each activity was used as an allocation key. For that purpose, we recorded the personnel consumption with different time- study methodologies. The results were analyzed by a spreadsheet program. The paper presents average costs for different costing units of maternal care.

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However, dispensaries are grossly underutilized so that the costs per service unit are rather high. We conclude that improved planning of elective services is a prerequisite for more effective and efficient use of personnel resources. In addition, the definition of medically and economically sound standards, in particular staffing standards, is critical to make cost analysis an effective management tool to guide rational resource allocation.

Sources of community health worker motivation: This study aimed to explore sources of CHW motivation to inform programs in Tanzania and similar contexts. Interviews were digitally recorded, transcribed, and coded prior to translation and thematic analysis. The authors then conducted a literature review on CHW motivation and a framework that aligned with our findings was modified to guide the presentation of results.

Results Sources of CHW motivation were identified at the individual, family, community, and organizational levels. At the individual level, CHWs are predisposed to volunteer work and apply knowledge gained to their own problems and those of their families and communities. Families and communities supplement other sources of motivation by providing moral, financial, and material support, including service fees, supplies, money for transportation, and help with farm work and CHW tasks.

Resistance to CHW work exhibited by families and community members is limited. The organizational level the government and its development partners provides motivation in the form of stipends, potential employment, materials, training, and supervision, but inadequate remuneration and supplies discourage CHWs. Supervision can also be dis-incentivizing if perceived as a sign of poor performance.

Conclusions Tanzanian CHWs who work despite not receiving a salary have an intrinsic desire to volunteer, and their motivation often derives from support received from their families when other sources of motivation are insufficient. Policy-makers and program managers should consider the burden that a lack of remuneration imposes on the families of CHWs. Community perceptions of rape and child sexual abuse: Rape of women and children is recognized as a health and human rights issue in Tanzania and internationally.

Exploration of the prevailing perceptions in rural areas is needed in order to expand the understanding of sexual violence in the diversity of Tanzania 's contexts. A qualitative design was employed using focus group discussions with male and female community members including religious leaders, professionals, and other community members.

The discussions centered on causes of rape, survivors of rape, help-seeking and reporting, and gathered suggestions on measures for improvement. Six focus group discussions four of single gender and two of mixed gender were conducted. The focus group discussions were recorded, transcribed verbatim, and analyzed using manifest qualitative content analysis. The participants perceived rape of women and children to be a frequent and hidden phenomenon. Participants perceived the need for educating the community to raise their knowledge of sexual violence and its consequences, and their roles as preventive agents.

In this rural context, social norms reinforce sexual violence against women and children, and hinder them from seeking help from support services. Addressing the identified challenges may promote help-seeking behavior and improve care of survivors of sexual violence, while changes in social and cultural norms are needed for the prevention of sexual violence. Sources of CHW motivation were identified at the individual, family, community, and organizational levels.

Tanzanian CHWs who work despite not receiving a salary have an intrinsic desire to volunteer, and their motivation often derives from support received from their families when other sources of motivation are insufficient. In addition, CHWs' intrinsic desire to volunteer does not preclude a desire for external rewards. Rather, adequate and formal financial. Background Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities.

Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda.

The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies change ideas and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention.

These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. In Uganda and Tanzania , the Expanded Quality Management Using Information Power EQUIP intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district.

Thus, intervention districts receive quality. Examination Phase of the Master's Thesis: This paper investigates the influence of the examination stage of student theses on the completion time of graduate studies at Makerere University, Uganda. The assessment is based on the administrative data of Master's degree students in the to enrollment cohorts at the School of Education, Makerere University. The total elapsed time…. Corporal Punishment in Tanzania 's Schools. The purpose of this survey was to acquire descriptive information regarding corporal punishment in Tanzania 's O-level secondary schools.

In addition, 14 students and 14 teachers were…. Adult Students go to Tanzania. A preparatory course and a three-week study safari to Tanzania were conducted jointly by the University of Southampton and Nottingham University. The course sought to increase the participants' understanding of Tanzania 's geography, economy, politics, education, and social systems. The actual visit is also described. Molecular docking and dynamic simulation studies evidenced plausible immunotherapeutic anticancer property by Withaferin A targeting indoleamine 2,3-dioxygenase.

