Improving the delivery of PMTCT care in Tanzania

Much has been written about the challenges of social desirability bias in self-reported measures. In order to alleviate this, our study team is using computer-assisted interviewing to survey our MAISHA study participants. We are using computer tablets that are equipped with audio computer-assisted self interview (ACASI) software. With an ACASI modality, our team is able to automate and administer questions to our study participants. The program runs on the tablets by presenting questions and response options visually and audibly. Participants then are able to select their preferred response using the touch screen, and data are saved directly into our data collection system. The questions and response options were pre-recorded in Swahili at Duke University’s Multimedia Project Studio by Godfrey Kisigo and Charity Agasaro.

 

 

 

We are excited to announce Haika Osaki as our new study coordinator and Linda Minja as our new assistant coordinator for the Maisha study! Haika joined our team in April 2019 and has taken charge of the day to day activities for the stigma reduction intervention. She has a background in Sociology (BA), Public Health (MPH) and has been vital to our research operations. Linda serves as an assistant statistician at Kilimanjaro Clinical Research Institute (KCRI) and as a data manager on the Maisha study. She has worked with our team since the start of the Option B+ project. She has a background in quantitative modeling and has ensured that the data collected is accurate and complete. Congratulations, Haika and Linda! We appreciate your hard work.

     

Haika (left) and Linda (right) pose for a picture at KCRI. 

Enrollment has begun! Today marks the first day of enrollment for the Maisha pilot trial at the Pasua and Majengo clinics. Women and their partners attending a first antenatal care appointment will be recruited, consented and enrolled in the study. We hope to enroll a total of 1,000 women and 500 male partners in a period of 8 months. Our incredible research assistants at each site will be responsible for this endeavor.

The Maisha intervention video is up and running! Thanks to an incredible team of actors, the video is now available for session 1 of the MAISHA intervention study. The Maisha video aims to dispel misconceptions that drive HIV stigma while normalizing pregnancy in the context of a positive HIV status. In this 7 minute film, we are introduced to Salma, who learns that she is HIV positive in the wake of her first antenatal care visit. Salma and her husband, Bahati, go through the motions of this diagnosis and show viewers what it means to be pregnant and living with HIV. The Maisha video, presented to all Maisha participants, aims to develop empathy and encourage support for people living with HIV.

Dr. Preeti Manavalan has been a member of the Option B+ study team since 2017, when she joined the team during the research year of her Infectious Diseases fellowship at Duke to help with data collection, analysis, and dissemination of findings. As a Fogarty Global Health Fellow, Dr. Manavalan is completing a year of research at Kilimanjaro Christian Medical Center in Moshi. During this time, she has had the opportunity to pursue her own research interests related to development of high-quality care models for people living with HIV and non-communicable diseases.

For her research, Dr. Manavalan aims to develop a task-shifting intervention to address hypertension among HIV-infected adults in Moshi. Hypertension is a leading risk factor for cardiovascular mortality and is an emerging threat among people living with HIV, but efforts at control have been largely neglected in resource-limited settings. Dr. Manavalan is collecting qualitative data to better understand the standard of care for hypertension management and to identify barriers and facilitators for improved care. She has screened patients for hypertension to determine the prevalence among HIV-infected adults engaged in care, and is assessing their risk factors, knowledge, attitudes, and practices of hypertension. Using this qualitative and quantitative data she will develop an integrative task-shifting intervention to improve blood pressure control among adults engaged in HIV care, and will evaluate its feasibility, fidelity and acceptability with a pilot feasibility study.

Dr. Manavalan hopes that results from her study will be used as formative data to inform future research for the development, integration and scale-up of task-shifting strategies to improve cardiovascular outcomes among people living with HIV.

From December 3-5, researchers, policy makers, government officials, and stakeholders involved in HIV work met in Arusha, Tanzania to share and discuss strategies, guidelines, innovations, and research findings on HIV and AIDS. The goal of the meeting was to disseminate the health sector HIV and AIDS guidelines and strategies, to share innovations and research findings to inform the HIV and AIDS response, and to prepare regional action plans to address identified challenges. Over the course of the meeting, the Option B+ team had three presentations and participated in discussions to inform the National AIDS Control Program (NACP)s action plan for the Northern Zone of Tanzania.

