Perceived Benefits, Challenges, and Recommendations for National HIV/AIDS Research Dissemination Efforts in Tanzania

Background Although a number of international and national HIV/AIDS conferences exist, there is not a national conference in Tanzania focusing on disseminating HIV/AIDS research conducted in the country. This creates a missed opportunity for researchers to share their research findings with local policy makers and HIV program implementers who can influence the adoption and implementation of locally promising research to public health and clinical practice settings. This paper reports on the findings from a brainstorming session conducted at the first HIV/AIDS Research Forum designed to enhance local dissemination efforts of HIV/AIDS research conducted in Tanzania. Method During the second day of the Forum, which was held in Morogoro, Tanzania, a 1-hour structured brainstorming session was conducted with the Forum participants. Participants included researchers, medical professionals, policymakers, representatives from different ministries. Transcription of the brainstorming session was analyzed to identify benefits of the Forum, perceived challenges for organizing similar HIV/AIDS research dissemination events, and recommendations for addressing the challenges. Results Overall, 50 participants attended the Forum and they perceived the forum to be beneficial because it brought together researchers, policymakers, and other stakeholders working in HIV/AIDS programs and implementers. Having policymakers and researchers in the same place enhance the likelihood of policymakers using research findings to inform policies and influence adoption and implementation of effective interventions. Forum participants identified several potential challenges of similar local HIV/AIDS research dissemination efforts including the costs and lack of funding for organizing and hosting such forums or having repetitive presentations. To address these concerns, they recommended a biennial national conference in order to allow more time to raise funds to cover the costs associated with organizing such a conference. Conclusion The benefits identified for the

Forum highlight the importance of developing a national level HIV/AIDS conference in Tanzania. However, the potential challenges discussed need to be addressed in order to develop a sustainable national HIV/AIDS conference by incorporating the recommendations that forum attendees proposed.

Background
Although significant progress has been made to address the burden of HIV/AIDS, it remains a pressing public health issue in Tanzania [1]. In Tanzania, only 960,000 people are aware of their HIV status, despite the fact that an estimated 1.4 million people are living with HIV [2]. The significant social and economic impacts of the epidemic can be observed in the loss of human capital and the damaging effects on the country's institutional capacity [1]. In response, international and local stakeholders, including the Tanzania Commission for AIDS (TACAIDS), and its partners monitor trends, risk factors, and the prevalence of HIV infection, alongside initiatives to guide strategic planning in the fight against HIV/AIDS [2,3].

TACAIDS is a government organization established by President Benjamin Mkapa in 2000
to coordinate the efforts of stakeholders in the multi-sectoral response to HIV/AIDS in Tanzania [3]. In 2001, TACAIDS developed the national policy on HIV/AIDS [2,3]. The National Multisectoral Strategic Framework was developed to organize and coordinate the contributions of stakeholders to the HIV/AIDS response in Tanzania and to address the damaging and nationwide impact of the HIV/AIDS epidemic [17]. Since its establishment, the organization has taken a strategic leadership role in communicating information about HIV/AIDS. TACAIDS collaborates with several domestic and international partners, including but not limited to, such as the National AIDS Control Programme (NACP) and the United States Agency for International Development (USAID) to disseminate comprehensive population and health surveys, and implements programs to combat the damaging social, economic, and health-related effects of HIV/AIDS [2,3] [4] to guide research [5][6][7][8][9] and programs increase HIV testing services uptake among men in Tanzania.
In an effort to enhance the local dissemination of HIV/AIDS research conducted in Tanzania, TACAIDS organized the first HIV/AIDS Research Forum, which was held on September 2018 in Morogoro, Tanzania. Dissemination is defined as an active approach of spreading evidence-based interventions to the target audience via predetermined channels using planned strategies [10,11]. Local HIV/AIDS research dissemination is crucial for sharing HIV/AIDS findings with local policymakers, HIV program implementing partners, and other stakeholders who can adopt and implement evidenced-based interventions that have been assessed for local acceptability and feasibility. Although a number of international and national HIV/AIDS conferences exist [12][13][14][15][16][17][18]