Indoleamine 2,3-dioxygenase IDO is emerging as an important new therapeutic drug target for the treatment of cancer characterized by pathological immune suppression. IDO catalyzes the rate-limiting step of tryptophan degradation along the kynurenine pathway. Reduction in local tryptophan concentration and the production of immunomodulatory tryptophan metabolites contribute to the immunosuppressive effects of IDO. Presence of IDO on dentritic cells in tumor-draining lymph nodes leading to the activation of T cells toward forming immunosuppressive microenvironment for the survival of tumor cells has confirmed the importance of IDO as a promising novel anticancer immunotherapy drug target.

On the other hand, Withaferin A WA - active constituent of Withania Somnifera ayurvedic herb has shown to be having a wide range of targeted anticancer properties. In the present study conducted here is an attempt to explore the potential of WA in attenuating IDO for immunotherapeutic tumor arresting activity and to elucidate the underlying mode of action in a computational approach. Our docking and molecular dynamic simulation results predict high binding affinity of the ligand to the receptor with up to Conclusively, our results strongly suggest WA as a valuable small ligand molecule with strong binding affinity toward IDO.

This study aims to determine the effectiveness of an electronic learning course to teach clinicians in Tanzania Ponseti method theory. A total of 30 clinicians were recruited from clinics with high referral rates for clubfoot patients and invited to 1 of 3 training sites: Baseline knowledge, measured through a pretest, was compared to performance on a posttest after e-learning course completion.

Successful implementation requires an understanding of the device availability and technology literacy of the users. Recurrence of preterm birth and perinatal mortality in northern Tanzania: To estimate the recurrence risk of preterm delivery and estimate the perinatal mortality in repeated preterm deliveries. The women were followed up to for consecutive births. A total of women were identified with a total of subsequent deliveries in the follow-up period. Recurrence risk of preterm birth and perinatal mortality was estimated using log-binomial regression and adjusted for potential confounders.

This recurrence risk was estimated to be 2. Babies born at term who had an older sibling who was also born at term had a perinatal mortality of 1. Previous delivery of a preterm infant is a strong predictor of future preterm births in Tanzania. Previous or repeated preterm births increase the risk of perinatal death substantially in the subsequent pregnancy.

Heuristic Elements of Plausible Reasoning. At least some of the reasoning processes involved in argumentation rely on inferences which do not fit within the traditional categories of inductive or deductive reasoning. The reasoning processes involved in plausibility judgments have neither the formal certainty of deduction nor the imputed statistical probability of induction. Tanzania at the Turn of the Century: Background Papers and Statistics. A World Bank Country Study. This report presents lessons from Tanzania 's development experience of the past four decades, with emphasis on the period since the last report , and assesses the imperatives for higher sustained growth and better livelihood for its citizens in the future.

The background papers review and assess Tanzania 's actual growth and poverty reduction…. Undereporting of acute pesticide poisoning in Tanzania: Acute pesticide poisoning APP is known to cause serious injuries to end users globally but the magnitude of this problem in Tanzania is not well known. This study aimed to determine the extent and pattern of underreporting of APP in Tanzania to inform the development of a surveillance system and appropriate interventions. This study integrates findings from two recent Tanzanian studies.

A household survey established the proportion of poisoned farmers in a typical rural area who reported to hospital for a pesticide poisoning. Only 5 of the farmers who reported attending hospital due to poisonings could be traced in medical records at the facilities they claimed to have attended. Three under-estimation factors were generated for sensitivity analysis to adjust for under-reporting.

A review of health facilities in three regions of Tanzania collected prospective data on admissions for APP in to generate population-based APP incidence rates stratified by circumstances of poisoning occupational, accidental, suicide, and unknown. Sensitivity analysis was conducted involving adjustment for high and low boundaries of the under-reporting of occupational APP and an adjustment for different scenario allocations of cases with 'unknown' circumstances to different combinations of known circumstances.

The study estimated the rate of occupational poisoning as ranging from The rate of all poisonings occupational and non-occupational ranged from Depending on the choice of scenario and under-reporting correction factor used, occupational APP could comprise from The study confirms that data on APP in Tanzanian hospitals are poorly reported and that occupational circumstances are particularly overlooked in.

Violence by an intimate partner is increasingly recognized as an important public and reproductive health issue. This study analyzes the data of the Tanzania section of the WHO Multi-Country Study on Women's Health and Domestic Violence, a large population-based cross-sectional survey of women of reproductive age in Dar es Salaam and Mbeya, Tanzania , conducted from to Intimate partner violence is likely to be an important influence on levels of induced abortion and pregnancy loss in Tanzania. Preventing intimate partner violence may therefore be beneficial for maternal health and pregnancy outcomes.

