{
  "abstract": "Introduction Sub-Saharan Africa (SSA), including Tanzania, is double-burdened with high rates of teenage pregnancy and new HIV infections among adolescent girls and young women (AGYW) aged 15–24 years. Moreover, pregnant AGYW living with HIV in SSA have poorer adherence and retention on HIV treatment and elevated risks of vertical HIV transmission to their infants, as compared with older women. This paper describes the methods for the ENGAGE project, aiming to investigate and optimise healthcare for prevention of vertical HIV transmission (commonly prevention of mother-to-child transmission (PMTCT)) for AGYW living with HIV in Tanzania.Methods and analysis ENGAGE uses a mixed-methods design to co-create and prototype an intervention package for pregnant/postpartum AGYW living with HIV through three phases in three Tanzanian regions. Phase 1 characterises the problem by investigating care engagement and outcomes in a cohort of N=10 147 AGYW receiving PMTCT services in routine healthcare. Phase 2 uses qualitative interviews to understand the social-structural drivers of care engagement from the perspective of AGYW, healthcare providers and community stakeholders and an evidence review of potential solutions. In phase 3, we will use findings from phase 1 and 2 to co-create (together with AGYW and healthcare providers) an intervention package to optimise PMTCT care for most at-risk AGYW. The co-creation will be done through an intervention development action cycle, where ideas are presented, feedback sought and refinements made iteratively via several workshops over about 6 months. The resulting co-created intervention package will be prototyped at selected facilities/communities and refined into a final version, ready for piloting for feasibility, acceptability and preliminary effect in a later phase. This protocol focuses on the co-creation phase 3 and its preceding phases 1 and 2.Ethics and dissemination ENGAGE has received ethical approval from the Tanzania National Health Research Ethics Committee (NIMR/HQ/R.8a/Vol.IX/4637), and the Swedish Ethical Review Authority (2024-05745-01) for analysis of data in Sweden. Findings will be disseminated to AGYW, healthcare providers, community stakeholders, health officials, researchers, policy makers and the wider local and global scientific community.",
  "authors": [
    {
      "affiliations": [
        "Programs, Management and Development for Health, Dar es Salaam, Tanzania, United Republic of",
        "Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of",
        "Global Public Health, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Goodluck Willey Lyatuu"
    },
    {
      "affiliations": [
        "Global Public Health, Karolinska Institutet, Stockholm, Sweden",
        "Womens and Children’s Health, Karolinska Institute, Stockholm, Sweden",
        "Center for Epidemiology and Community Medicine, Stockholm, Sweden"
      ],
      "name": "Elin C Larsson"
    },
    {
      "affiliations": [
        "Programs, Management and Development for Health, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Hellen Siril"
    },
    {
      "affiliations": [
        "Grants and Business Development, Management and Development for Health, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Theodora Mbunda"
    },
    {
      "affiliations": [
        "Programs, Management and Development for Health, Dar es Salaam, Tanzania, United Republic of",
        "Global Public Health, Karolinska Institutet, Stockholm, Sweden",
        "Obstetric and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Roseline F Urrio"
    },
    {
      "affiliations": [
        "Strategic Information, Management and Development for Health, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Lameck Machumi"
    },
    {
      "affiliations": [
        "Global Public Health, Karolinska Institutet, Stockholm, Sweden",
        "Strategic Information, Management and Development for Health, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Daima Machang’u"
    },
    {
      "affiliations": [
        "Global Public Health, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Regine Unkels"
    },
    {
      "affiliations": [
        "Strategic Information, Management and Development for Health, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Wilhellmuss I Mauka"
    },
    {
      "affiliations": [
        "Epidemiology & Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania, United Republic of"
      ],
      "name": "Michael Johnson Mahande"
    },
    {
      "affiliations": [
        "Programs, Management and Development for Health, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Brenda Simba"
    },
    {
      "affiliations": [
        "Strategic Information, Management and Development for Health, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Charles Festo"
    },
    {
      "affiliations": [
        "Strategic Information, Management and Development for Health, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Andrew Mganga"
    },
    {
      "affiliations": [
        "Health, Social Welfare and Nutrition Services, Tanzania President’s Office Regional Authorities and Local Government, Dodoma, Tanzania, United Republic of"
      ],
      "name": "Rashid Said Mfaume"
    },
    {
      "affiliations": [
        "Regional Administrative Secretary, Kagera, Tanzania President’s Office Regional Authorities and Local Government, Dodoma, Tanzania, United Republic of"
      ],
      "name": "Samwel Laizer"
    },
    {
      "affiliations": [
        "Regional Administrative Secretary, Tabora, Tanzania President’s Office Regional Authorities and Local Government, Dodoma, Tanzania, United Republic of"
      ],
      "name": "Honoratha Rutatinisibwa"
    },
    {
      "affiliations": [
        "Regional Administrative Secretary, Dar es Salaam, Tanzania President's Office Regional Authorities and Local Government, Dodoma, Tanzania, United Republic of"
      ],
      "name": "Ayoub Kibao"
    },
    {
      "affiliations": [
        "Regional Administrative Secretary, Kagera, Tanzania President’s Office Regional Authorities and Local Government, Dodoma, Tanzania, United Republic of"
      ],
      "name": "Pascal Muhode"
    },
    {
      "affiliations": [
        "National AIDS, STIs, and Hepatitis Control Programme, Tanzania Ministry of Health, Dodoma, Tanzania, United Republic of"
      ],
      "name": "Prosper Njau"
    },
    {
      "affiliations": [
        "National AIDS, STIs, and Hepatitis Control Programme, Tanzania Ministry of Health, Dodoma, Tanzania, United Republic of"
      ],
      "name": "Werner Maokola"
    },
    {
      "affiliations": [
        "Preventive Services, Tanzania Ministry of Health, Dodoma, Tanzania, United Republic of"
      ],
      "name": "Anath Rwebembera"
    },
    {
      "affiliations": [
        "Preventive Services, Tanzania Ministry of Health, Dodoma, Tanzania, United Republic of"
      ],
      "name": "Michael Msangi"
    },
    {
      "affiliations": [
        "Preventive Services, Tanzania Ministry of Health, Dodoma, Tanzania, United Republic of"
      ],
      "name": "Mukome A Nyamhagatta"
    },
    {
      "affiliations": [
        "Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Bruno F Sunguya"
    },
    {
      "affiliations": [
        "Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Helga Naburi"
    },
    {
      "affiliations": [
        "Global Public Health, Karolinska Institutet, Stockholm, Sweden",
        "Infectious Diseases, Södersjukhuset Venhälsan, Stockholm, Sweden",
        "Clinical Research and Education, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Anna Mia Ekström"
    },
    {
      "affiliations": [
        "Global Public Health, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Anna E Kågesten"
    }
  ],
  "title": "ENding HIV transmission to infants by Generating Evidence to optimise prevention and care for pregnant and postpartum Adolescent Girls and young women with HIV in Tanzania (ENGAGE): study protocol for a mixed-methods research project",
  "uid": "feb2a386-40b3-56fa-882b-29deefa7df98"
}