Setting and participants
In September 2018, a two-day Forum was organized by TACAIDS in Morogoro, a town in eastern Tanzania. The forum was held at Sokoine University of Agriculture on September 27-28th. During the first day, the executive director of TACAIDS provided welcoming remarks and requested for participants to introduce themselves and share the name of their respective institutions. A total of 50 attendees were at the forum representing ministries and institutions with diverse background and specialties, including but not limited to, academicians, researchers, policy and decision makers, funding agencies, and implementation partners. After introduction and the official opening of the forum, a number of research presentations were made by different forum participants followed by a discussion session after every 1-2 presentations.
During the second day, the secretariat provided a recap of the presentations from the first day before additional presentations were made and discussed. After the presentations and discussions, a brainstorming session was conducted by co-authors (DFC, AMK) to assess:

Data Analysis
The study was underpinned in a pragmatism methodological orientation and included a descriptive qualitative analysis [20] aimed at understanding perceived benefits of the HIV/AIDS research dissemination Forum as well as challenges of organizing future Forums and recommendations for addressing these challenges. We transcribed the audiorecording of the brainstorming session and reviewed the transcript to compare with the notes taken during the brainstorming to support or clarify some statements in the transcript. After the transcription phase, the experienced qualitative research team member provided training in qualitative data analysis to research assistants (SS, JV, RR, AO) new to qualitative research. We then developed deductive codes, based on previous qualitative research in Tanzania [7], with primary and secondary code definitions and quotes supporting these codes [21]. SS, JV, RR, and AO coded the transcripts in analytical phases by applying deductive codes but also identifying emerging codes. Coders reviewed the data and applied these structural (deductive) codes. Reliability and validity were established by having at least two research assistants code a subset of the transcript and comparing their respective codes during consensus-coding meetings to resolve any discrepancies [22]. In the second phase, single code reports were generated and reviewed before refining the codes and creating categories related to the deductive codes which  Representatives from different ministries and institutions were able to learn how they can become involved in the campaign. Another benefit of the forum that participants reported was the ability for forum attendees to identify challenges of hosting similar HIV/AIDS research forum and provide recommendations on how to organize future meetings and a potential national HIV/AIDS conference: So, I think the focus that if the question is there an interest in holding similar HIV meeting, yes! Because we have seen here, people have been interested… Potential challenges and solutions we will be sharing on the meetings and discussion we have reached here. Now, once we go back, we will come up with these solutions and share again with this meeting. This is what I am trying to see.

Perceived Challenges of HIV/AIDS Research Dissemination Forum
Aside from the perceived benefits, participants also reported potential challenges of organizing an HIV/AIDS research conference. As aforementioned, the low attendance policy makers at previous HIV/AIDS research meetings made the participants question whether enough policy makers would attend future HIV/AIDS research meetings. The potential poor attendance of policy makers and decision makers raised another challenge of how researchers would be able to have the support needed to translate the research into policies needed to make implement evidence-based interventions at the national or regional levels. Participants mentioned that the abstract requirement for attending future HIV/AIDS research forums or conference can also deter non-researchers from attending and contribute to the low attendance of policy makers and other stakeholders whose primary work does not involve research. I don't think that you have ever got something from the ministry over here, because they don't write abstracts. Somebody cannot [may not] be a scientific but can have great ideas .We all see the politicians, we never have a paper from the parliament, but you [they] have great ideas, of which they are relating in this forum.
Related to the presentations, participants shared that if the conference is held too frequently (i.e. annually), then there is the possibility that there will be repetitive presentations from year to year. This concern stemmed from the fact that researchers may not have enough time to complete their projects and advance to new projects within one year since research projects take a long time to be developed, funded, approved by institutional review boards, and carried out. Other potential challenges were related to the costs associated with organizing a national or regional HIV/AIDS conference, the lack of coordination between organizations involved in HIV/AIDS programs, and the potential time conflict between the national conference and international HIV/AIDS conferences.