Truck drivers' opinion on road safety in Tanzania --a questionnaire study. Even though the traffic fatality risk fatalities per , inhabitants in Tanzania is quite low, the fatality rate fatalities per 10, vehicles is one of the highest in the world. With increasing vehicle density this means that the number of people dying in traffic will increase dramatically in the near future. Therefore, it is important to implement measures to increase traffic safety as soon as possible, and in order to be able to do this in an efficient way, it is important to investigate where the main problems lie.

The study was done to increase the knowledge about the situation of the Tanzanian truckers, who are the most frequent road users in the country. The drivers were interviewed in 3 different towns in southern Tanzania , and participation was voluntary. The questionnaire treated demographics, the state of the drivers' vehicles, the frequency of breakdowns, and the maintenance of the vehicles.

Further questions concerned driver behavior, crash involvement, crash risk, and crash mitigation. The drivers who participated in the study were predominantly male and their average age was 36 years. Truck drivers reported driving Around 40 percent of the trucks did not have any seat belts installed, with a larger share of older trucks lacking belts. Most of the drivers who had seat belts reported using them, however.

Almost 40 percent of the drivers reported being involved in at least one crash, and 45 percent of those drivers had experienced fatal crashes. This underlines that the crash frequency per vehicle is very high, and the results are often severe, especially when heavy vehicles are involved.

Results from a Chem panel measured on the Beckman LX20 analyzer were used to develop the model. Application of portable digital devices and scanner allows estimating the color coordinates and increasing the accuracy and sensitivity of the tests. Accuracy ranged from Cost effectiveness analysis of the New Jersey rapid testing algorithm for HIV testing in publicly funded testing sites. Clients of sex workers in Switzerland: The results were plotted on Levey-Jennings charts and analysed with quality control rules, for a period of one month.

When asked what the 3 most common crash causations were, driver-related causes were named frequently. The reality of task shifting in medicines management- a case study from Tanzania. Tanzania suffers a severe shortage of pharmaceutical staff. This negatively affects the provision of pharmaceutical services and access to medicines, particularly in rural areas. Task shifting has been proposed as a way to mitigate the impact of health worker shortfalls. The aim of this study was to understand the context and extent of task shifting in pharmaceutical management in Dodoma Region, Tanzania.

We explored 1 the number of trained pharmaceutical staff as compared to clinical cadres managing medicines, 2 the national establishment for staffing levels, 3 job descriptions, 4 supply management training conducted and 5 availability of medicines and adherence to Good Storage Practice. A cross-sectional study was conducted in public health facilities in A pre-tested questionnaire was administered to the person in charge of the facility to collect data on staff employed and their respective pharmaceutical tasks.

Availability of 26 tracer medicines and adherence to Good Storage Practice guidelines was surveyed by direct observation. The national establishments for pharmaceutical staffing levels and job descriptions of facility cadres were analysed. While required staffing levels in were 50, the region employed a total of only 14 pharmaceutical staff in Job descriptions revealed that, next to pharmaceutical staff, only nurses were required to provide dispensing services and adherence counselling.

The first training on supply management was provided in with no refresher training thereafter. Task shifting is a reality in the pharmaceutical sector in Tanzania and it occurs mainly as a coping mechanism rather than a formal response to the workforce crisis. Epidemiology of hypertension in Northern Tanzania: Sub-Saharan Africa is particularly vulnerable to the growing global burden of hypertension, but epidemiological studies are limited and barriers to optimal management are poorly understood.

Therefore, we undertook a community-based mixed-methods study in Tanzania to investigate the epidemiology of hypertension and barriers to care. In Northern Tanzania , between December and June , we conducted a mixed-methods study , including a cross-sectional household epidemiological survey and qualitative sessions of focus groups and in-depth interviews. To investigate relationships with potential risk factors, we used adjusted generalised linear models. Hypertension awareness was defined as a self-reported disease history in a participant with confirmed hypertension.

To explore barriers to care, we identified emerging themes using an inductive approach within the framework method. We enrolled adults median age 45 years from households, including men Overall, the prevalence of hypertension was Traditional medicine use was inversely associated with hypertension PRR 0. In the qualitative sessions, we identified barriers to optimal care, including poor point-of-care communication, poor understanding of hypertension and structural barriers such as long wait times and undertrained.

Ethnobotanical study of some of mosquito repellent plants in north-eastern Tanzania. Background The use of plant repellents against nuisance biting insects is common and its potential for malaria vector control requires evaluation in areas with different level of malaria endemicity. The essential oils of Ocimum suave and Ocimum kilimandscharicum were evaluated against malaria vectors in north-eastern Tanzania. Methodology An ethnobotanical study was conducted at Moshi in Kilimanjaro region north-eastern Tanzania , through interviews, to investigate the range of species of plants used as insect repellents.

