Evaluating the process implementation fidelity of oral pre-exposure Prophylaxis (prep) framework in Kinondoni municipal council, Tanzania

Abstract

ABSTRACT Background: Effective implementation of Oral Pre-Exposure Prophylaxis (PrEP) has been increasingly proved through clinical trials and PrEP demonstration projects to be highly potential in reducing risk to new HIV infection among key populations. It is on the basis of these achievements that Tanzania started developing Oral PrEP framework in 2018. However, there is limited information on how well the framework is being implemented in Tanzania, and the fidelity of the implementation process of the PrEP framework, is not well understood. It is this gap in knowledge that this study intended to fill. Objective: To evaluate the process implementation fidelity of the oral pre-exposure prophylaxis framework in Kinondoni Municipal Council, Tanzania. Methodology: An exploratory cross-sectional study was conducted using qualitative and quantitative data collection methods. Qualitative data were collected by using in-depth interviews among healthcare providers while in quantitative data, a questionnaire was used to collect data among Key Populations. A convenience sampling procedure was considered in selecting KPs using PrEP services. A purposive sampling procedure facilitated the selection of healthcare workers. The sample size of 10 key informants were used in qualitative data, while in quantitative data collection, a sample size of 135 participants was involved. Descriptive statistics using SPSS was used in analyzing quantitative data while and thematic approach was used to analyze qualitative data. Results: The study found that the process of PrEP delivery in Kinondoni Municipal Council comprises the identification of eligible PrEP candidates, PrEP initiation, adherence monitoring, and continuation and discontinuation of PrEP among KPs. PrEP use as a method of preventing HIV was significantly associated with willingness to accept and take a pill every day among KPs. Moreover, the study found barriers facing the implementation fidelity of the oral PrEP, including low awareness among community members, misconception and stigmatization, and non-compliance among PrEP users. Conclusion and recommendation: The study confirms that Kinondoni Municipal Council PREP service is largely delivered per the National oral Pre-exposure prophylaxis implementation framework stipulated under the guideline effect. Among other things, it is recommended that all health facilities providing PrEP should integrate community and facility-based PrEP services.