Research Repository :: Browsing by Author "Mbotwa, Christopher"

Browsing by Author "Mbotwa, Christopher"

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Acceptability of an mHealth intervention to promote the use of pre-exposure prophylaxis among individuals at increased risk of HIV. The case of the Jichunge smartphone app in Dar es Salaam, Tanzania.
(IAS, 2022-07-29) Mbotwa, Christopher; Kazaura, Method; Moen, Kåre; Leshabari, Melkizedeck; Metta, Emmy; Mmbaga, Elia J.
Background: Reducing HIV infection rates among at-risk populations is more likely to contribute to achieving the 2030 goal of ending the epidemic. Countries in sub-Saharan Africa, including Tanzania, have started rolling out pre-exposure prophylaxis (PrEP), but adherence to the daily pills poses a challenge. Evidence indicates that mHealth is a promising solution for promoting uptake, retention, and adherence to PrEP. However, evaluation data of its implementation in Africa settings are scarce. This study aimed at assessing acceptability and initial use of mHealth in promoting PrEP use among female sex workers (FSW) and men who have sex with men (MSM) in Dar es Salaam, Tanzania. Methods: FSW and MSM residing in Dar es Salaam who owned smartphones and were eligible for PrEP were recruited using respondent-driven sampling and provided with the Jichunge, a smartphone-based application designed to promote adherence to PrEP and retention in PrEP services. The app offers users information about HIV and PrEP, reminds them to take their daily pill, allows them to consult a doctor and peer educator, and includes an online forum where may engage in discussions with other PrEP users. Results: A total of 885 participants (470 FSW and 415 MSM) with a median age of 26 and 21 years, respectively, were recruited. Most (559; 63.2%) opened the app and registered pill-taking (523; 59.1%) at least once. About a third of the participants accessed the app’s PrEP and HIV editorial contents (348; 39.3%) and participated in the discussion forum (277; 31.3%). A total of 172(19.4%) consulted a doctor or peer educator via the app. FSW were significantly more likely than MSM to open the app (FSW:74%; MSM: 50.8%; p<0.001), register daily pill use (FSW:71.7%; MSM: 44.8%; p<0.001), access editorial contents (FSW:47.0%; MSM: 30.6%; p<0.001), and engage in the discussion forum (FSW:34.3%; MSM: 27.9%; p=0.044). Online consultation was not statistically significant different between the two populations (FSW:20.1%; MSM: 18.1%; p=0.336). Conclusion: The use of different services of Jichunge was significantly high. This suggests that mHealth is acceptable and can be a valuable platform to promote the use of PrEP and other services among HIV at-risk populations in Tanzania.
Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach
(JMIR Publications, 2021-07-07) Mauka, Wilhellmuss; Mbotwa, Christopher; Moen, Kåre; Lichtwarck, Hanne Ochieng; Haaland, Inga; Kazaura, Method; Leyna, Germana H; Leshabari, Melkizedeck T; Mmbaga, Elia J
Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion.
Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach
(JMIR Publications, 2021-10-07) Mauka, Wilhellmuss; Mbotwa, Christopher; Moen, Kåre; Lichtwarck, Hanne Ochieng; Haaland, Inga; Kazaura, Method; Leyna, Germana H; Leshabari, Melkizedeck T; Mmbaga, Elia J
Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion.
Factors associated with uptake of postpartum family planning services in Dodoma City Council, Tanzania: A cross-section study
(National Insititute of Medical Research (NIMR), 2022-06-13) Ezekiel, Mangi J; Akwary, Elibariki R; Mbotwa, Christopher; Mosha, Idda H
Background: Postpartum family planning is very essential to mothers’ health. However, its utilization remains low in developing countries. Objective: To determine the proportion and factors associated with uptake of PPFP services in Dodoma Tanzania. Methods: A cross-sectional study employing a quantitative approach was conducted among women who gave birth one year before the study period (June 2020) in Dodoma city council. A two-stage sampling technique was employed to recruit a total number of 209 participants. An interviewer-administered questionnaire was used to collect data. Data were entered and cleaned using Epi Info 7 and later exported to and analyzed using SPSS version 25.0. Bivariate and multiple logistic regression models were employed during data analysis. Odds ratios with 95% confidence intervals were computed to identify factors associated with postpartum family planning. Results: Majority (53.6%) of women used contraceptives within one year after delivery. Three factors were significantly associated with the uptake of postpartum family planning. Lower odds for uptake of PPFP were found among self-employed women (AOR: 0.5, 95% CI 0.25–0.74) and unemployed women (AOR: 0.2, 95% CI 0.05–0.31) when compared with employed women. Using community health fund insurance (AOR: 2.4, 95% CI 1.09–6.42) and National Health Insurance Fund (AOR: 2.7, 95% CI 1.54–5.99) as a mode of payments for health had higher odds for uptake of PPFP compared to cash mode. Women with an adequate number of antenatal care visits had higher odds (AOR: 2.9, 95% CI 1.24–6.89) of uptake of PPFP compared to women with an inadequate number of antenatal care visits. Conclusion: The uptake of PPFP among women was not adequate and was associated with being employed, being covered by health insurance and adequate antenatal care visits. More interventions are needed to enhance PPFP use among women.
