Lameck Luwanda

• MD, MSc
• Study physician at Ifakara Health Institute

Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-ca...

Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-ca...

Excessive antibiotic use and antimicrobial resistance are major global public health threats. We developed ePOCT+, a digital clinical decision support algorithm in combination with C-reactive protein test, hemoglobin test, pulse oximeter and mentorship, to guide health-care providers in managing acutely sick children under 15 years old. To evaluate...

Effective, scalable and sustainable strategies to improve quality of care are needed to address the substantial burden of preventable deaths of children under-five in resource-constrained settings. Clinical decision support systems (CDSS), digital tools which generate recommendations for healthcare providers based on patient-specific information, s...

Excessive antibiotic use and antimicrobial resistance are major global public health threats. We developed ePOCT+, a digital Clinical Decision Support Algorithm in combination with C-reactive protein test, haemoglobin test, pulse oximeter and mentorship, to guide healthcare providers in managing acutely sick children under 15 years old. To evaluate...

Electronic clinical decision support algorithms (CDSAs) have been developed to address high childhood mortality and inappropriate antibiotic prescription by helping clinicians adhere to guidelines. Previously identified challenges of CDSAs include their limited scope, usability, and outdated clinical content. To address these challenges we develope...

Electronic clinical decision support algorithms (CDSAs) have been developed to address high childhood mortality and inappropriate antibiotic prescription by helping clinicians adhere to guidelines. Previously identified challenges of CDSAs include its limited scope, usability, and outdated clinical algorithms. To address these challenges we develop...

Background The extent to which drug–drug interactions (DDIs) between antiretrovirals (ARVs) and co-medications are recognized and managed has not been thoroughly evaluated in limited-resource settings. Objectives This prospective questionnaire-based study aimed to determine the prevalence and risk factors for unrecognized/incorrectly managed DDIs...

Aim: To provide insight in the primary health care (PHC) case management of febrile children under-five in Dar es Salaam, and to identify areas for improving quality of care. Methods: We used data from the routine care arm of the ePOCT trial, including children aged 2–59 months who presented with an acute febrile illness to two health centers in Da...

Although integration of HIV and maternal health services is recommended by the World Health Organization, evidence to guide implementation is limited. We describe facility-level implementation of policies for integrating HIV care within maternal health services and explore experiences of service users and providers in rural Tanzania (Ifakara), Sout...

Universal antiretroviral therapy (ART) for pregnant and postpartum women in sub-Saharan Africa has required adaptations to service delivery. We compared national policies on differentiated HIV service delivery with facility-level implementation, and explored provider and user experiences in rural Malawi, Tanzania and South Africa. Four national pol...

We estimated the costs of Option B+ for HIV-infected pregnant women in 12 facilities in Morogoro Region, Tanzania, from a provider perspective. Costs of prevention of mother-to-child (PMTCT) HIV services were measured over 12 months to September 2017 to estimate the average costs per HIV testing episode, per HIV-positive case diagnosed, per patient...

Effective implementation of policies for expanding antiretroviral therapy (ART) requires a well-trained and adequately staffed workforce. Changes in national HIV workforce policies, health facility practices, and provider experiences were examined in rural Malawi and Tanzania between 2013 and 2017. In both countries, task-shifting and task-sharing...

National HIV testing policies aim to increase the proportion of people living with HIV who know their status. National HIV testing policies were reviewed for each country from 2013 to 2018, and compared with WHO guidance. Three rounds of health facility surveys were conducted to assess facility level policy implementation in Karonga (Malawi), uMkha...

Background: Cryptococcal meningitis accounts for 15% of all AIDS-mortality globally. Most cases in low- and middle-income countries are treated with fluconazole monotherapy, which is associated with a high mortality. New available therapies are needed. Short course amphotericin B has been shown to be a safe and efficient therapeutic option. Sertra...

A 40-year-old HIV-positive female presented with an erythematous macular eruption involving the malar and periorbital area, the forehead and neck of six weeks of duration (A). She had initiated antiretroviral treatment with co-formulated tenofovir/lamivudine/efavirenz QD plus isoniazid preventive therapy (IPT) 18 weeks before with CD4 counts of 496...

Fig. S1. Use of a blackboard during the communication training. The image shows four examples of health care provider strategies to convince a patient to start antiretroviral therapy (ART), written on a blackboard. Fig. S2. Adherence assessment checklist.

Objectives Our objectives were to describe trends in enrolment and clinical outcomes in the open, prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) in the Morogoro region of southern Tanzania, and identify strengths and areas for improvement in the care of HIV-positive individuals in rural Tanzania. Methods We included adults (≥15...

Flowchart of participants in the cohort. (TIF)

Background Strategies to improve the uptake of Prevention of Mother-To-Child Transmission of HIV (PMTCT) are needed. We integrated HIV and maternal, newborn and child health services in a One Stop Clinic to improve the PMTCT cascade in a rural Tanzanian setting. Methods The One Stop Clinic of Ifakara offers integral care to HIV-infected pregnant w...

Minimal dataset. (XLSX)

Background: The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) is a single-site, open and ongoing prospective cohort of people living with human immunodeficiency virus (PLWHIV) established in 2005 at the Chronic Diseases Clinic of Ifakara (CDCI), within the Saint Francis Referral Hospital (SFRH) in Ifakara, Tanzania. The objectives of KIULA...

Objective: To investigate the prevalence and determinants of virologic failure (VF) and acquired drug resistance-associated mutations (DRM) in HIV-infected children and adolescents in rural Tanzania. Design: Prospective cohort study with cross-sectional analysis. Methods: All children ?18 years attending the paediatric HIV Clinic of Ifakara an...

Background: Immune reconstitution inflammatory syndrome associated with dermatophytoses (tinea-IRIS) may cause considerable morbidity. Yet, it has been scarcely reported and is rarely considered in the differential diagnosis of HIV associated cutaneous lesions in Africa. If identified, it responds well to antifungals combined with steroids. We pre...

Background Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage, and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa. Methods From December 2012, we implemented an intervention package to improve prevention of mother-to-child transmission (PMTCT) and pediatric HIV care in...

The acquisition of drug-resistance mutations among African children living with in human immunodeficiency virus on antiretroviral treatment has been scarcely reported. This threatens the overall success of antiretroviral programs and the clinical outcomes of children in care. We present a well characterized series of children from rural Tanzania wi...

A support tool for teaching to achieve an improvement in the study and understanding of the subjects Human Morfophysiology I and IV is prepared for students and professors of the medical sciences. It deals with aspects related to the metabolism of the biological compounds which contain nitrogen in their structures, mainly the ammonia, the amino aci...