Generating and utilizing scientific evidence to inform plans, interventions, decisions and resource allocation in health services and programs is at the very core of MDH’s work and approach. To achieve this, aside from the service delivery projects, MDH plays an active role in designing and implementing clinical and operational research, as well as secondary analysis of routine care data, to provide evidence-based answers to the various national and global public health challenges and priorities. Findings from this work are widely disseminated in programmatic and scientific peer-reviewed forums to contribute towards expanding knowledge base and inform national and global plans, policies and decisions. By June 2019, findings from MDH’s work had contributed to scientific publications, conference presentations and policy briefs. Below is a summary of MDH’s clinical and operational research projects and list of scientific publications that have resulted from MDH’s work.

DNDI LIVING STUDY 2018-2019

The Living study 2018-19 is a multi-country study - across Tanzania, Kenya and Uganda - funded by the Drugs for Neglected Diseases Initiative (DNDI), which aims at evaluating the effectiveness of Lopinavir/ritonavir (LPV/r) pellets, in addition to other NRTIs, in pediatric ART in routine care settings, among children who cannot swallow tablets. The study addresses a major global challenge of limited options and formulations of antiretroviral drugs for pediatric ART. In Tanzania, the study is implemented by MDH in collaboration with Ifakara Health Institute (IHI) and has three study sites in Dar es Salaam and Morogoro regions. The study employs a single-arm phase IIIB non-randomized, non-comparative, open label study design and evaluates a composite primary endpoint of virologic response, being alive and on study drug at 48 weeks as the primary study endpoint. Other outcomes include treatment adherence, drug resistance, clinical and immunological failure and adverse events. By the end of 2018 all study sites had completed enrollment and were at different stages of follow-up.

AFYA II (CASH TRANSFER) STUDY 2018-2019

The Afya II is randomized comparative controlled trial - funded by the University of California Berkeley - implemented by MDH in collaboration with Health for a Prosperous Nation (HPON-TZ) in Shinyanga, Tanzania. The study aims at optimizing the efficiency and implementation of cash transfers to improve ART adherence among PLHIVs. This study will evaluate the dose-response relationship between cash transfers and viral suppression and identify the most effective cash transfer size for maximal retention and viral suppression outcomes after 6 months of ART use. By the end of 2018 study enrollment was complete and follow-up ongoing.

H: Community ART (3IE 2016-2017)

This was a implementation research project implemented by MDH in collaboration with the Harvard T.H.Chan School of Public Health, National AIDS Control Program (NACP), CHMTs, CBHCs and HBCs at the selected health facilities in Dar es Salaam region. The key objective of the project was to assess the feasibility, acceptability and effectiveness using the HBCs to deliver ARVs to stable clients at the community as one of the differentiated care model.  The primary outcome of the project was the proportion of clients with suppressed viral load among those receiving home delivery of ARVs vs those continued with the current standard of care.  A total of 48 HFs participated, 24 randomly assigned to the intervention arm and 24 continued with the standard of care (control arm). Up to 2,000 clients were enrolled, 1000 in each arm. A total of 636 clients, mostly women received ARVs at home during the study period. We performed a series of qualitative interviews to assess feasibility and acceptability. The preliminary findings showed that the community ART project is feasible and accepted by the HCPs and clients and the quantitative data shows that it is not inferior to the current standard of care.

TRIAL OF VITAMINS STUDIES (TOV4 2014-2019 & TOV5 2015-2020)

TOV4 and TOV5 studies are two separate individual-randomized, double-blinded, placebo-controlled clinical trials of vitamin D, part of a long series of vitamin clinical trials among PLHIVs that MDH has been conducting in partnership with the Harvard T.H. Chan School of Public Health (HSPH) and Muhimbili University of Health and Allied Sciences (MUHAS). TOV4 investigates the effect of vitamin D on mortality and TB incidence among HIV-infected adults; whereas TOV5 investigates effects of vitamin D on maternal HIV disease progression/death, infant small for gestational age and infant stunting at 12 months, among HIV-infected pregnant women; in Dar es Salaam region. By the end of 2018 both studies had completed enrollment and were at different stages of follow-up and analysis.

POST PARTUM INTRAUTERINE DEVICE (PPIUD) PROJECT 2015-2019

PPIUD is a family planning implementation research project funded by International Federation of the Gynecologists and obstetricians (FIGO) and implemented by the Association of Gynecologist and Obstetrician in Tanzania (AGOTA), Harvard T.H. Chan School of Public Health (HSPH) and MDH. In this project MDH leads project evaluation component whereby a step-wedge design is employed to assess the institutionalization of PPIUD services at the antenatal clinic and labor wards in Tanzania. The intervention is implemented in five referral hospitals across Arusha, Dar es Salaam, Dodoma, Mbeya and Pwani regions. The intervention package comprises of training of HCPs on PPIUD counselling and insertions, supporting delivery of PPIUD education at the HFs and ensuring that the HFs are adequately stocked with the IUDs.

Key project accomplishments by the end of 2018, include recruitment and follow-up of 24,238 women and attaining over 80% of targeted follow-up clients across multiple timepoints; and successful completion of data collection and cleaning from both women and up to 149 HCPs, including quantitative and qualitative surveys, interviews and checklist guided observations at multiple time points.

   

Uzazi Bora Project 2012-2014: Improving the quality of maternal health services during labour, delivery and post-delivery in Dar es Salaam: 2012-2014

Uzazi Bora was a two-year implementation research project implemented by MDH in collaboration with Temeke MMOH, the Tanzania Ministry of Health, and the Harvard T.H. Chan School of Public Health and the François-Xavier Bagnoud Center for Health and Human Rights (FXB) at Harvard University. The overall aim of the project was to investigate and address gaps in respectful care during childbirth as well as evaluating interventions to mitigate the impacts of maternal deaths on the health and wellbeing on the children left behind. At baseline survey, the project revealed that up to 15% of post-partum women at facility-based exit interview and 77% at home-based interview reported some form of D&A during facility-based childbirth. Following these findings two interventions were identified and implemented to address D&A observed, i.e.: (1) Open Birth Days (OBD) and (2) Respectful Maternity Care (RMC) workshops, which revealed a promising trend towards addressing D&A during childbirth.

Overall, this project provided among the earliest evidence to describe, quantify and raise awareness on the magnitude of D&A in Tanzania. The inclusive and participatory approach used by the project greatly contributed to mobilize and engage women-clients themselves, health care providers, health managers and health stakeholders in general to acknowledge and begin to take steps to address gaps in respectful care during childbirth, as a significant barrier to quality and outcomes of maternal health services.

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