Reasons Influencing PrEP continuity among Key and Priority Populations in Tabora region, Tanzania. A cross-sectional study.

Adam  Mrisho; Honoratha  Rutatinisibwa; George  Msalale; Ramadhani  Shemtandulo; Benson  Mturi; Steven  Ambonisye; AbelaAbele  Rumisha; Mohamed  Ayoub; Charles  Shirima; Wilhellmuss  Mauka; Shallon  Atuhaire; Evaline  Maziku; Anath  Rwebembera; Goodluck  Lyatuu; David  Sando

doi:10.51168/sjhrafrica.v3i12.285

Authors

Adam Mrisho Management and Development for Health
Honoratha Rutatinisibwa Regional Administrative Secretary- Tabora.
George Msalale Regional Administrative Secretary- Tabora.
Ramadhani Shemtandulo Management and Development for Health (MDH)
Benson Mturi Management and Development for Health (MDH)
Steven Ambonisye Management and Development for Health (MDH)
AbelaAbele Rumisha Management and Development for Health (MDH)
Mohamed Ayoub Management and Development for Health (MDH)
Charles Shirima Management and Development for Health (MDH)
Wilhellmuss Mauka Management and Development for Health (MDH)
Shallon Atuhaire Faculty of science and Technology Cavendish University Uganda.
Evaline Maziku Ministry of Health - United Republic of Tanzania.
Anath Rwebembera Ministry of Health - United Republic of Tanzania.
Goodluck Lyatuu Management and Development for Health (MDH).
David Sando Management and Development for Health (MDH).

DOI:

https://doi.org/10.51168/sjhrafrica.v3i12.285

Keywords:

PrEP- Pre- Exposure Prophylaxis, KPP- Key and priority population, FSW- Female sex workers

Abstract

Background:

In Tabora, PrEP continuity 6 months after among newly enrolled among Key and Priority Population (KPP) is low at 47%. However, information on reasons influencing to PrEP continuity in KPP in Tabora is limited. We report study findings from nine (9) health facilities (HFs) in the Tabora region.

Methodology:

This was a cross-sectional survey, deployed both quantitative and qualitative methods. 425 current or previous PrEP beneficiaries started PrEP between July 2020 to January 2021 were administered with a structured questionnaire, whereby 157 participants were purposively selected for 18 focused group discussions (FGDs). Recruitment of study participants carried between February to April 2022.

Results:

A total of 425 KPPs, aged 15-70 years with average 30 years, the majority 288(58%) were FSWs, the proportion of interruption was 25(20.5%). Reported reasons for PrEP interruptions, (57%) were due to drug side effects and the least was migration (3%). There was an association between interruptions and clients’ age (P<0.05), area of service offered (P=0.010.) and being knowledgeable about PrEP: (P<0.05). There is significant relationship between awareness and PrEP interruptions, though in proportions of those aware and had interruptions was at 33%.

Conclusion:

Drugs side effects, misconception, stigma, pill burden and migration were cited among influencing reasons for PrEP interruptions.

Recommendations:

Interventional study recommended to explore on the reasons cited for PrEP discontinuity in reaching PrEP goals in prevention services.

Author Biographies

Adam Mrisho, Management and Development for Health

Adam Mrisho; Medical Doctor, A holder of Post Graduate Diploma in Human Resources Management, A Public Health Specialist (MPH) with more than 12 years of experience in HIV/AIDS care and treatment, Reproductive, Maternal, Newborn, and Child Health (RMNCH)/Elimination of mother-to-child transmission (eMTCT) of HIV and syphilis, supply chain management, and integrated TB/HIV programs in collaboration with the Government of Tanzania (GoT), other HIV implementing partners (IPs), community-based organizations (CBOs), and bilateral donors such as PEPFAR/CDC.

Specifically relating to KVP, in January 2020 Dr. Mrisho led MDH’s successful rollout of Tabora’s KVP/AGYWs and other related targeted subpopulations i.e fisherfolks, mining communities, and long track drivers in Community HIV Testing Services that improved from 3% to 18% contribution to HTS Total positive (18000+) in Tabora region by 2020. Also, under his leadership, over a 9-month period in 2020, community interventions for KVP resulted in 2601 new clients knowing their status to reach UNAIDS 1^st 95. This was achieved through Dr. Mrisho’s ability to develop trusting and collaborative working relationships with KVP peer groups, KVP Forum, Community Advocacy IPs, and the GoT under RCHMTs. Dr. Mrisho has also led the rollout of HIV SELF TEST and PrEP programs to reach more KVPs as per New National HTS guidelines through their networks and PREP to consented HIV Negative as a prevention package to risk subpopulation (KVPs) to reach epidemic control.