Also, bioassays were used to evaluate the protective potential of selected plants extracts against mosquitoes. Results The plant species mostly used as repellent at night are: The most popular repellents were O. Bioassay of essential oils of the two Ocimum plants was compared with citronella and DEET to study the repellence and feeding inhibition of untreated and treated arms of volunteers.

Using filter papers impregnated with Ocimum extracts, knockdown effects and mortality was investigated on malaria mosquito Anopheles arabiensis and Anopheles gambiae, including a nuisance mosquito, Culex quinquefasciatus. Likewise the extracts of Ocimum plants induced KD90 of longer time in mosquitoes than citronella, a standard botanical repellent. Conclusion The use of whole plants and their products as insect repellents is common among village communities of north-eastern Tanzania and the results indicate that the use of.

Alcohol consumption among pregnant women in Northern Tanzania Alcohol can be harmful to the development of the foetus. In most developed countries, pregnant women are recommended to abstain from alcohol, however in developing countries, women are less likely to receive these recommendations.

With respect to pregnant women in Northern Tanzania , this study aims to 1 describe time trends in level of alcohol consumption, 2 assess socio-demographic predictors of alcohol consumption, and 3 describe associations between alcohol consumption and health-related maternal and foetal outcomes.

Poisson regression analysis was used to assess associations between potential risk factors and alcohol consumption, and between alcohol consumption during pregnancy and maternal and foetal health outcomes. From to , the proportion of women reporting alcohol consumption during pregnancy decreased from The socio-demographic predictors most strongly related to alcohol consumption were religion Catholics Background Intimate partner violence against women is a prevailing public health problem in Tanzania , where four of ten women have a lifetime exposure to physical or sexual violence by their male partners.

To be able to suggest relevant and feasible community and health care based interventions, we explored community members' understanding and their responses to intimate partner violence. Methods A qualitative study using focus group discussions with 75 men and women was conducted in a community setting of urban Tanzania.

We analysed data using a grounded theory approach and relate our findings to the ecological framework of intimate partner violence. Results The analysis resulted in one core category, "Moving from frustration to questioning traditional gender norms", that denoted a community in transition where the effects of intimate partner violence had started to fuel a wish for change. At the societal level, the category "Justified as part of male prestige" illustrates how masculinity prevails to justify violence. At the community level, the category "Viewed as discreditable and unfair" indicates community recognition of intimate partner violence as a human rights concern.

At the relationship level, the category "Results in emotional entrapment" shows the shame and self-blame that is often the result of a violent relationship. At the individual level, the risk factors for intimate partner violence were primarily associated with male characteristics; the category "Fed up with passivity" emerged as an indication that community members also acknowledge their own responsibility for change in actions.

Conclusions Prevailing gender norms in Tanzania accept women's subordination and justify male violence towards women. At the individual level, an increasing openness makes it possible for women to report, ask for help, and become proactive in suggesting preventive measures. At the community level, there is an increased willingness to intervene but further.

Accrediting retail drug shops to strengthen Tanzania 's public health system: Retail drug sellers are a major source of health care and medicines in many countries. In Tanzania , drug shops are widely used, particularly in rural and underserved areas. Previously, the shops were allowed to sell only over-the-counter medicines, but sellers who were untrained and unqualified often illegally sold prescription drugs of questionable quality.

In , we worked with Tanzania 's Ministry of Health and Social Welfare to develop a public-private partnership based on a holistic approach that builds the capacity of owners, dispensers, and institutions that regulate, own, or work in retail drug shops. For shop owners and dispensers, this was achieved by combining training, business incentives, supervision, and regulatory enforcement with efforts to increase client demand for and expectations of quality products and services.

The accredited drug dispensing outlet ADDO program's goal is to improve access to affordable, quality medicines and pharmaceutical services in retail drug outlets in rural or peri-urban areas with few or no registered pharmacies. The case study characterizes how the ADDO program achieved that goal based on the World Health Organization's health system strengthening building blocks: The ADDO program has proven to be scalable, sustainable, and transferable: Tanzania has rolled out the program nationwide; the ADDO program has been institutionalized as part of the country's health system; shops are profitable and meeting consumer demands; and the ADDO model has been adapted and implemented in Uganda and Liberia.