On the first day of the meeting, Linda Minja and James Ngocho presented data on retention in HIV care under Option B+ across 39 clinics in the Kilimanjaro region. The analysis used medical record data obtained from the Tanzania National AIDS Control Database. Findings highlighted the high loss to follow-up during initiation of PMTCT care and during the postpartum period, with higher loss of newly diagnosed clients. Results pointed to the need for targeted interventions that recognize the vulnerability of newly diagnosed patients, and address both early and postpartum retention.

On the third day of the meeting, Dr. Melissa Watt, who was visiting from the U.S., presented results from the Option B+ cohort to continue the conversation about care retention among pregnant and postpartum women. After sharing findings about facility-level implementation of Option B+ guidelines, care engagement at six months, depression, HIV disclosure, and barriers to care, the presentation concluded with a discussion of next steps, leading into an introduction of the stigma-based counseling intervention. Dr. Jane Rogathi then presented an overview of the new R21 activities and goals. The presentations stimulated great conversation, ideas, and support from attendees.

We are thrilled to celebrate the graduation of our study coordinator, Dr. Jane Rogathi, who received her PhD in Epidemiology (Public Health) from Kilimanjaro Christian Medical University College on November 17. Jane completed her thesis research on intimate partner violence and depression affecting women during pregnancy and after childbirth. The study was based in antenatal clinics at two sites in Moshi municipality. Jane’s expertise and experience in the clinic is a great asset to our team, and we are so grateful to have her helping to lead the implementation of our study.

Hongera sana, Dr. Rogathi!

In 2015, Dr. Melissa Watt received a small grant from the Duke Center for AIDS Research to explore HIV care engagement for women initiating ART during pregnancy in Cape Town, South Africa. This research, conducted in collaboration with researchers at the University of Cape Town, helped lay the foundation for the team’s current work in Tanzania and Dr. Watt’s broader research program on the prevention of mother-to-child transmission (PMTCT).

In Cape Town, researchers conducted repeat interviews with twenty women during pregnancy and again within three months after giving birth, to explore and understand the challenges women faced and the support they received navigating their HIV care as a new mother. Disclosure of women’s HIV status emerged as an important theme, with findings detailed in a manuscript recently published in AIDS and Behavior. The Duke Global Health Institute (DGHI) featured the article on its website and in its newsletter.

You can read the research brief and find a link to the article here.

On August 9, 2018, the team hosted a scientific symposium and stakeholder meeting at KCMC to discuss addressing HIV stigma in PMTCT in the Kilimanjaro Region. The aim of the meeting was to bring together scientists and health practitioners working on PMTCT-related activities in order to share our preliminary research findings on PMTCT in the Kilimanjaro Region, and  solicit input on an intervention to address HIV stigma in the context of PMTCT. The meeting was attended by representatives from the Tanzanian Ministry of Health, the Elizabeth Glaser Pediatric AIDS Foundation, the KCMC Community Advisory Board (CAB), and representatives from local healthcare facilities.

The day’s presentations and group activities generated great discussion about the study findings and implications for PMTCT care in the region, as well as ideas for the proposed stigma intervention.

It is our hope that this symposium provides a platform from which we can identify areas of synergy and collaboration to strengthen PMTCT research and implementation within Kilimanjaro Region.

After a year of hard work coordinating the Option B+ study at KCMC, Godfrey Kisigo will have the chance to further his training in global health research at the Duke Global Health Institute. Godfrey will bring his multitude of experiences, dedicated work ethic, and bright smile to Durham as he joins 29 other classmates as part of the new Master of Science in Global Health cohort at DGHI.

While the KCMC team was sad to see Godfrey leave Moshi, we are grateful that Godfrey will continue to work with the Option B+ team as he completes his studies at DGHI!

Read more about Godfrey and his fellow classmates at DGHI here.