4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Trend of Pre-antiretroviral Therapy HIV-1 Drug Resistance in Kilombero and Ulanga Antiretroviral Cohort, South-Western Tanzania, for over 15 years (2005-2020)(University of the Witwatersrand, Johannesburg, 2024) Ntamatungiro, Alex; Kagura, JulianaIntroduction Pre-treatment HIV drug-resistance (PDR) may result in increased risk of virological failure and subsequently acquisition of new HIV drug resistant mutations. With recent increase in antiretroviral therapy (ART) coverage and periodic modifications of the guidelines for HIV treatment, monitoring changes in levels of PDR is critical, particularly in under-sampled areas, such as rural Tanzania. This PhD project aimed to determine the trend and patterns of PDR in the Kilombero and Ulanga antiretroviral cohort (KIULARCO), analyse the impact of recent HIV-1 infection, and dolutegravir rollout in rural Tanzania. Methods The study comprised a systematic review and meta-analysis of primary studies about prevalence of PDR among ART-naive people living with HIV (PLHIV) (³15 years old), published between 2017 and 2022. The data had to be in one or several of the countries of Eastern Africa, namely, Ethiopia, Kenya, Malawi, Rwanda, Mozambique, Tanzania, and Uganda. Thereafter, cross- sectional analyses of data on newly HIV-1-diagnosed ART-naïve adults (aged ≥ 15 years), enrolled in the on-going prospective clinic-based observational rural antiretroviral cohort- KIULARCO focusing on various aspects of PDR. Multivariate logistic regressions were used to determine the factors associated with recent HIV-1 infection, and viral suppression at 12-months in patients initiating dolutegravir-based ART in the KIULARCO. Results Overall, the pooled prevalence estimate of any PDR was 10.0% (95% CI: 7.9%–12.0%, I2 =88.9%) among 22 studies in the general adults’ population, which was higher than the previously reported prevalence of 8.7% using data available until 2016 in the Eastern Africa region. PDR was mainly driven by non-nucleoside reverse transcriptase inhibitors (NNRTI); whereas the pooled prevalence of PDR to nucleoside reverse transcriptase inhibitors (NRTI) was 2.6% (95% CI: 1.8%–3.4%, I2=69.2%). Remarkably, PDR to NRTIs in a sub-population of recently HIV-1 infected PLHIV in the KIULARCO was high at 12.5%. Also, there was a notable tendency to an increasing prevalence of PDR to NRTI, with the overall prevalence of 2.1% in the first five-year period (2005-2009) of the ART program in Tanzania, and 3.4 % in the most recent period (2019-2022). Moreover, there was no PDR to the dolutegravir co-administered NRTI in those with viremia ≥50 copies/mL, at one year, in patients initiating dolutegravir-based ART in the KIULARCO 2 years after dolutegravir roll. Notably, dolutegravir-based ART was associated with >2 times the odds of viral suppression compared to NNRTI-based ART with an adjusted odds ratio (aOR) of 2.10 (95% CI 1.12-3.94). Conclusions There is notable level of PDR to NRTI among general adults’ population in Eastern Africa region, that was high among recently HIV-1 infected PLHIV in a representative rural Sub-Saharan Africa setting. Hence, routine surveillance of pre-existing resistance to the DTG co-administered NRTI remains particularly important, in resource-limited settings, to prevent risk of failure of newer antiretroviral agents such as dolutegravir, which would be detrimental to Tanzania and other low- and middle-income countries for the aim to “end AIDS by 2030”. Our results underline the benefit of programmatic uptake of dolutegravir -based ART in low- and middle-income countries.Item Financial literacy as a determinant of financial inclusion in Tanzania(2022) Mmari, Peter JosephFinancial inclusion is considered to be an effective tool to reduce access and usage barriers in the banking sector. Despite its effectiveness, its benefits have not been fully realized by Tanzanians due to both supply and demand side limiting factors. Tanzania records a high level of financial exclusion in the banking sub-sector because 83 per cent of her adult population is un-banked. The high level of exclusion in banking though poses challenges to Tanzanians it is also a global concern and for that it continues to attract more research for effective interventions, (Demirgüç-Kunt, Klapper, Singer, Ansar, & Hess, 2018). The empirical literature on financial inclusion suggests that financial exclusion in the banking sector is explained by various demand-side factors, including the high level of financial illiteracy in societies, (Chikalipah, 2017). In the context of Tanzania, information regarding the role of financial literacy in influencing financial inclusion in the banking sector is limited. In addition, the moderating effect of demographic variables on the ability of financial literacy to influence financial inclusion remains to be unknown and hence the need for this research. In efforts to address this gap, this study uses the theories of Planned Behaviour (TPB), (Ajzen, 1991) and the Technology Acceptance Model (TAM),(Davis, 1989; Venkatesh & Davis, 2000) to develop a measurement model for financial literacy and digital financial literacy as constructs hypothesized to influence individual’s financial inclusion. Following a positivist and quantitative research approach, this study employs the Structural Equation Modelling technique by using Smart Partial Least Square 3, software to examine the causal relationship between financial literacy and digital financial literacy with financial inclusion. Data for the study were collected through a cross-sectional survey conducted on a sample of 440 respondents from eight districts in Tanzania.Item Stock market effects of the 2015 presidential election in Tanzania(2021) Masima, Nyangwe JobIn this study we analyse for the first time the impact of the 2015 presidential elections on the returns of the Dar Es Salaam Stock Market. A wide range of studies have been conducted on the impact of presidential elections on stock market returns of many countries. Most of these studies have been piloted in developed nations, very little in Africa and no known study in Tanzania. This study provides new knowledge on these fronts for the finance literature in Africa, developing markets and Tanzania. The study was based on event study methodology and employed the market model to estimate the expected return, consequently leading to the computation of abnormal returns. The event days were the 12th July 2015 (nomination day) and 29th October 2015 (election day). Furthermore, a robustness of event study was conducted by testing for structural breaks to determine exogenous dates to confirm event dates assumed at the beginning of the study. A variety of GARCH models were further used to test for the effect of the presidential elections on the returns of the DSE. The graphic representation of the Dar Es Salaam stock market from the period 4th January 2010 to 30th December 2019 indicated an increase in volatility clustering over time compared to period before 2014; highly volatile markets lower investor confidence. Different patterns of abnormal returns were observed for both nomination and election period. The NP10 test indicated negative averages during the break and post break period while positive returns were observed during the pre break period. It is not unusual for this to happen during a period of structural break, but that it continues after, implies that the market is still reeling of the uncertainties generated by the Presidential election activities. The empirical findings showed that the 2015 presidential elections had an impact and sticky effect on the returns of the Dar Es Salaam Stock Market. The study recommends that investors investing on the Dar Es Salaam stock market should carefully plan and carry out investments decisions during and after the period of general elections as returns could be affected either positively or negatively during this period