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

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

Risk factors for inappropriate blood requisition among hospitals in Tanzania.

BACKGROUND: Blood is a critical aspect of treatment in life saving situations, increasing demand. Blood requisition practices greatly effect sufficient supply in blood banks. This study aimed to determine the risk factors for inappropriate blood requisition in Tanzania. METHODS: This was a cross sectional study using secondary data of 14,460 patients' blood requests from 42 transfusion hospitals. Primary data were obtained by using cluster-sampling design. Data were analysed using a two-level mixed-effects Poisson regression to determine fixed-effects of individual-level factors and hospital level factors associated with inappropriate blood requests. P-value <0.05 (2-tails) was considered statistically significant. RESULTS: Inappropriate requisition was 28.8%. Factors significantly associated with inappropriate requisition were; reporting pulse rate and capillary refill decrease the risk (RR 0.74; 95% CI 0.64, 0.84) and (RR 0.73; 95% CI 0.63, 0.85) respectively and the following increased the risk; having surgery during hospital stay (RR 1.22; 95% CI 1.06, 1.4); being in general surgical ward (RR 3.3; 95% CI 2.7, 4.2), paediatric ward (RR 1.8; 95% CI 1.2, 2.7), obstetric ward (RR 2.5; 95% CI 2.0, 3.1), gynaecological ward (RR 2.1; 95% CI 1.5, 2.9), orthopaedics ward (RR 3.8; 95% CI 2.2, 6.7). Age of the patient, pallor and confirmation of pre-transfusion haemoglobin level were also significantly associated with inappropriate requisition. Majority of appropriate requisitions within the wards were marked in internal medicine (91.7%) and gynaecological wards (77.8%). CONCLUSIONS: The proportion of inappropriate blood requests was high. Blood requisition was determined by clinical and laboratory findings and the ward patients were admitted to. Adherence to transfusion guidelines is recommended to assure the best use of limited blood supply

Impact of Training to Improve Knowledge on Blood Transfusion among Health Care Providers from Tertiary Hospitals in Tanzania

Background: Blood transfusion is a lifesaving therapy which is linked to the adverse outcome when given inappropriately. Inadequate knowledge and skills among health care providers have been reported to contribute to safety issues for recipients and wastage of the precious resource. This study was conducted to determine the impact of training of health care providers in Tanzania on improving the knowledge regarding the transfusion of blood and blood components.Methodology: This was a cross-sectional study which used secondary data from pre and post training assessment questionnaire whereby trainees answered the same set of questions before training (pre-test) and after training (post-test). The questionnaire consisted of two Likert scale questions and eight YES/NO questions which assessed the perception of clinicians, nurses and Laboratory personnel on blood transfusion practices. Moreover, there were thirty multiple-choice questions for assessment of basic knowledge related to usage of blood and blood components.Results: One hundred and eleven (111) health care providers who attended training on blood transfusion were recruited into this study, out of which 72.1% (80/111) were from secondary health care facilities and 6.3% (7/111) were from tertiary health care facilities. The pre-test mean percent score was 32.8% (SD ±12.9%), while the post-test mean percent score was 56.6% (SD ±12.9%). The mean percentage of knowledge gain was 26.6% (SD±13.0%) and 27.1% (SD±12.5%) for health care providers and National Blood Transfusion Service staff respectively. It was observed that only 25.8% (24/93) and 19% (19/100) of participants were aware of the transfusion timing of various blood components and principles of platelet transfusion, respectively. Regarding bedside blood handling practices, only 52.9% (46/87) responded, ‘warm whole blood unit and packed red blood by putting under room temperature for 30 minutes and the majority of participants 63.1% (65/103) reported not to ask for consent before blood transfusion.Conclusion: There was a modest improvement in the knowledge on blood transfusion practice among participants. The overall performance of participants increased from 33% in the pre-test to 57% in the post-test. Therefore, this study has shown the positive impact of training for health care providers in improving their knowledge. We recommend regular on job training courses and mentorship program for health care providers for proficiency in clinical transfusion practice. Key words: Blood Transfusion, Training and Health care providers

Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach

BackgroundThere is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. ObjectiveWe present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. MethodsA participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. ResultsThe relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. ConclusionsThe participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial RegistrationInternational Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR20200382322657

Criteria for assessment of inappropriate requisition of PRBC/Whole blood.

<p>Criteria for assessment of inappropriate requisition of PRBC/Whole blood.</p

Reported clinical presentation of patients’ blood requests (N = 14,460).

<p>Reported clinical presentation of patients’ blood requests (N = 14,460).</p

Model comparison.

<p>Model comparison.</p

The variables associated with inappropriate blood request (N = 11,494).

<p>The variables associated with inappropriate blood request (N = 11,494).</p