The critical element that was essential to the ADDO program's success is stakeholder engagement-the successful buy-in and sustained commitment came directly from the effort, time, and resources spent to fully connect with vital stakeholders at all levels. Plausible Reasoning in Tactical Planning. Our work attempts to formalize the plausible inferences that frequently occur in Each hierarchy represents knowledge about a class of concepts arranged in a tree structure according to some viewpoint. Determinants of concurrent sexual partnerships within stable relationships: Objective Concurrent sexual partnerships CP have been identified as a potential driver in the HIV epidemic in southern Africa, making it essential to understand motivating factors for engagement in CP.

We aimed to assess community attitudes and beliefs about relationship factors that influence men and women in stable relationships to engage in CP in Tanzania. Social exchange theory was used for interpreting the data. Design Qualitative study with focus group discussions FGDs. Our analysis focused specifically on beliefs about how relationship factors influence engagement in CP. Results Dissatisfaction with a stable relationship was believed to be a contributing factor for engagement in CP for both men and women.

Participants more commonly reported financial dissatisfaction as a contributing factor for women engaging in CP within stable relationships, whereas emotional and sexual dissatisfaction were reported as contributing factors for men and women. Furthermore, participants described how potential outside partners are often evaluated based on what they are able to offer compared with stable partners.

Conclusions Efforts to reach men and women in stable relationships with HIV prevention messages must consider the various dimensions of motivation for engaging in CP, including relationship dynamics. The dementia diagnosis gap in sub-Saharan Africa SSA is large, partly because of difficulties in screening for cognitive impairment in the community.

Study participants were recruited from people who attended screening days held in villages within the rural Hai district of Tanzania. Criterion validity was assessed against the gold standard clinical dementia diagnosis using DSM-IV criteria. Construct validity was assessed against, age, education, sex and grip strength and instrumental activities of daily living IADLs.

Internal consistency and floor and ceiling effects were also examined. During community screening, the IDEA cognitive screen had high criterion validity, with an area under the receiver operating characteristic curve of 0. Higher scores on the screen were significantly correlated with lower age, male sex, having attended school, better grip strength and improved performance in activities of daily living.

The IDEA cognitive screen had high criterion and construct validity and is suitable for use as a cognitive screening instrument in a community setting in SSA. Only moderate internal consistency may partly reflect the multi-domain nature of dementia as diagnosed clinically.

The challenges of achieving high training coverage for IMCI: Health worker training is a key component of the integrated management of childhood illness IMCI. However, training coverage remains low in many countries. We conducted in-depth case studies in two East African countries to examine the factors underlying low training coverage 10 years after IMCI had been adopted as policy.

Key factors allowing the first two districts to perform better were: However, IMCI training coverage remained well below target levels across all sites. The main barrier to expanding coverage was the cost of training due to its duration, the number of facilitators and its residential nature. Mechanisms for financing IMCI also restricted district capacity to raise funds. In Kenya, limited financial decentralization meant that district managers had to rely on donors for financial support. Critically, the low priority given to IMCI at national and international levels also limited the expansion of training.

Levels of domestic and donor support for IMCI have diminished over time in favour of vertical programmes, partly due to the difficulty in monitoring and measuring the impact of an integrated intervention like IMCI. Background Rape of women and children is recognized as a health and human rights issue in Tanzania and internationally. Methods A qualitative design was employed using focus group discussions with male and female community members including religious leaders, professionals, and other community members.

Results The participants perceived rape of women and children to be a frequent and hidden phenomenon. Conclusions In this rural context, social norms reinforce sexual violence against women and children, and hinder them from seeking help from support services. A case study of pharmaceutical policy reforms in Tanzania. Regulation of the pharmaceutical sector is a challenging task for most governments in the developing countries. In , the Pharmacy Council spearheaded policy reforms in the pharmaceutical sector aimed at taking over the control of the regulation of the business of pharmacy from the Tanzania Food and Drugs Authority.

This study provides a critical analysis of these reforms. The study employed a qualitative case- study design. Data was collected through in-depth interviews, focus group discussions and document reviews. Data was analyzed thematically using a policy triangle framework. The analysis was done manually. The reforms adopted an incremental model of public policy-making and the process was characterized by lobbying for political support, negotiations and bargaining between the interest groups.

These negotiations were largely centred on vested interests and not on the impact of the reforms on the efficiency of pharmaceutical regulations in the country. Stakeholders from the micro and meso levels were minimally involved in the policy reforms. Recent pharmaceutical regulation reforms in Tanzania were overshadowed by vested interests, displacing a critical analysis of optimal policy options that have the potential to increase efficiency in the regulation of the business of pharmacy.