title: CLINICAL outcomes and loss to follow-up among people living with HIV participating in the NAMWEZA intervention in Dar es Salaam, Tanzania: a prospective cohort study.
abstract: BACKGROUND
  Psychosocial factors have been linked with loss to follow-up (LTFU) and clinical outcomes among people living with HIV (PLH), however little is known about the effect of psychosocial support on LTFU among PLH in treatment and care. The purpose of this study was to explore the effect of NAMWEZA ("Yes, together we can") friends' psychosocial support intervention on clinical outcomes and LTFU among PLH. NAMWEZA is based on a novel program using "appreciative inquiry", positive psychology approaches to empower, promote positive attitudes and foster hope.
  
  
  METHODS
  PLH participating in the NAMWEZA intervention in HIV care clinics in Dar es Salaam Tanzania were compared with non-exposed PLH obtained from facilities that routinely collect clinical information and both followed longitudinally for 24 months. Baseline sociodemographic, clinical measures (CD4 cell count, hemoglobin (HGB), weight), and LTFU measures were collected. Chi square, Fisher's exact tests, and t-tests were used to compare the frequencies for categorical variables and the means of continuous variables from the intervention and the comparison groups to identify variables that were significantly different across the two groups. Random effects models were performed to examine the bivariate associations between the intervention status and clinical outcomes.
  
  
  RESULTS
  At the end of 24 months of follow-up mean CD4 count and HGB levels increased significantly in both intervention and comparison groups (p = 0.009 and p < 0.0001, respectively). Weight increased significantly only in the intervention group (p = 0.003). Cumulative LTFU was three times higher in the comparison compared to the intervention (p < 0.001) group. Having a low CD4 count, extremes of weight, low HGB, younger age, and male gender were significantly associated with LTFU among the unexposed group, while being on ART for duration of 12 months or more was protective against LTFU in those intervened.
  
  
  CONCLUSIONS
  Among PLH on ART, exposed or not exposed to NAMWEZA intervention, clinical care outcomes improved over time. LTFU was much higher in the comparison group with factors commonly known to predict LTFU only apparent in the comparison group. NAMWEZA could be a promising peer-facilitated model to reduce LTFU among PLH in care that can be integrated in ART services; however, more research is needed to evaluate its longer term effects.
authors.affiliation: Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. neemasiril@gmail.com.|Management and Development for Health (MDH), Plot number 802, Mwai Kibaki Road, 255, Dar es Salaam, Tanzania. neemasiril@gmail.com.
authors.forename: Hellen N
authors.initials: HN
authors.lastname: Siril
authors.affiliation: Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Sylvia F
authors.initials: SF
authors.lastname: Kaaya
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Smith Fawzi
authors.affiliation: African Academy for Public Health (AAPH), Dar es Salaam, Tanzania.
authors.forename: Expeditho
authors.initials: E
authors.lastname: Mtisi
authors.affiliation: African Academy for Public Health (AAPH), Dar es Salaam, Tanzania.
authors.forename: Magreat
authors.initials: M
authors.lastname: Somba
authors.affiliation: Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Japheth
authors.initials: J
authors.lastname: Kilewo
authors.affiliation: Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mugusi
authors.affiliation: African Academy for Public Health (AAPH), Dar es Salaam, Tanzania.
authors.forename: Anna
authors.initials: A
authors.lastname: Minja
authors.affiliation: African Academy for Public Health (AAPH), Dar es Salaam, Tanzania.
authors.forename: Anna
authors.initials: A
authors.lastname: Kaale
authors.affiliation: National Institute for Medical Research (NIMR), Mwanza, Tanzania.|Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania.|Population Health Department, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001294:Attitude to Health; D001835:Body Weight; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000276:immunology / Q000523:psychology* / Q000628:therapy*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013636:Tanzania; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D006454:Hemoglobins
keywords: ART; Dar es Salaam; HIV/AIDS; LTFU; NAMWEZA; PLH; Psychosocial; Tanzania