Quality of HIV services for people who inject drugs in Pwani and Tanga regions of Tanzania

Abstract

People who inject drugs (PWID), face a 35 times higher risk of acquiring HIV than those who do not. Across the world, 1 in every 8 people who inject drugs, is living with HIV. Societal stigma, discriminatory laws and inadequately skilled healthcare providers for PWID services exacerbate the gap in the HIV care cascade. PWID living with HIV face substantial barriers to managing HIV and drug-use related illnesses. We examined routine hospital data, anonymous facility surveys and observational provider-client interactions to determine the quality of HIV care for PWID in two regions in Tanzania. Surveys were conducted with 3 facility site managers, 102 observational interactions, supplemented with indicators from routine data between October 2021-March 2024. A mean score percent and standard deviation (SD) percent was generated for each observational interaction to summarize scores across the dataset, including technical and interpersonal skills. Most observations of medication assisted treatment (MAT) clients were male (88%), PWID (67%), and age 25+ (72%). Overall quality scores for MAT provider-client encounters which followed interpersonal and technical guidelines was 91.7% (SD 12.0%), Routine PEPFAR MER indicators show a quarterly increase in overall cumulative enrollment at the hospital facility and also in MAT enrollment but defaulting on direct observed treatment (DOT) averages at 29% for all three facilities. Although observed quality of care between provider-client was high, routine data indicated high rates of attrition. To address defaulting from care, interpersonal and technical skills by providers should be continually reinforced through mentoring or supportive supervision; rigorous continuous quality improvement initiatives and research is needed into understanding the drivers behind defaulting and retention of care of MAT clients.