Providing anti-retroviral therapy in the context of self-perceived stigma: a mixed methods study from Tanzania

Adherence to anti-retroviral treatment (ART) has been a significant step towards improving quality of life among people living with HIV. However, stigma has been described to influence adherence to ART. A cross-sectional mixed methods study was conducted to explore factors related to stigma and perceived influence of stigma on adherence to treatment amongst ART-prescribed patients and health care providers, respectively in Tanzania. Stigma was assessed through interviewer administered survey among 295 patients. The results from patients showed that 279/295 (95%) were satisfied with the services provided at the Care and Treatment Centres (CTCs). The set up of CTCs 107/295 (36%), and queuing at the CTCs 88/295 (30%) were associated with stigma (P<0.001). The perceived influence of stigma on adherence to ART was assessed using focus group discussions (FGDs) of 33 health care providers (HCPs). Through FGDs, HCPs perceived the set up of CTCs as friendly yet violated confidentiality. The HCPs reported that ART-prescribed patients hide identifiable cards to avoid being recognised by other people. Some patients were reported to rush to avoid familiar faces, and due to the rush they picked wrong medicines. Also some patients were reported to throw away manufacturers’ box with dosage instructions written on the box, resulting in use of doses contrary to the prescriptions.  We conclude that despite the fact that most patients were satisfied with the services provided at the CTCs, it is important that HCPs provide dosage instructions on another piece of paper or use disposable bags. A common dispensing window for all patients regardless of the diagnosis may be useful to minimize stigma. Also HCPs may introduce appointment system to avoid long queue at the CTCs.

Life threatening arrhythmias: Knowledge and skills among nurses working in critical care settings at Muhimbili National Hospital, Dar es Salaam, Tanzania

Introduction: A life threatening arrhythmia is a medical condition that requires immediate intervention, or it can cost a patient’s life. However, there is limited understanding of nurses’ knowledge and skills in identification and care provided to patients with life threatening arrhythmias in Tanzania.  The objective of this study was to assess knowledge and skills of nurses in identifying life threatening arrhythmias and the required patient care.Methods: A descriptive cross-sectional study was conducted to assess the knowledge and skill level of nurses in identification of life threatening arrhythmias and the required patient care, as well as exploring the barriers in acquiring and implementing particular knowledge and skills. A convenient sample of 141 nurses working in critical care areas at Muhimbili National Hospital, were recruited.Results: The majority (44%) of the participants were 31-40 years old and more than three quarters were females. The majority (60%) scored highly when tested about their knowledge of life threatening arrhythmia identification. However, the majority of nurses (84.4%) scored poorly when being observed on their skills. A total of 116 (82.3%) nurses were able to identify asystole on an electrocardiogram strip, and demonstrated a high level of knowledge (95%) in the nursing care of patients in asystole. Although they demonstrated poor skills in general, nurses were competent (97.9%) in electrode placement on the patient’s chest before connecting the patient to the cardiac monitor. The overwhelming workload was identified by many (68.8%) as the major barrier in acquiring and implementing knowledge and skills.Conclusion: Although the majority of the participants scored highly in their level of knowledge regarding life threatening arrhythmias, they scored poorly in most of the observed skills when identifying and treating this patient group. It is important that hospital administration take into consideration the identified areas of deficiency and work to improve the skills among nurses and enhance optimal care of patients

A cross-sectional study on knowledge and implementation of the nursing process among nurses at Muhimbili National Hospital-Tanzania

