Facilitating factors and barriers to optimum uptake of multi-month dispensing of anti retroviral treatment in Morogoro municipality, Tanzania

Abstract

Background: Multi-Month Dispensing - was adopted in 2018 due to increasing number of ART clients attributed by adoption of test and treat policy in 2017 to improve quality services however challenges to Multi-Month Dispensing implementation still exist despite of the facilitators to its uptake. It is therefore important to understand them so as to inform the stakeholders on how best to improve service provision in the health care system in policy and decision making to cultivate the opportunities and maximize the benefits of optimum uptake of Multi-Month Dispensing of Anti-Retroviral Therapy. Objective: To assess the facilitating factors and barriers to optimum uptake of Multi-Month Dispensing of Anti-Retroviral Therapy in Morogoro Municipality, Tanzania. Methodology: Mixed method study design was employed. Patients’ records from the CTC2 database, Pharmacy module, and patients' files were reviewed for quantitative data on Multi Month Dispensing coverage and proportion of stable clients. In qualitative approach, 22 in depth interviews were conducted with 9 CTC health care providers and 13 stable PLHIV. Findings: The study showed that Multi-Month Dispensing coverage was 77% while the proportion of stable clients was 81%. 13% of stable clients were not receiving Multi-Month Dispensing. In qualitative, facilitators reported were Test and treat policy implementation, service providers’ ability to identify eligible clients, health care providers’ moral support, fast track services, timely collection of HIV Viral load, Implementation of quality improvement, decongestion of clinics, client’s inspiration, little interference with client’s socio-economic activities, travel costs reduction. Reported challenges included insufficient gloves, inadequate drug supply of Anti-Retroviral drugs, prolonged turn-around time of HIV Viral Load results, delayed TB Preventive Therapy (TPT) initiation and staff shortage at CTC. Conclusion and recommendations: Despite of the reported enablers, challenges still persevered in the implementation of MMD. Strengthening enablers while working towards alleviating the barriers can further lead to better achieve MMD service delivery.