Adapting a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV care and treatment clinics in Dar es Salaam, Tanzania
Abstract Background HIV prevalence among people who use drugs (PWUD) in Tanzania is 4–7 times higher than in the general population, underscoring an urgent need to increase HIV testing and treatment among PWUD. Drug use stigma within HIV clinics is a barrier to HIV treatment for PWUD, yet few interv...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Harm Reduction Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12954-024-00965-4 |
| _version_ | 1797259402425663488 |
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| author | Linda B. Mlunde Khalida Saalim Jessie K. Mbwambo Pfiriael Kiwia Elizabeth Fitch Willbrord Manyama Isack Rugemalila Sue Clay Barrot H. Lambdin Rachel D. Stelmach Carla Bann Laura Nyblade |
| author_facet | Linda B. Mlunde Khalida Saalim Jessie K. Mbwambo Pfiriael Kiwia Elizabeth Fitch Willbrord Manyama Isack Rugemalila Sue Clay Barrot H. Lambdin Rachel D. Stelmach Carla Bann Laura Nyblade |
| author_sort | Linda B. Mlunde |
| collection | DOAJ |
| description | Abstract Background HIV prevalence among people who use drugs (PWUD) in Tanzania is 4–7 times higher than in the general population, underscoring an urgent need to increase HIV testing and treatment among PWUD. Drug use stigma within HIV clinics is a barrier to HIV treatment for PWUD, yet few interventions to address HIV-clinic drug use stigma exist. Guided by the ADAPT-ITT model, we adapted the participatory training curriculum of the evidence-based Health Policy Plus Total Facility Approach to HIV stigma reduction, to address drug use stigma in HIV care and treatment clinics (CTCs). Methods The first step in the training curriculum adaptation process was formative research. We conducted 32 in-depth interviews in Dar es Salaam, Tanzania: 18 (11 men and 7 women) with PWUD living with HIV, and 14 with a mix of clinical [7] and non-clinical [7] CTC staff (5 men and 9 women). Data were analyzed through rapid qualitative analysis to inform initial curriculum adaptation. This initial draft curriculum was then further adapted and refined through multiple iterative steps of review, feedback and revision including a 2-day stakeholder workshop and external expert review. Results Four CTC drug use stigma drivers emerged as key to address in the curriculum adaptation: (1) Lack of awareness of the manifestations and consequences of drug use stigma in CTCs (e.g., name calling, ignoring PWUD and denial of care); (2) Negative stereotypes (e.g., all PWUD are thieves, dangerous); (3) Fear of providing services to PWUD, and; (4) Lack of knowledge about drug use as a medical condition and absence of skills to care for PWUD. Five, 2.5-hour participatory training sessions were developed with topics focused on creating awareness of stigma and its consequences, understanding and addressing stereotypes and fears of interacting with PWUD; understanding drug use, addiction, and co-occurring conditions; deepening understanding of drug use stigma and creating empathy, including a panel session with people who had used drugs; and working to create actionable change. Conclusion Understanding context specific drivers and manifestations of drug use stigma from the perspective of PWUD and health workers allowed for ready adaptation of an existing evidence-based HIV-stigma reduction intervention to address drug use stigma in HIV care and treatment clinics. Future steps include a pilot test of the adapted intervention. |
| first_indexed | 2024-04-24T23:08:51Z |
| format | Article |
| id | doaj.art-03df592f6d044f1bb6d7a9c374de2174 |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-04-24T23:08:51Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-03df592f6d044f1bb6d7a9c374de21742024-03-17T12:20:05ZengBMCHarm Reduction Journal1477-75172024-03-0121111310.1186/s12954-024-00965-4Adapting a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV care and treatment clinics in Dar es Salaam, TanzaniaLinda B. Mlunde0Khalida Saalim1Jessie K. Mbwambo2Pfiriael Kiwia3Elizabeth Fitch4Willbrord Manyama5Isack Rugemalila6Sue Clay7Barrot H. Lambdin8Rachel D. Stelmach9Carla Bann10Laura Nyblade11Muhimbili University of Health and Allied SciencesRTI InternationalMuhimbili