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Background Insufficient knowledge on blood-borne pathogens has been identified as a factor that influences occupational exposure to needle stick and sharps injuries. The objective of this study was to assess healthcare workers’ knowledge on occupational exposure to HIV. Methods A cross sectional survey was conducted at Tumbi designated regional hospital and Dodoma regional hospital, Tanzania in February 2012. A self-administered questionnaire was used to capture information on knowledge of occupational exposure to HIV infection. Results A total of 401 healthcare workers responded to a self-administered questionnaire. High proportion of healthcare workers (96.3%) understood that they are at risk of occupational exposure to HIV. The majority of healthcare workers trained on post exposure prophylaxis procedure and use of personal protective equipment were clinicians (87.1% and 71.4% respectively) and nurses (81.8% and 74.6% respectively). Over a quarter of the healthcare workers were not aware of whom to contact in the event of occupational exposure. One third of healthcare workers did not have comprehensive knowledge on causes of occupational HIV transmission and did not know when post exposure prophylaxis is indicated. Healthcare workers not trained on the use of person protective equipment were less likely to have comprehensive knowledge on occupational exposure to HIV (OR = 0.5; 95% CI 0.3 – 0.9). Knowledge on causes of occupational exposure varied with the cadre of healthcare workers. Nurses were more likely to have comprehensive knowledge on occupational exposure to HIV than non-clinical staff (OR = 2.6; 95% CI 1.5 – 4.5). Conclusion A substantial proportion of studied healthcare workers had little knowledge on occupational exposure to HIV and was not aware of a contact person in the event of occupational exposure to HIV. Training on post exposure prophylaxis and infection prevention and control including the use of person protective equipment provided to nurses and clinicians should be extended to other clinical and non-clinical hospital staff.

Background HIV status disclosure facilitates access to HIV-related prevention and treatment services and increases opportunities for social support, HIV risk reduction with partners, and index testing for sexual partners or children. This study assessed the effect of a program model of community-based social welfare volunteers on HIV status disclosure among caregivers of orphans and vulnerable children (OVC). Methods This was a longitudinal study, which was based on OVC caregivers who were beneficiaries of the USAID Kizazi Kipya project in Tanzania. They were enrolled (baseline) by community social welfare volunteers during 2017–2018, received services, and reassessed at midline in 2019. Caregivers who reported having been HIV tested, were asked to voluntarily report the status in order for the volunteers to establish and provide needed services. Those who reported their HIV status as negative or positive were grouped as “disclosed”, and those who knew their status but did not report it were documented as “undisclosed”. McNemar’s tests compared disclosure rates at baseline and midline. Multivariable analysis was conducted using generalized estimating equation (GEE). Results The study analyzed 140,664 caregivers (72% female) from 81 district councils of Tanzania. Their mean age at enrollment was 47.4 years. Overall, 81.3% of the caregivers disclosed their HIV status to the project staff at baseline; this increased significantly to 96.1% at midline (p < 0.001). Disclosure at baseline varied significantly by sociodemographic characteristic (p < 0.05), with higher disclosure in females, among urban residents, and higher educated caregivers. However, the observed disclosure variations by sociodemographic characteristics at baseline disappeared at midline and disclosure reached around 96% across the characteristics (p > 0.05). In the multivariable analysis, caregivers’ likelihood of HIV status disclosure was nearly 6 times higher at midline than at baseline, when baseline characteristics were adjusted for (OR = 5.76, 95% CI 5.59–5.94, p  < 0.001). There were 26,329 caregivers who did not disclose their HIV status at baseline (i.e., 0% diclosure rate at baseline), but 94.7% (n = 24,933) had disclosed by midline, and their disclosure trend was rapidly increasing as their duration of exposure to the project increased. Conclusions This study detected an increased caregivers’ HIV status disclosure to the USAID Kizazi Kipya project staff by 14.8%, from 81.3% at baseline to 96.1% at midline within an average project exposure period of 1.4 years. The observed loss of sociodemographic differences in HIV status disclosure rate at midline implies that community-based interventions may be well-positioned to successfully address and eliminate sociodemographic barriers to service uptake and consequently improve services coverage and health outcomes.

Although Tanzania experiences a general decline in HIV prevalence, some populations such as caregivers of orphans may be at a higher risk than the general population, suggesting that infection pathways still need further exploration. This study examines how food insufficiency relates to HIV infection among caregivers of orphans and vulnerable children (OVC) in Tanzania. Data are from a community-based, USAID-funded Kizazi Kipya project that aims at increasing the uptake of HIV services, as well as other health and social services by OVC and their caregivers in Tanzania. Caregivers who were enrolled in the project from January to July 2017 in seven regions of Tanzania, and had reported their HIV status to the project, were included in the analysis. While HIV status was the outcome, the main independent variable was food insufficiency which was assessed using the Household Hunger Scale (HHS). Using Stata (version 14.0; StataCorp LP, College Station, TX, USA), data analysis involved multilevel mixed-effects logistic regression.. Of the 47,617 caregivers analyzed (73.7% females), 61.8% and 4.6% were experiencing moderate and severe hunger, respectively. The overall HIV prevalence among the caregivers was 28.3%. Nevertheless, the prevalence was as high as 34.2% among caregivers in severe hunger households. Multivariate analysis revealed an increasing likelihood of being HIV positive as hunger increased (moderate hunger: OR=1.10, 95%CI: 1.03-1.18; severe hunger: OR=1.51, 95%CI: 1.32-1.74). These observations were adjusted for marital status, age, sex, education, place of residence, family size, disability status, and health insurance. Food insufficiency is associated with a higher likelihood of HIV infection among OVC caregivers in Tanzania, suggesting that improving access to adequate food has a potential to reduce HIV risks among them. Furthermore, food insufficiency could be considered an important criterion for targeting HIV testing and treatment services to expand coverage.