Background: The nursing process involves a series of actions that begin with assessing the patient, identifying problems, setting goals with expected outcomes, implementing care to achieve those goals, and finally evaluating the effectiveness of the care given. Utilization of the nursing process to guide nursing care enhances the quality of patient care and outcomes for both the patient and family members. The purpose of this study was to assess the knowledge and implementation of the nursing process among nurses working at Muhimbili National Hospital, Dar es Salaam, Tanzania. Methods: We conducted a descriptive cross-sectional study design. A convenient sample of 102 registered nurses (RN) completed a self-administered questionnaire in April 2016. Descriptive statistics and non-parametric tests were used to assess the significance levels of associated variables. Results: Of 102 respondents, only 16 (15.7%) had high knowledge of the nursing process. Similarly, a few (11, 10.8%) respondents had a high level of practice. The majority of RN (94, 92.2%) were aware of the role of the nurses in providing care to admitted patients. However, only a few (32, 31.4%) were aware of the purpose of the nursing process. Respondents were more likely to have high knowledge in the nursing process if they had a diploma in nursing education (95% CI 0.000-0.029, p < 0.01). The small number of nurses in the ward and inadequate motivational strategies were reported to deprive the implementation of the nursing process. Conclusion: Overall, low knowledge of the nursing process, understaffing and workload have contributed to the ineffective implementation of the nursing process.  On-the-job refresher courses are a short-term strategy that may improve the nurses’ knowledge and motivation to implement the nursing process. This study underscores the need for policymakers to advocate for the employment of a sufficient number of nurses to enable implementation of the nursing process to all admitted patients

What motivates or demotivates injecting drug users to participate in hypothetical HIV vaccine efficacy trials? A qualitative study from urban Tanzania

Background: HIV vaccine efficacy trials require the active participation of volunteers who are committed and adherent to the study protocol. However, information about the influence of Injecting Drug Users (IDUs) to participate in HIV vaccine efficacy trials in low-income countries is inadequate. The present study explored the factors that motivate or hinder IDUs from participating in HIV vaccine efficacy trials in Dar es Salaam, Tanzania.Methods: A qualitative descriptive study design was employed among IDUs at Muhimbili National Hospital (MNH). A purposeful sampling technique was used to recruit the participants. Three (3) focus group discussions (FGDs) and 10 In-Depth Interviews (IDIs) were used to collect the data. The data from participants were audio-recorded, transcribed, and analysed using the content analysis approach.Findings: The participants reported that altruism and the desire to reduce risks of HIV infection were the motivators to participate in hypothetical HIV vaccine trials. In addition, participants reported to consult close relatives towards motivation to participate in the vaccine trial. In contrast, the perceived fear of vaccine side effects, lack of information about HIV vaccine studies, and HIV-related stigma towards participants were described as barriers to participate in the HIV vaccine trials.Conclusion: Participation in a hypothetical HIV vaccine trial among IDUs is influenced by positive and negative factors. Actual recruitment plans could be made through a better explanation of HIV vaccine trials, the expected individual and collective benefits associated with the trials. Community involvement and sensitisation is likely to enhance participation in future HIV vaccine trials in Tanzania

Collaboration Between the National Tuberculosis Programme and a Non Governmental Organisation in TB/HIV Care at a District level: Experience from Tanzania.

The increase in tuberculosis and HIV/AIDS patients in many countries in Africa including Tanzania, is outstripping the ability of public health services to cope. This calls for a closer collaboration between tuberculosis programmes and other stakeholders involved in HIV/AIDS care. To determine the feasibility of establishing collaboration between the tuberculosis programme and an NGO in TB/ HIV care at a district level in Tanzania. Quantitative and qualitative study designs involving TB as well as HIV suspects and patients together with health workers, were conducted between December, 2001 and September, 2002. A total of 72 patients and 28 key informants were involved. The collaboration was in the following areas; voluntary counselling and testing for HIV, diagnosis and treatment of TB, referral and follow up of patients and suspects, home based care, psychological support and training. Both the tuberculosis programme and NGO benefited from the collaboration. TB case detection among PLWA increased more than three folds and TB treatment was integrated in home based care of NGO. The main barriers identified in this study were; poor communication, poor referral system and lack of knowledge and skills among health staff. The study has shown that it is possible for a tuberculosis programme and a non governmental organisation to collaborate in TB/HIV care. The study has also identified potential areas of collaboration and barriers that needed to be overcome in order to provide such comprehensive services at a district level

Safe birth matters: facilitators and barriers to uptake of the WHO safe childbirth checklist tool in a Tanzania Regional Hospital