University of Health and Allied SciencesKimara Peer Educators and Health PromotersRTI InternationalKimara Peer Educators and Health PromotersTemeke Regional Referral Hospital3C Regional ConsultantsRTI InternationalRTI InternationalRTI InternationalRTI InternationalAbstract Background HIV prevalence among people who use drugs (PWUD) in Tanzania is 4–7 times higher than in the general population, underscoring an urgent need to increase HIV testing and treatment among PWUD. Drug use stigma within HIV clinics is a barrier to HIV treatment for PWUD, yet few interventions to address HIV-clinic drug use stigma exist. Guided by the ADAPT-ITT model, we adapted the participatory training curriculum of the evidence-based Health Policy Plus Total Facility Approach to HIV stigma reduction, to address drug use stigma in HIV care and treatment clinics (CTCs). Methods The first step in the training curriculum adaptation process was formative research. We conducted 32 in-depth interviews in Dar es Salaam, Tanzania: 18 (11 men and 7 women) with PWUD living with HIV, and 14 with a mix of clinical [7] and non-clinical [7] CTC staff (5 men and 9 women). Data were analyzed through rapid qualitative analysis to inform initial curriculum adaptation. This initial draft curriculum was then further adapted and refined through multiple iterative steps of review, feedback and revision including a 2-day stakeholder workshop and external expert review. Results Four CTC drug use stigma drivers emerged as key to address in the curriculum adaptation: (1) Lack of awareness of the manifestations and consequences of drug use stigma in CTCs (e.g., name calling, ignoring PWUD and denial of care); (2) Negative stereotypes (e.g., all PWUD are thieves, dangerous); (3) Fear of providing services to PWUD, and; (4) Lack of knowledge about drug use as a medical condition and absence of skills to care for PWUD. Five, 2.5-hour participatory training sessions were developed with topics focused on creating awareness of stigma and its consequences, understanding and addressing stereotypes and fears of interacting with PWUD; understanding drug use, addiction, and co-occurring conditions; deepening understanding of drug use stigma and creating empathy, including a panel session with people who had used drugs; and working to create actionable change. Conclusion Understanding context specific drivers and manifestations of drug use stigma from the perspective of PWUD and health workers allowed for ready adaptation of an existing evidence-based HIV-stigma reduction intervention to address drug use stigma in HIV care and treatment clinics. Future steps include a pilot test of the adapted intervention.https://doi.org/10.1186/s12954-024-00965-4TanzaniaDrug abuseSubstance useSocial stigmaStereotypingHealth facilities |
| spellingShingle | Linda B. Mlunde Khalida Saalim Jessie K. Mbwambo Pfiriael Kiwia Elizabeth Fitch Willbrord Manyama Isack Rugemalila Sue Clay Barrot H. Lambdin Rachel D. Stelmach Carla Bann Laura Nyblade Adapting a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV care and treatment clinics in Dar es Salaam, Tanzania Harm Reduction Journal Tanzania Drug abuse Substance use Social stigma Stereotyping Health facilities |
| title | Adapting a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV care and treatment clinics in Dar es Salaam, Tanzania |
| title_full | Adapting a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV care and treatment clinics in Dar es Salaam, Tanzania |
| title_fullStr | Adapting a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV care and treatment clinics in Dar es Salaam, Tanzania |
| title_full_unstemmed | Adapting a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV care and treatment clinics in Dar es Salaam, Tanzania |
| title_short | Adapting a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV care and treatment clinics in Dar es Salaam, Tanzania |
| title_sort | adapting a health facility hiv stigma reduction participatory training intervention to address drug use stigma in hiv care and treatment clinics in dar es salaam tanzania |
| topic | Tanzania Drug abuse Substance use Social stigma Stereotyping Health facilities |
| url | https://doi.org/10.1186/s12954-024-00965-4 |
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