In 2018, only 65% of Tanzanian children aged 0-14 years living with human immunodeficiency virus (HIV) were on treatment, suggesting that challenges exist. This study explores factors associated with uptake of antiretroviral therapy (ART) among HIV-positive orphans and vulnerable children (OVC). Data are from the USAID Kizazi Kipya project that aims to increase the uptake of HIV/AIDS and other health and social services by OVC and their caregivers. HIV-positive OVC aged 0-14 years who were enrolled in the project from January 2017 to September 2018 were analyzed. ART status (off ART or on ART) was the outcome variable. Multivariate analysis was performed using multilevel logistic regression. Of the 10,047 HIV-positive OVC aged 0-14 years analyzed, 93.5% were currently on ART at enrollment. In the multivariate analysis, OVC with male caregivers were 4-times more likely than those with female caregivers to be on ART (OR=4.03, 95% CI=1.49-10.90). OVC with HIV-positive caregivers were 12-times more likely than those with HIV-negative caregivers to be on ART (OR=12.0, 95% CI=3.81-37.70). OVC with caregivers who did not disclose their HIV status were 74% less likely to be on ART than OVC of HIV-negative caregivers (OR=0.26, 95% CI=0.08-0.90). OVC living in urban areas were more than 5-times as likely as their rural counterparts to be on ART (OR=5.55, 95% CI=2.21-14.0). The majority of the OVCLHIV in the current study were currently on ART (93.5%) at enrollment. However, uptake of ART by the OVC was dependent on factors external to themselves. Advancing ART uptake may require targeting OVC of female caregivers, OVC of HIV-negative caregivers, as well as OVC of caregivers of undisclosed HIV statu, and rural areas.

Vocational education often is ignored during discussions of secondary education reform even though it accounts for between 25 percent and 79 percent of upper secondary enrollment in the former centrally-planned countries of the European Union. Based on information, data, and feedback from most of these countries, this paper develops a set of propositions about vocational education reform, not with a view to prescribing a detailed “one-size-fits-all” strategy, but rather it derives some principles that continued reform of vocational education could take into account, to the benefit of fiscal efficiency.

This paper summarizes the experiences to date of the new EU countries (the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia—the EU8) in the reform of higher education systems in a period of growing demand; changing patterns of access; rapid expansion and increased participation rates; and an apparent dilution of average quality. The study discusses the growing experience with a variety of financing mechanisms in EU8 countries, drawing on detailed country case studies, and seeks to develop some useful lessons from experience, mindful that each country will continue to develop its own solution based on national priorities.

The study reviews the experience in the EU8 countries of the emergence of private higher education institutions and introduction of fees for student who do not gain regular admission. This has resulted in a dual-track system that is affecting the equity of access to higher education. The authors have addressed this with a variety of financing mechanisms in the EU8 countries and seek to develop some useful policy options to \"level the playing field\" for countries contemplating further reforms, which would include the introduction of variable fees, needs-based grants and loans to increase private financial flows into higher education while facilitating equal access across the board. The study begins with and introduction. Chapter 2 provides an overview of current higher education systems in the EU8 in a comparative perspective. Chapter 3 suggests some directions for further reform initiatives. Chapter 4 concludes.

This report explores the fiscal aspects of vocational education reform in the context of secondary education as a whole and considers the implications of any changes in the vocational education (VE) system for post-secondary and other modes of skill development. The report begins by describing the inherited system of vocational education in the former socialist countries of Central and Eastern Europe which was based on the assumption that everyone had to be trained for a specific occupation before starting work and that it was the function of vocational schools to provide such training. The report explores the scope for improvements in fiscal efficiency via a number of propositions about VE in the EU8 countries today: a) It would not be possible or advisable to fund adequately a traditional VE system which would provide ready-to-work recruits with narrowly specialized skills for the economy's enterprises; b) One way to reduce costs to government would be to locate practical training entirely in-plant but this is increasingly difficult; c) EU8 employers' traditional expectations of a fully-subsidized VE system delivering ready-to-work, specifically-skilled recruits are unreasonable; d) Traditional VE was the traditional answer to the question \"What to do with those who have performed less well in basic education?\" but this answer no longer convinces; and e) Parents and students are showing an increasing preference for general education (GE) over VE. Each of these propositions was discussed in this report not with a view to prescribing a detailed \"one-size-fits-all\" strategy for all the EU8 countries, but rather to deriving some principles that continued reform of VE could take into account, to the benefit of fiscal efficiency.