Background: The World Health Organization (WHO) developed the Safe Birth Checklist (SCC) to facilitate best practices in safe birthing practices. The SCC is utilizing existing evidence-based WHO guidelines and recommendations which has combined those into a single and practical bedside tool. The SCC is the first checklist-based intervention to target the prevention of maternal and neonatal deaths. Objective: The objective of this project was to pilot-test the World Health Organization Safe Childbirth Checklist with Maternity Regional Hospital in, Tanzania. Study Design and Methods: Retrospective analysis on 35 charts were completed to identify presence or absence of documentation aligned with evidenced based checklist items. Staff training, end user observations and focus group discussions were utilized to elicit feedback about the tool and the process. Descriptive statistics and manual content analysis were used to analyze the rate of uptake and ownership over the checklist. The Checklist is broken down into four sections or time points (that are considered natural pause points in the care of laboring women). The four different pause points are admission, delivery, post-partum, and discharge Results: We trained 26 participants out of 32 staff how to use the SCC. Delivery time point had the lowest at SCC completion rate at 39% compared to discharge having the highest completion rate at 93%. There was variation in completion rate of the checklist items at each time point. Checklist items at the beginning of each time point were completed between 94% and 100% of the time with the latter checklist list items completed between 29% and 57% of the time Conclusion: This project was able to identify facilitators and potential barriers to the successful uptake of the Safe Childbirth Checklist in Shinyanga Regional Hospital. Based on these findings, the MOH have opportunities to utilize those findings in the scale-up of the implementation of the checklist and future evaluation activities

Factors that Influence the Willingness of Young Adults in Dar es Salaam, Tanzania, to Participate in Phase I/II HIV Vaccine Trials.

HIV/AIDS continues to destroy the lives of young people especially in low-income countries. The inclusion of youths in HIV vaccine trials is of utmost importance in obtaining an effective vaccine that is acceptable to them.\ud To characterize the willingness of young adults in Tanzania to participate in an HIV vaccine trial and the factors that influence this willingness. Four hundred and fifty young adults who visited a youth-friendly Infectious Diseases Clinic (IDC) from February 2012 to September 2012 completed a self-administered questionnaire concerning sociodemographic information, their knowledge about and perception of HIV vaccine studies, and the availability of social support. Of our participants, 50.6% expressed willingness to participate in HIV vaccine trials, and this willingness was positively correlated with having some knowledge about HIV vaccine studies (AOR, 2.2; 95% CI: 1.4-3.4), a positive perception toward such studies (AOR, 2.3; 95% CI: 1.5-3.6), having a relationship with someone who could help them make a decision (AOR, 2.5; 95% CI: 1.3-4.9), and age at the time of sexual debut (AOR, 2.6; 95% CI 1.0-6.7) for 15- to 19-year-olds and (AOR, 2.7; 95% CI 1.0-7.1) for older participants. The participants exhibited a moderate willingness to participate in HIV vaccine trials, which was associated with a positive perception of and some knowledge about such trials, having a relationship with someone who might influence their decision as well as age at time of sexual debut. More efforts should be made to inform the youths about specific HIV vaccine trials and related matters, as well as to engage significant others in the decision-making process

Perceptions About Repeat HIV Testing in an Incidence Study: A Qualitative Study among a Potential Cohort for HIV Vaccine Trials in Dar es Salaam, Tanzania

