The Ifakara Clinic Platform: Care and Treatment‚ Training & Research

The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) was initiated in 2004 as a prospective cohort of all consenting patients enrolled into HIV care at the Chronic Diseases Clinic Ifakara at the St. Francis Referral Hospital.

KIULARCO aims at identifying outcomes and needs of people living with HIV in rural sub-Saharan Africa. Up to now more than 11,000 patients have been enrolled – with currently 4,800 under active care (Letang E, Swiss Medical Weekly 2017. Vanobberghen F, PlosOne 2017). An established biobank since the very beginning enables evolutionary studies of the HIV pandemic as well as analyses into emerging resistance patterns and comorbidities.

The comprehensive longterm database serves for nested projects aiming at understanding the needs and outcomes of HIV patients receiving treatment in this rural setting and generates a substantial number of publications yearly (pubmed).

Stig2Health is nested in the Kilombero and Ulanga Antiretroviral Cohort and evaluates multiple measures to reduce stigma in newly diagnosed HIV-patients on linkage and retention in care. In 2019 the same-day counselling for newly diagnosed patients by HIV-positive lay persons was implemented within a pre-post study design. In addition, newly diagnosed patients are shown a video featuring HIV-positive persons from the same environment, sharing on how they managed to integrate HIV into their daily lives, how they cope with challenges and how they learned to lead a normal life. The video also disseminates information on relevant disease aspects, medications and prognosis. The study provides mobile-health support (m-health; practice of medicine and public health supported by mobile devices) through interventions such as two-way communication voice calls, assistance for scheduled clinic visits and much more. Further, group sessions by trained lay counsellors offer guidance and support to patients during waiting times for clinical visits.

This prospective implementation research project analyzes the acceptability and feasibility of a pre-exposure prophylaxis in HIV sero-discordant couples. We prospectively include sero-discordant, sexually active couples aged 15 years or older, of whom the HIV-positive partner was enrolled into KIULARCO within the previous 14 days. After counselling on HIV, transmission risks and prevention methods, PrEP is offered to the partner if tested negative for HIV, a normal kidney function is present and active hepatitis B excluded.

Follow-up visits for both partners after 1, 2, 3, 4 and 6 months assess information on sexual behavior, pregnancies, contraceptive methods, symptoms of sexually transmitted diseases, adherence to PrEP and ART.

The GIVE-MOVE is an open-label randomised clinical trial assessing if genotype-informed, eHealth-assisted management of HIV-positive children and adolescents failing on antiretroviral therapy (ART) i) improves health outcomes at 9 months after randomisation, and ii) is more cost-effective than standard care. The trial started in 2020, is conducted at different sites in Lesotho and Tanzania (GIVE MOVE) and plans to include 276 patients failing on ART. Read more

This randomized controlled double-center open label trial is performed in a rural (St. Francis Referral Hospital, Ifakara) and an urban center (Mwananyamala, Dar es Salaam) in Tanzania. It compares a management algorithm including “extended focused assessment of sonography for HIV and tuberculosis” (eFASH), in combination with chest X ray and microbiological tests to the standard of care in HIV-positive and HIV-negative adults with clinically suspected extrapulmonary tuberculosis. The primary objective is the proportion of correctly managed patients with clinically suspected extrapulmonary tuberculosis. Secondary objectives are to assess the proportion of symptom-free patients, and the time to death during follow-up. Sample size is 700 patients, study duration is two and a half years, including a six-month follow-up.

This implementation project established screening, management and a referral system for malnutrition within the rural Kilombero district in Southwestern Tanzania. The study compared the effect of mass screening versus index screening on detection rates of undernourished children, and assessed in a pre-post study design the number of children hospitalized with malnutrition, including the facility-based case fatality rates of undernourished children.

This prospective observational study investigates the evolution of cardiac insufficiency (i.e. left ventricular ejection fraction, cardiomyopathy) and recovery in young mothers around birth at the St. Francis Referral Hospital in Ifakara, Tanzania. Collected data includes patient characteristics, concomitant medication in association to cardiac recovery, the mode of delivery and maternal/neonatal outcomes (i.e. birth weight, death, development of child). Starting from December 2015 all women presenting with post-partum cardiomyopathy are followed-up for 6-12 months. Sample size is 130 patients.

This randomized controlled double-center open label trial is performed at the St. Francis Referral Hospital, Ifakara (Tanzania) and the Mokhotlong Government Hospital (Lesotho). The main objective is to compare the efficacy of 3 antihypertensive treatment strategies using locally available antihypertensive drugs in HIV-positive and HIV-negative patients in sub-Saharan Africa. The current WHO-recommended treatment and two potentially more efficient treatment approaches are compared in patients with uncomplicated arterial hypertension. In addition, surrogate markers of end-organ damage, time to blood pressure control and multiple blood pressure measurement techniques are evaluated.

In this prospective observational study, we actively enroll all patients with abdominal disorders or trauma presenting to the emergency room of the St. Francis Referral Hospital in Ifakara, Tanzania. Patients with abdominal complaints receive abdominal ultrasound, those with history of blunt or penetrating abdominal or thoracic trauma receive an “extended focused assessment with Ultrasound in Trauma” (eFAST). From these sonographic examinations done by board-certified emergency room personnel in point-of-care emergency sonography, the frequency of sonographic findings and diagnoses will be described.

Within a prospective observational study, we include all patients aged 10 years and older attending at St. Francis Referral Hospital in Ifakara, Tanzania with respiratory symptoms or chest pain. The aim of the study is to compare the diagnoses of trained clinicians using clinical information with lung ultrasound (LUS) using a pocket-ultrasound device - to the diagnoses using clinical information with conventional lung sonography in a rural sub-Saharan Africa setting. This includes comparisons of diagnoses made by trained clinicians performing LUS using a pocket-sized ultrasound device to the final diagnosis determined by an experienced physician.

The recently opened Heart and Lung Diseases Clinic (HLDC) serves as recruitment study site for a prospective patient cohort defining the epidemiological and clinical spectra of non-communicable heart and lung diseases in Kilombero, Ulanga and Malinyi districts and assessing treatment modalities, disease course and outcomes.

Patients have follow-up clinical visits at 2, 6, and 12 months, and then every 12 months, if disease progression is considered stable. Clinical data and examinations such as electrocardiography and echocardiography are registered and stored for further analysis. The HLDC cohort also serves as platform for nested studies and clinical trials.

In this prospective observational study, we examined the impact of performing peripheral smear for patients enrolled into KIULARCO; aetiology, characterization and treatment of moderate to severe anaemia were documented for non-pregnant patients aged > 18 years with moderate or severe anaemia. A differentiated blood smear was sent to a remote hematologist for expert interpretation and recommendation of management. Causes of anemia and managements are collated as the basis for comparisons to a diagnosis based on an automated blood smear.

This study aims to improve cervical cancer screening in women living with HIV attending Chronic Disease Clinics in semi-rural Tanzania, by introducing and assessing the impact of a series of interventions defined by national and international recommendations. Based on a mixed-method, before-/after-study approach the benefits of i) portable colposcopy, ii) human papilloma virus testing and iii) the treatment of precancerous cervical lesions by loop electrosurgical excision procedure will be assessed. This study will provide evidence on the cervical disease prevalence in the cohort, stratified by stage and co-infections, as well as on the acceptability, feasibility and associated costs. Additionally, the comparative performance of a novel diagnostic test (QG-MPH) versus established tests (Prevocheck and Seegene Anyplex™ II 28 HPV Test) as potential triage tools for the development of clinical decision algorithms in cervical cancer screening, will be evaluated.