Socio-cognitive factors influencing access to HIV prevention services among people who inject drugs in Dar es Salaam, Tanzania: An integrated bio-behavioural survey

• Published in: PloS one Vol. 17; no. 1; p. e0261500
• Main Authors: Likindikoki, Samuel L, Meyrowitsch, Dan W, Mizinduko, Mucho M, Ishungisa, Alexander M, Tersbøl, Britt P, Leyna, Germana H, Moen, Kåre, Makyao, Neema, Lange, Theis, Leshabari, Melkizedeck T, Mmbaga, Elia J
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28-01-2022; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; Aggression; AIDS; Bar codes; Behavior; Biology and Life Sciences; Care and treatment; Cognition - physiology; Cognitive ability; Complications and side effects; Condoms; Cross-Sectional Studies; Data collection; Demographics; Demography; Disease prevention; Drug addicts; Drug use; Drug Users - psychology; Drugs; Education; Educational Status; Epidemics; Epidemiology; Female; Health risks; HIV; HIV infection; HIV Infections - prevention & control; HIV Testing; Human immunodeficiency virus; Humans; Income; Infection control; Interviews as Topic; Intravenous drug abuse; Logistic Models; Logistics; Male; Medicine and Health Sciences; Mental health; Methods; Middle Aged; Needle Sharing; Odds Ratio; People and Places; Polls & surveys; Population; Prevention; Public health; Regression analysis; Reimbursement; Risk; Risk factors; Risk perception; Sample size; Seeds; Sexual assault; Sexually transmitted diseases; Social Sciences; Statistical analysis; STD; Surveys; Surveys and Questionnaires; Syringes; Tanzania; Violence; Tanzania; Dar es Salaam Tanzania; Denmark; United States > US; Norway
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0261500

People who inject drugs (PWID) in Sub-Saharan Africa have limited access to comprehensive HIV services. While it is important to inform programming, knowledge about factors influencing access to comprehensive HIV services is scarce. We assessed the proportions of PWID with access to HIV prevention services and associated socio-cognitive factors in Tanzania.
A cross-sectional survey was conducted among PWID between October and December 2017 in Dar es Salaam, Tanzania. Data on access to HIV prevention services, demographics and selected socio-cognitive factors were collected through structured face-to-face interviews. Weighted descriptive and forward selection multivariable logistics regression analyses were done to assess independent associations between HIV prevention services and predictors of interest. The results were two tailed and a p-value of less than 0.05 was considered statistically significant.
The study included 611 PWID (males: 94.4%) with a median age of 34 years (Interquartile Range (IQR), 29-38). A large majority of participants reported to have access to condoms (87.8%), sterile needles/syringes (72.8%) and ever tested for HIV (66.0%). About half (52.0%) reported to have used condoms in the past one month and about a third (28.5%) accessed a peer educator. The odds of testing for HIV decreased among participants who perceived their HIV risk to be high (aOR = 0.29; 95%CI: 0.17-0.49) and those experienced sexual violence (aOR = 0.60; 95%CI 0.37-0.98). However, the odds of testing for HIV increased among participants with secondary level of education (aOR = 2.16; 95%CI: 1.06-5.55), and those who reported having correct comprehensive HIV knowledge (CCHK) (aOR = 1.63; 95%CI 1.12-2.41). The odds of access to condoms increased among females (aOR = 2.23; 95%CI: 1.04-5.02) but decreased among participants with secondary level of education (aOR = 0.41; 95%CI: 0.19-0.84), an income of >TZS 200,000 (aOR = 0.39; 95%CI: 0.23-0.66) and those who perceived their HIV risk to be high (aOR = 0.13; 95%CI: 0.03-0.36). The odds of access to peer educators was higher among participants with primary (aOR = 1.61; 95%CI: 1.01-2.26), and secondary (aOR = 2.71; 95%CI: 1.39-5.33) levels of education. The odds of access to sterile needle and syringe decreased among participants who perceived their HIV risk to be high (aOR = 0.11;95%CI 0.05-0.22), and low-medium (aOR = 0.25;95%CI 0.11-0.52) but increased among those with primary level of education (aOR = 1.72;95%CI 1.06-2.78).
Access to condom, HIV testing, sterile needles and syringes were relatively high among PWID. However, condom use and access to peer educators was relatively low. HIV knowledge and risk perception, gender, education, and sexual violence influenced access to HIV prevention services. There is an urgent need to address the identified socio-cognitive factors and scale up all aspects of HIV prevention services to fast-track attainment of the 2025 UNAIDS goals and ending the HIV epidemic.