Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
PLoS One. 2022 Jan 28;17(1):e0261500. doi: 10.1371/journal.pone.0261500. eCollection 2022.
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.
在撒哈拉以南非洲地区，注射毒品的人（PWID）获得全面的 HIV 服务的机会有限。虽然了解这些因素对于制定计划很重要，但关于影响他们获得全面 HIV 服务的因素的知识却很少。我们评估了坦桑尼亚 PWID 获得 HIV 预防服务的比例，以及相关的社会认知因素。
2017 年 10 月至 12 月期间，在坦桑尼亚达累斯萨拉姆对 PWID 进行了横断面调查。通过结构化的面对面访谈收集了有关 HIV 预防服务、人口统计学和选定社会认知因素的数据。使用加权描述性和前向选择多变量逻辑回归分析来评估 HIV 预防服务与感兴趣的预测因素之间的独立关联。结果为双侧，p 值小于 0.05 被认为具有统计学意义。
该研究纳入了 611 名 PWID（男性：94.4%），中位数年龄为 34 岁（四分位间距（IQR），29-38）。绝大多数参与者报告说能够获得避孕套（87.8%）、无菌针头/注射器（72.8%）和曾接受过 HIV 检测（66.0%）。大约一半（52.0%）的人报告在过去一个月内使用过避孕套，约三分之一（28.5%）的人接受过同伴教育者的帮助。参与者认为自己的 HIV 风险高（aOR = 0.29；95%CI：0.17-0.49）和经历过性暴力（aOR = 0.60；95%CI 0.37-0.98）时，接受 HIV 检测的可能性降低。然而，参与者具有中等教育水平（aOR = 2.16；95%CI：1.06-5.55）和正确的综合 HIV 知识（CCHK）（aOR = 1.63；95%CI 1.12-2.41）时，接受 HIV 检测的可能性增加。女性获得避孕套的可能性增加（aOR = 2.23；95%CI：1.04-5.02），但中等教育水平的参与者获得避孕套的可能性降低（aOR = 0.41；95%CI：0.19-0.84），收入超过 200,000 坦桑尼亚先令（aOR = 0.39；95%CI：0.23-0.66）和认为自己 HIV 风险高的参与者（aOR = 0.13；95%CI：0.03-0.36）。参与者具有小学（aOR = 1.61；95%CI：1.01-2.26）和中学（aOR = 2.71；95%CI：1.39-5.33）教育水平时，获得同伴教育者的可能性更高。参与者认为自己 HIV 风险高（aOR = 0.11；95%CI 0.05-0.22）和低中等（aOR = 0.25；95%CI 0.11-0.52）时，获得无菌针头和注射器的可能性降低，但具有小学教育水平（aOR = 1.72；95%CI 1.06-2.78）时，获得的可能性增加。
PWID 获得避孕套、HIV 检测、无菌针头和注射器的比例相对较高。然而，避孕套的使用和获得同伴教育者的比例相对较低。HIV 知识和风险认知、性别、教育程度和性暴力影响了 HIV 预防服务的获得。迫切需要解决这些社会认知因素，并扩大所有方面的 HIV 预防服务，以加快实现 2025 年 UNAIDS 目标和终结 HIV 疫情。