As MDH’s Regional Program Manager (RPM) in Tabora, Dr. Mrisho led a team of 84 clinical, administrative, and financial staff. He also brings to this project experience and well-established working relationships in two target regions of Geita and Kagera. He served as MDH’s RPM in Geita, leading 32 clinical, administrative, and financial staff. Dr. Mrisho was also the Clinical and Strategic Information Manager for MDH’s Kagera Regional programs. For the past five years, Dr. Mrisho has worked with Regional and District Health Management Teams to ensure Kagera, Geita, and Tabora regions achieve set national and donor targets, including early identification through targeted testing in reaching sub-populations ( KVP, AGYWs) and retention, and that HIV/AIDS quality of care is delivered per national guidelines in MDH-supported facilities. Under his leadership in the Geita region (with 6 district councils), he has worked with RHMTS and other partners to improve identification and linkage to ART--reducing the treatment gap from 19% to 5% by September 2019, HVL coverage from 76% to 90% by September 2020, HEID below 2 months coverage from 33% to 80% by September 2020, and Isoniazid Preventive Therapy (IPT) coverage among PLHIV on ART from 49% in Sept 2019 to 82% in Dec 2020uptake and ever completed IPT among current PLHIV on ART from 69% in Sept 2018 to 91% in Sept 2019

Additionally, Dr. Mrisho managed collaboration with the Regional and District Health Management Teams of Tabora to increase the number of healthcare facilities providing comprehensive HIV/AIDS care in the region from 71 facilities in 2020 to 142 facilities in Dec 2020, with the aim of ensuring 149 facilities offer these services by September 2021. This increase in facilities has contributed to the easy availability and accessibility of HTS, prevention, treatment, and support services within communities with the result that 18000+ clients were initiated on ART by September 2020.

Honoratha Rutatinisibwa, Regional Administrative Secretary- Tabora.

Public health specialist, vast experience in HIV Care and treatment services, worked as DMO in Musoma Municipal council and later appointed as regional medical officer for Tabora region.

George Msalale, Regional Administrative Secretary- Tabora.

Dr George, among the prominent Regional Aids Control Coordinators in URT, ToTs in various clinical areas including Basic ART Management and TBHIV.

Ramadhani Shemtandulo, Management and Development for Health (MDH)

Vast experience in Monitoring and Evaluation in PEPFAR/CDC supported program, played key role in quantitative analysis of this study.

Benson Mturi, Management and Development for Health (MDH)

Major in computer science, vast experience in CTC database, DHIS2 as well community intervention focusing KpP data management, currently working in capacity of data Manager for community intervention focusing KPP in Tabora region under MDH.

Steven Ambonisye, Management and Development for Health (MDH)

Experience in HIV data management at facility level, recently promoted to oversee community intervention focusing KPP in Tabora region under MDH. Holder of Bachelor in computer science.

AbelaAbele Rumisha, Management and Development for Health (MDH)

Dr AbelaAbele experienced in KPP related prevention and HTS services, working in capacity of District community HTS and prevention officer. Played vital role in orientation of data collectors for this study.

Mohamed Ayoub, Management and Development for Health (MDH)

Dr Mohamed Experience in KPP related prevention and HTS services, working in capacity of District community HTS and prevention officer. Played vital role in orientation of data collectors for this study.

Charles Shirima, Management and Development for Health (MDH)

Dr Charles Experience in KPP related prevention and HTS services, worked as field assistant and later in capacity of community art officer. Played vital role in orientation of data collectors for this study.

Wilhellmuss Mauka, Management and Development for Health (MDH)

Dr Wilhellmuss is Public health specialist, currently working in capacity of public health evaluation manager under MDH.

Shallon Atuhaire, Faculty of science and Technology Cavendish University Uganda.

Dr Shallon is a Public health specialist, PhD holder, working in capacity of Lecturer at CUU in the faculty of science and Technology. She coordinates research for students under FST at CUU.

Evaline Maziku, Ministry of Health - United Republic of Tanzania.

Head of HIV prevention at National Aids Control Program – MOH, URT, vast experience in KPP related interventions. Holder of Msc. Pediatrics.

Anath Rwebembera, Ministry of Health - United Republic of Tanzania.

Public health specialist, vast experience in care and treatment services, for so many years worked as Pediatric care and treatment focal at MOH-NACP. Currently serves as Program Manager- at National Aids Control Program.

Goodluck Lyatuu, Management and Development for Health (MDH).

Dr Goodluck, Director of Programs at MDH. Specialist with over 10 years’ experience in clinical and public health management. He completed his doctor of medicine training in 2009 at Muhimbili University of Health and Allied Sciences in Dar es Salaam and Master of Public Health in 2013 at Dartmouth’s Geisel School of Medicine, Hanover, USA. PhD holder in public health at Karolinska university- Sweden.

David Sando, Management and Development for Health (MDH).

MDH CEO, Dr. Sando who is an experienced Global Health specialist, having worked as both a physician and a public health specialist, Dr. Sando has a wealth of experience in managing PEPFAR and non-PEPFAR funded projects.