Accessibility of malaria commodities in Geita District Council, mainland Tanzania: the experiences from healthcare providers and clients.

Background: Access to essential malaria commodities is a cornerstone in malaria control. However optimal availability and access to essential malaria commodities remain a challenge in Tanzania. Therefore, this study aimed to explore the factors affecting the accessibility of malaria commodities in Tanzania. Methods: This was a mixed-method cross-sectional study using both quantitative and qualitative approaches. Data were collected between February and March 2023 from health facilities, health facility staff, and patients. Results: Availability of malaria commodities in government health facilities was 100% for all items while in the private and faith-based facilities, this ranged from 10% to 80%. The reasons for stockouts in Government facilities were related to delayed and inadequate quantity delivery while in private facilities the main reason was the lack of cash for procurement. Both private facilities' clients and healthcare providers concurred that most people do not access complete treatment due to the high costs of prescribed medicines and poor stocking levels. Conclusion: The availability, hence the accessibility, of malaria commodities in private and faith-based health facilities is still sub-optimal. Logistic management needs to be improved to eliminate stockouts and malaria commodities high costs need a permanent solution.

Assessment of vaccine management performance in health facilities of Mwanza Region, Tanzania: a cross-sectional study.

BACKGROUND: Effective Vaccine Management (EVM) initiative provides the platform needed to monitor and assess the vaccine supply chain system to identify strengths and weaknesses of the system at all levels and enhance the development of continuous improvement plan to strengthen the system. This study was conducted to determine the vaccine management performance in Health Facilities of Mwanza Region, Tanzania. METHODS: This was a descriptive cross-sectional study that was carried out in 102 health facilities providing immunization services from eights districts of Mwanza Region in Tanzania. The World Health Organization (WHO) effective vaccine management assessment tools were used to collected data. Both quantitative and qualitative (through key informant interviews) approaches were used. The quantitative data were analysed using the existing WHO criteria for analysing effective vaccine management assessment data, while deductive thematic analysis was used for the qualitative data. RESULTS: The finding shows that the overall score for vaccine management performance was 53% which is below the WHO acceptable minimum score of 80%. None of the health facilities had reached the benchmark but only 67% had an average performance (> = 50-< 80%). The highest health facility score was 76% and the lowest being 27%. Among the categories assessed, the highest score was on information technology with 72%, while the lowest was on standard operating procedures with a score of 43%. The major challenges which contributed to low performance were lack of training, low knowledge about vaccine management practices, unavailability of standard operating procedures (SOPs), and limited financial resources to support operations for vaccine management practices. Skills gap, incomplete stock records and management, as well as low availability of SOPs were the key challenges reported that affected vaccine management practices. CONCLUSIONS: Effective vaccine management performance was low across all districts under the study. Increasing personnel capacity and ensuring availability of resources to support operations were reported as key interventions in improving vaccine management practices. Hence, effectively working on continuous improvement plan with key highlighted actions is highly recommended to all actors from national level to sub-national level managers and healthcare workers as frontline vaccine handlers.

Performance of Jazia Prime Vendor System in ensuring availability of health commodities in Singida Region, Tanzania: a pre- and post-evaluation study.

BACKGROUND: Availability of the health commodities in public health facilities in Tanzania remains a challenge, and has been reported to be below 70%. Moreover, Medical Stores Department's capacity to supply health commodities has been only 40%. Therefore, Jazia Prime Vendor System (Jazia PVS) was outsourced to complement the Medical Stores Department. In 2017 Jazia PVS was introduced in Singida Region after being piloted in three other Regions. This study therefore, was conducted to assess the performance of Jazia PVS in enhancing the availability of the health commodities in the public health facilities between 2017 and 2019 in Singida Region, Tanzania. METHODS: A mixed method pre- and post-evaluation analytical study design was used in all the selected public health facilities in the Municipal and District Councils of Singida Region, Tanzania. These included 138 public health facilities: One Regional Referral Hospital, four District Hospitals, 19 Health Centres and 114 Dispensaries. Percent availability of health commodities was abstracted from electronic logistics management information system. Documentary review involved quarterly orders, Jazia PVS delivery notes, and payment vouchers; while all the 138 pharmacists incharge were interviewed. RESULTS: The mean availability of health commodities was modestly higher after adoption of Jazia PVS (mean = 59.17%, SD = 6.12%) than before Jazia PVS (mean = 54.39%, SD = 5.36%); and the difference between means was 4.78% (t = -9.49, df = 136, p < 0.001). Furthermore, 20.3% (109/421) of orders were fulfilled, while 58% (312/421) were not, (χ2 = 10.46, df = 6, p = 0.1067). About 73.7% of orders (320/434) were delivered on time, while 26.3% (114/434) delayed, (χ2 = 121, df = 6, p < 0,001). Prompt payment to Jazia PVS was 43.0% (164/381) deliveries, while 57.0% (217/382) were not punctual, (χ2 = 26, df = 6, p < 0.001). Satisfaction level of the pharmacists incharge for Jazia PVS was 11.8%, (χ2 = 78.04, df = 3, p < 0.001). CONCLUSION: With Jazia PVS, availability of health commodities improved by 4.78% in 2 years. Prompt payment of Jazia PVS will enhance performance of the vendor.

High viral suppression and detection of dolutegravir-resistance associated mutations in treatment-experienced Tanzanian adults living with HIV-1 in Dar es Salaam.

