Background Adherence to tuberculosis (TB) treatment is challenging because of many factors. The World Health Organization has recommended the use of digital adherence monitoring technologies in its End TB Strategy. However, evidence on improving adherence is limited. EvriMED is a real-time medication-monitoring device which was found to be feasible and acceptable in a few studies in Asia. In Tanzania, however, there may be challenges in implementing evriMED due to stigmatization, network and power access, accuracy, and cost effectiveness, which may have implications for treatment outcome. We propose a pragmatic cluster randomized trial to investigate the effectiveness of evriMED with reminder cues and tailored feedback on adherence to TB treatment in Kilimanjaro, Tanzania. Methods/design We will create clusters in Kilimanjaro based on level of health care facility. Clusters will be randomized in an intervention arm, where evriMED will be implemented, or a control arm, where standard practice directly observed treatment will be followed. TB patients in intervention clusters will take their medication from the evriMED pillbox and receive tailored feedback. We will use the ‘Stages of Change’ model, which assumes that a person has to go through the stages of pre-contemplation, contemplation, preparation, action, and evaluation to change behavior for tailored feedback on adherence reports from the device. Discussion If the intervention shows a significant effect on adherence and the devices are accepted, accurate, and sustainable, the intervention can be scaled up within the National Tuberculosis Programmes. Trial registration Pan African Clinical Trials Registry, PACTR201811755733759 . Registered on 8 November 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3483-4) contains supplementary material, which is available to authorized users.

Introduction Tuberculosis (TB) remains a major cause of morbidity and mortality, especially in sub-Saharan Africa. We qualitatively evaluated the implementation of an Evidence-Based Multiple Focus Integrated Intensified TB Screening package (EXIT-TB) in the East African region, aimed at increasing TB case detection and number of patients receiving care. Objective We present the accounts of participants from Tanzania, Kenya, Uganda, and Ethiopia regarding the implementation of EXIT-TB, and suggestions for scaling up. Methods A qualitative descriptive design was used to gather insights from purposefully selected healthcare workers, community health workers, and other stakeholders. A total of 27, 13, 14, and 19 in-depth interviews were conducted in Tanzania, Kenya, Uganda, and Ethiopia respectively. Data were transcribed and translated simultaneously and then thematically analysed. Results The EXIT-TB project was described to contribute to increased TB case detection, improved detection of Multidrug-resistant TB patients, reduced delays and waiting time for diagnosis, raised the index of TB suspicion, and improved decision-making among HCWs. The attributes of TB case detection were: (i) free X-ray screening services; (ii) integrating TB case-finding activities in other clinics such as Reproductive and Child Health clinics (RCH), and diabetic clinics; (iii), engagement of CHWs, policymakers, and ministry level program managers; (iv) enhanced community awareness and linkage of clients; (v) cooperation between HCWs and CHWs, (vi) improved screening infrastructure, (vii) the adoption of the new simplified screening criteria and (viii) training of implementers. The supply-side challenges encountered ranged from disorganized care, limited space, the COVID-19 pandemic, inadequate human resources, inadequate knowledge and expertise, stock out of supplies, delayed maintenance of equipment, to absence of X-ray and GeneXpert machines in some facilities. The demand side challenges ranged from delayed care seeking, inadequate awareness, negative beliefs, fears towards screening, to financial challenges. Suggestions for scaling up ranged from improving service delivery, access to diagnostic equipment and supplies, and infrastructure, to addressing client fears and stigma. Conclusion The EXIT-TB package appears to have contributed towards increasing TB case detection and reducing delays in TB treatment in the study settings. Addressing the challenges identified is needed to maximize the impact of the EXIT-TB intervention.

Background Adherence to antiretroviral (ARV) treatment for HIV infection is challenging because of many factors. The World Health Organization (WHO) has recommended using digital adherence technologies (DATs). However, there is limited evidence on how DATs improve adherence. Wisepill® is an internet-enabled medication dispenser found feasible and acceptable in several studies. However, limited evidence is available on its effectiveness in improving ART adherence, specifically among children and adolescents. Furthermore, DATs are often developed without involving the target groups. We propose a two-stage project consisting of a formative study to customize an existing Wisepill DAT intervention and a randomized clinical trial to investigate the effectiveness of DAT combined with reminder cues and tailored feedback on adherence to ARV treatment among children and adolescents living with HIV and retention in care among breastfeeding women living with HIV in Kilimanjaro and Arusha Region, Tanzania. Methods We will conduct a formative mixed-methods study and three sub-trials in Kilimanjaro and Arusha Regions among (1) children aged 0–14 years and their caregivers, (2) adolescents aged 15–19 years and (3) breastfeeding women and their HIV-negative infants. In the formative study, we will collect and analyse data on needs and contents for DATs, including the contents of short message service (SMS) texts and tailored feedback. The results will inform the customization of the DAT to be tested in the sub-trials. In the trials, participants will be randomized in the intervention arm, where the DAT will be implemented or the control arm, where standard care will be followed. Participants in the intervention arm will take their medication from the Wisepill box and receive daily reminder texts and tailored feedback during clinic visits. Discussion If the intervention improves adherence to ART and the devices are acceptable, accurate and sustainable, the intervention can be scaled up within the National Aids Control Programmes. Trial registration PACTR202301844164954, date 27 January 2023.