Recommendations For HIV/AIDS Research Dissemination Forum
Participants offered several suggestions for overcoming potential challenges described above and make key recommendations that can inform the development of a future HIV/AIDS Research Dissemination Forum or national conference. First, participants agreed that there is a need to have these forums and some participants suggested such forums happen every two years to give researchers more time so that they can come with new findings and minimize the costs of having the forum annually: I think we need them every, after every two years because we need researches that will be really informative and that can be translated into policies. So, in coordinating these researches, I am suggesting whoever is interested in researching on HIV/AIDS in this country, after getting a clearance, or before getting clearance from the National Institute Second, participants suggested that TACAIDS develop strategies in collaboration with other organizations to solicit funds to cover the costs associated with organizing such forums. Third, to increase the coordination among organizations involved in HIV/AIDS programs in the country, participants recommended that any issues between TACAIDS and other organizations are resolved in order to attract multi-sectoral stakeholders and increase teamwork and inter-organizational communication. Fourth, participants preferred a national-level forum over a regional-level one. An increase in inter-organizational communication can allow organizations to combine forums and come together instead of having several smaller forums. Participants also recommended greater crosscollaborations between researchers, policy makers, and program implementers prior to the conference in order to enhance the success of the conference. Regarding this recommendation, participants also stated that future forums and conferences should allot the first day for scientific presentations and the second day for policy dialogue and action plans. Participants also stated that presentations from personnel who do not submit scientific papers but can share relevant ideas. Furthermore, discussion-based forums, where presentations are delivered in simple language instead of in complex scientific terms and statistics, are preferred in order for members outside of the scientific community to understand. The following quotation illustrates another one of the key recommendations: I am now seeing the contradiction because we have NACP and we have TACAIDS, when do you go to NACP they say they have the data, TACAIDS you have the implementations… When you have to discuss with your fellows at NACP who are doing the same activities, so that you share the same activities in the same event, you see… I'm proposing you put up a task force so that you resolve everything that may [be] part of the contradictions. That way when we start moving we move as a team, instead of moving as TACAIDS alone.
Because in a way you go there to organize the events now that you need to organize.

Discussion
To our knowledge, this is the first study from a brainstorming session organized to explore the perceived benefits of an HIV/AIDS forum in Tanzania These challenges may be unknown to researchers and other groups and the forum can be an opportunity for policy makers to share more about the policy making processes and policy makers can also learn how to work with different groups and organizations such as faith-based organizations that may not be responding positively to current policies [26].
Having a better understanding of how the different sectors work can allow more collaborative efforts towards HIV prevention as reported by members of the Madikwe Forum [24]. Another benefit of the forum was that participants also had a chance to discuss potential challenges and recommendations on to address the challenges for the forum or national conference to be sustainable.
The challenges identified focused on the potential poor attendance of policy makers and other non-researchers because of the abstract requirements, the lack of new presentations if the forum is held too frequently, the lack of coordination between organizations involved in HIV/AIDS-related activities, and the costs associated with hosting the forum and potential national HIV/AIDS conference. The potential poor attendance of policy makers and different ministries is a valid concern, especially for researchers, since policy makers have the decision-making power but are not usually present in research meetings. Recommendations to enhance attendance from policy makers and nonresearchers included the removal of the abstract requirement. Another recommendation that can improve attendance is having the meeting every two years. Findings from the study in Bostwana showed that that attendance from high-level government representatives was low due to the possible frequent meetings that the Madikwe Forum held [24]. The lack of new presentations and not having enough time to complete tasks were also identified as an issue in the Madikwe Forum when [24]. Furthermore, the recommendation to have the forum or conference ever two years would reduce the costs associated with planning and hosting the event and allow TACAIDS and other organizations more time to raise the funds needed to attenuate some of the costs. Researchers will also have more time to seek or receive funding to develop new projects and have a higher chance of having new findings to present. Other necessary recommendations that can help increase attendance and make the forum and future conference sustainable are the need for better cross-organizational collaborations and the preference for discussion-based presentations instead of those filled with scientific terms and statistics.

Limitations
Despite the strengths of the study, there are some limitations worth highlighting. The challenges and recommendations do not represent the views of several stakeholders and organizations involved in HIV/AIDS research dissemination that were not present at the forum. In addition, the majority of the research team members are researchers and not policy makers. Therefore, the interpretation of the results may be influenced by the research team members' background. The other limitation was that the recording from the brainstorming session proved to be difficult to decipher at times. To address this issue, multiple members of the team listened and re-transcribe segments of the audio that were difficult to decipher.