Study design and setting
The DYNAMIC Tanzania study was a pragmatic, open-label, parallel-group, cluster randomized trial conducted in 40 primary health facilities in Tanzania. The health facility was the unit of randomization, since the intervention was targeted at the health facility level.Study sites were purposefully chosen to represent a variety of health-care and epidemiological settings within five councils in the Mbeya and Morogoro region, with a total population in those councils of 1,701,717 (ref. First-level health facilities included in the DYNAMIC Tanzania study include dispensaries and health centers with the latter distinguished by several characteristics. Health centers are characterized by multiple outpatient consultation rooms, potential presence of medical doctors, occasional small inpatient wards and a broader array of diagnostic and therapeutic capabilities compared to dispensaries.