Information regarding repeat HIV testing is useful in the conduct of HIV vaccine trials as potential trial participants are required to undergo repeat HIV testing. In an incidence study conducted in 2008 among 1042 Police Officers 30% of them did not participate in a repeat HIV test. This study was therefore conducted to explore perceptions on repeat HIV testing among members of the incidence study cohort that also served as a source of volunteers for subsequent HIV vaccine trials. This qualitative cross-sectional study was conducted in Dar es Salaam. The study included male and female Police Officers who were eligible to participate in the HIV incidence study. Participants were selected purposefully from eight Police stations out of the 32 stations. Data was collected using in-depth interviews and analysed qualitatively using the content analysis approach. A majority of participants were willing to undergo a repeat HIV test and stated that it was important to repeat an HIV test to confirm their health status, and hence continue protecting themselves. Participants who participated in a repeat HIV test as a part of incidence study reported that the repeat HIV testing process was acceptable because counselling was provided, testing was voluntary, there was trust in the health care providers and a freedom to choose where to test. Participants who did not repeat the HIV test held that repeat a HIV test was not necessary since they believed that the initial test was adequate. Others said that communication breakdown was the main cause as they weren't aware of the importance of a repeat HIV test. Fear of the test results was also mentioned as one of the reasons. The participants were eager to gain more knowledge about the importance of a repeat HIV test. In order to facilitate repeat HIV testing in potential cohorts for HIV vaccine trials, more information and education regarding the repeat HIV test is needed. It is also important to make sure that researchers are well informed on what study participants are supposed to know.\u

A Qualitative Study of Perceived Risk for HIV Transmission among Police Officers in Dar es Salaam, Tanzania.

Understanding people's views about HIV transmission by investigating a specific population may help to design effective HIV prevention strategies. In addition, knowing the inherent sexual practices of such a population, as well as the risky circumstances that may facilitate HIV transmission, is crucial for the said strategies to become effective. In this article, we report how police officers in Dar es Salaam, Tanzania, perceived the problem of HIV and AIDS in their local context, particularly in relation to unsafe sexual practices. The study was done with the view to recommending ways by which HIV transmission could be minimised within the police force. The study was conducted among members of the police force in Dar es Salaam, Tanzania. Eight focus group discussions (FGDs) were conducted, with a total of 66 participants who were mixed in terms of age, gender, and marital status. Some of these were caregivers to patients with AIDS. Data were analysed using the interpretive description approach. The participants believed that both individual sexual behaviour and work-related circumstances were sources of HIV infection. They also admitted that they were being tempted to engage in risky sexual practices because of the institutional rules that prohibit officers from getting married during their training and for three years after. Nevertheless, as members of the Police Force, they stressed the fact that the risky sexual behaviour that exposes them to HIV is not limited to the force; it is rather a common problem that is faced by the general population. However, they complained, the nature of their job exposes them to road accident victims, subjecting them further to possible infection, especially when they have to handle these road accident casualties without proper protective gear. Individual sexual behaviour and job-related circumstances are worth investigating if proper advice is to be given to the police regarding HIV prevention strategies. In order to improve the lives of these police officers, there is a need to review the existing institutional rules and practices to accommodate individual sexual needs. In addition, improving their working environment may minimize the risk of HIV transmission from handling casualties in emergency situations

A qualitative evaluation of volunteers' experiences in a phase I/II HIV vaccine trial in Tanzania

Evaluating experiences of volunteers in an HIV vaccine trial will be useful for the conduct of future trials. The purpose of this study among volunteers who participated in a phase I/II HIV vaccine trial in Dar es Salaam, Tanzania was to assess what characterized their experiences during the trial. We conducted four focus group discussions with 35 out of the 60 individuals (women and men) after the five scheduled vaccinations. An interpretive description approach was applied to data analysis. As a result of the trial interventions, both men and women gained confidence in their own abilities to have safer, less risky sexual behaviour. The participants experienced the trial as a way of accessing free [insured] medical services. Most of the men said they had gone from self-medication to professional medical consultation. Despite these benefits, the participants faced various challenges during the trial. Such challenges included mistrust of the trial shown by health care providers who were not connected to the trial and discouragement from friends, colleagues and family members who questioned the safety of the trial. However, they managed to cope with these doubts by using both personal and trial related interventions. We found that during the phase I/II HIV vaccine trial, participants had both the opportunities and the ability to cope with the doubts from the surrounding community. Follow up visits enhanced the opportunities and individuals' abilities to cope with the doubts during the trial. Understanding this discourse may be useful for the trial implementers when designing future trials.\ud \ud \ud \u