Background: Musculoskeletal (MSK) disorders account for 20% of all years lived with disability worldwide. There have been few prevalence studies of MSK disorders in Africa, and none published from Tanzania. Screening for MSK disorders is not routinely conducted in healthcare facilities and there are no registered rheumatology consultants in northern Tanzania. This pilot study aimed to provide an initial estimate of the community-based prevalence, and predictors, of MSK disorders and to assess the functional status and disability associated with MSK disorders. Methods: A cross-sectional pilot study was conducted in a single village in the Hai District Kilimanjaro region from March to June 2019, involving the administration of Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) physical examinations during household and school visits. Individuals positive by GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and the Modified Health Assessment Questionnaire (MHAQ) tools. Multivariable logistic regression analyses were used to understand the influence of demographic variables (age and sex), tribe and religion on GALS/pGALS, REMS and MHAQ outcomes. Results: A total of 1854 participants were enrolled. Of the 1172 individuals enrolled at the household level, 95 showed signs of MSK disorders during the GALS/pGALS examination (8.1%, 95% CI: 6.6 – 9.8) and 37 during the REMS examination (3.2%, 95% CI: 2.2 – 4.3), respectively. Among all 682 participants enrolled in schools, seven showed signs of MSK disorders during the GALS/pGALS examination (1.0%, 95% CI: 0.4 – 2.1) and three during the REMS examination (0.4%, 95% CI: 0.0 – 1.3), respectively. In the household enrolled population female gender and increasing age were significantly associated with GALS and REMS positive findings. Among the GALS positive individuals, increasing age was significantly associated with REMS positive status and increasing MHAQ scores, indicating worse function and greater disability. Conclusions: Our pilot study confirms the prevalence of MSK disorders in this study population and predictors of MSK disorders that are comparable to those seen elsewhere in the world. These pilot data can inform the design of future investigations of the determinants of MSK disorders and their impacts on health, livelihood, and well-being in Tanzania.

Background: In Tanzania, disclosure of HIV status to children remains a challenge despite the World Health Organization (WHO) recommendation that children should be informed about their HIV status between the ages of 6 to 12 years. This study aims to determine HIV status disclosure and related factors among children living with HIV in Kilimanjaro, Tanzania. Method: A cross-sectional study using a convergent parallel mixed-methods design was conducted from September 2021 to February 2022 among children aged 6-14 years receiving HIV care. Semi-structured questionnaires were collected from caregivers of undisclosed children, including socio-demographic data and reasons for non-disclosure. Additionally, we interviewed 20 caregivers of children in-depth who had disclosed and not disclosed the status to their children; we also interviewed children whose HIV status had been disclosed, followed by a focus group discussion. Bivariate and multivariate logistic regression analyses identified factors associated with HIV status disclosure. P<0.05 was considered statistically significant. We did thematic content analysis for qualitative data. Results: 121 children and their parents or caregivers were included in the analysis and 51(42%) knew about their HIV status. 31%(n=38) of children were between the ages 6-8 and among them, 33(87%) did not know about their status. Thirty-nine percent (n=47) of children were between the ages of 9-11; 32(68%) did not know about their status. 30% (n=36) of the children were above 12 years old, and 5(14%) did not know their status. 60 children were girls (49.5%); the majority (n=75;62%) lived with their biological parents; 112 children had primary education (93%); and 94 (78%) children attended referral hospitals for ART services. Moreover, 86(71%) of the children had caregivers who had been interviewed. In the final multivariate model, children aged above 12 years (OR= 30; 95%; Cl= 7.2-124); children aged 9-11(OR=2.7;95%; CI= 0.8-9.0) and having a treatment supporter (OR=2.9; 95%CI=1.0-8.2) were significantly associated with HIV status disclosure to their children compared to their counterparts respectively. Through IDI, we revealed the following themes: (1) HIV disclosure challenges and reasons not to disclose the status, (2) the process of the disclosure, and (3) the Importance of disclosure. Conclusion: HIV status disclosure to children living with HIV in Kilimanjaro region was associated with age above 12 years and having a treatment supporter, unlike the WHO recommendation. Therefore, health facilities should introduce new strategies to ensure children know their HIV status.