To curb HIV infection rate in Tanzania, antiretroviral therapy (ART) has been scaled up since 2006, and in 2019, the country shifted to regimen including dolutegravir as a default first line. We assessed the success of ART and the contribution of HIV drug resistance (HIVDR) to unsuppressed viral loads. Between February and May 2023 a cross-sectional survey with random sampling was conducted in the six clinics in an urban cohort in Dar es Salaam. Patients with unsuppresed viral loads (local criteria viral load (VL) ≥ 1000 copies/mL) were tested for HIVDR mutations using the WHO adapted protocol for plasma samples. Mutations were interpreted using the Stanford HIVDR database. In total 600 individuals participated in this survey, the majority were female (76.83%), mean age ([Formula: see text] standard deviation) was 44.0 ([Formula: see text] 11.6) years. The median duration on ART (interquartile range) was 6.5 (3.9-10.2) years. Approximately 99% were receiving tenofovir + lamivudine + dolutegravir as a fixed dose combination. VL testing was successful in 99.67% (598/600) of survey patients and only 33 had VL ≥ 1000 copies/mL, resulting in a viral suppression level of 94.48% (565/598, 95% CI 92.34-96.17%). For 23 samples, protease and reverse transcriptase (RT) genotyping were successful, with 13 sequences containing RT inhibitor surveillance drug resistance mutations (SDRMs) (56.5%). No SDRM against protease inhibitors were detected. Thirty samples were successfully genotyped for integrase with 3 sequences (10.08%) containing integrase strand transfer inhibitor (INSTI) SDRMs. In samples successfully genotyped in the three genetic regions, 68.18% (16/22) had a genotypic susceptibility score (GSS) ≥ 2.5 for the concurrent regimen, implying factors beyond drug resistance caused the unsuppressed viral load. For five patients, GSS indicated that HIVDR may have caused the unsuppressed viral load. All three patients with INSTI resistance mutations were highly resistant to dolutegravir and accumulated nucleoside and non-nucleoside RT inhibitor HIVDR mutations. Although in this cohort the last 95 UNAIDS target was almost achieved, HIVDR mutations, including INSTIs resistance mutations were detected in HIV-positive individuals taking ART for at least one year. We recommend the design and implementation of high-impact interventions to prevent the increase of HIVDR, failure of dolutegravir and address the non-resistance factors in the study area.

Factors Associated with HIV Drug Resistance in Dar es Salaam, Tanzania: Analysis of a Complex Adaptive System.

HIV drug resistance (HIVDR) is a complex problem with multiple interconnected and context dependent causes. Although the factors influencing HIVDR are known and well-studied, HIVDR remains a threat to the effectiveness of antiretroviral therapy. To understand the complexity of HIVDR, a comprehensive, systems approach is needed. Therefore, a local systems map was developed integrating all reported factors influencing HIVDR in the Dar es Salaam Urban Cohort Study area in Tanzania. The map was designed based on semi-structured interviews and workshops with people living with HIV and local actors who encounter people living with HIV during their daily activities. We visualized the feedback loops driving HIVDR, compared the local map with a systems map for Sub-Saharan Africa, previously constructed from interviews with international HIVDR experts, and suggest potential interventions to prevent HIVDR. We found several interconnected balancing and reinforcing feedback loops related to poverty, stigmatization, status disclosure, self-esteem, knowledge about HIVDR and healthcare system workload, among others, and identified three potential leverage points. Insights from this local systems map were complementary to the insights from the Sub-Saharan systems map showing that both viewpoints are needed to fully understand the system. This study provides a strong baseline for quantitative modelling, and for the identification of context-dependent, complexity-informed leverage points.

Vaccine storage and distribution between expanded program on immunization and medical store department in Tanzania: a cost-minimization analysis.

BACKGROUND: In 2016, the Tanzanian government shifted the vaccine supply chain responsibilities from the Medical Store Department (MSD) to the Expanded Program on Immunization (EPI) to reduce costs. However, cost estimates that informed the decision were based on invoice value of vaccines and related supplies, rather than a proper economic evaluation study. Therefore, this study aims to compare the actual storage and distribution costs of vaccines and related supplies between MSD to EPI. METHOD: Micro-costing approach was used to estimate resource use at MSD and EPI for the year 2018. Data were collected through a review of documents, warehouse databases, and interviews with key staff at MSD and EPI. We included both capital and recurrent costs. Microsoft Excel® was used for analysis with input data from the UNICEF forecasting tool, WHOs vaccine volume and capacity estimation tool, diesel generator calculator, and supply chain service fee estimator version 1.02. RESULTS: The total vaccine storage and distribution costs were estimated to be USD 1,996,286 at MSD and USD 543,648 at EPI. Distribution and program management costs represented 41% (USD 819,288) and 38% (USD 762,968) of the total costs at MSD, while storage and distribution costs represented 43% (USD 234,423) and 34% (USD 184,620) of the total costs at EPI, respectively. The cost drivers at MSD were fuel and transport (21%), receiving and dispatch (19%) and, program management personnel cost (14%), while at EPI were storage space (20%), program management personnel cost (18%) and fuel and transport (15%). CONCLUSION: The storage and distribution of vaccines in Tanzania via the EPI reduced the vaccine supply chain cost to about 27% of the program costs at MSD.