Predictors of mHealth use in promoting adherence to pre-exposure prophylaxis among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania
(Springer Nature, 2021-07-04) Mbotwa, Christopher; Kazaura, Method; Moen, Kåre; Leshabari, Melkizedeck; Metta, Emmy; Leyna, Germana; Mmbaga, Elia J.
Background There is evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, and PrEP is recommended by the World Health organization (WHO) for use by individuals at high risk of HIV infection. However, low adherence has been reported to hamper its effectiveness. Some evidence indicates that mHealth interventions may be a promising way of promoting PrEP adherence. Nevertheless, evaluations of mHealth interventions in Africa, the region most affected by HIV, are scarce. This study aimed at identifying the extent of and predictors for use of a smartphone based mHealth application among female sex workers in Dar es Salaam, Tanzania. Methods As part of a quasi-experimental study in Tanzania, 470 female sex workers who were eligible for PrEP and who owned a smartphone were recruited using respondent driven sampling. All participants were provided with an mHealth application called Jichunge, a smartphone-based app designed to promote adherence to PrEP by offering users information, advise and support during start-up and use of PrEP. We collected data through structured interviews at baseline and extracted user data from the app for a period of 30 days. Modified Poisson regression model with robust standard errors was used to identify predictors for the optimal use of the Jichunge app. Results Overall, the optimal use of the Jichunge app was 46.4%. Optimal use was significantly higher among women who were older (aPR = 1.3, 95% CI: 1.10-1.65, p = 0.004 for age 25-34 years, and aPR = 1.6, 95% CI: 1.19-2.07, p = 0.001 for age at least 35 years), who had secondary education or higher (aPR = 1.8, 95% CI: 1.08-2.94, p = 0.023), who had suboptimal social support (aPR = 1.2, 95% CI: 1.02-1.48, p = 0.030), who had high awareness of PrEP (aPR = 1.3, 95% CI: 1.08-1.55, p = 0.005), and who had experience using common mainstream social media applications (aPR = 1.4, 95% CI: 1.08-1.71, p = 0.009). Conclusion Optimal use of the Jichunge app was substantially higher among women with higher age, higher education, higher PrEP awareness, less social support, and experience using common social media applications. Individual and interpersonal factors should be considered in planning mHealth interventions. Further studies to determine predictors of longer-term mHealth engagement are needed.
Predictors of mHealth use in promoting adherence to pre-exposure prophylaxis among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania
(Springer Nature, 2022-07-04) Mbotwa, Christopher; Kazaura, Method; Leshabari, Melkizedeck; Metta, Emmy; Leyna, Germana; Mmbaga, Elia J
Background There is evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, and PrEP is recommended by the World Health organization (WHO) for use by individuals at high risk of HIV infection. However, low adherence has been reported to hamper its effectiveness. Some evidence indicates that mHealth interventions may be a promising way of promoting PrEP adherence. Nevertheless, evaluations of mHealth interventions in Africa, the region most affected by HIV, are scarce. This study aimed at identifying the extent of and predictors for use of a smartphone based mHealth application among female sex workers in Dar es Salaam, Tanzania. Methods As part of a quasi-experimental study in Tanzania, 470 female sex workers who were eligible for PrEP and who owned a smartphone were recruited using respondent driven sampling. All participants were provided with an mHealth application called Jichunge, a smartphone-based app designed to promote adherence to PrEP by offering users information, advise and support during start-up and use of PrEP. We collected data through structured interviews at baseline and extracted user data from the app for a period of 30 days. Modified Poisson regression model with robust standard errors was used to identify predictors for the optimal use of the Jichunge app. Results Overall, the optimal use of the Jichunge app was 46.4%. Optimal use was significantly higher among women who were older (aPR = 1.3, 95% CI: 1.10-1.65, p = 0.004 for age 25-34 years, and aPR = 1.6, 95% CI: 1.19-2.07, p = 0.001 for age at least 35 years), who had secondary education or higher (aPR = 1.8, 95% CI: 1.08-2.94, p = 0.023), who had suboptimal social support (aPR = 1.2, 95% CI: 1.02-1.48, p = 0.030), who had high awareness of PrEP (aPR = 1.3, 95% CI: 1.08-1.55, p = 0.005), and who had experience using common mainstream social media applications (aPR = 1.4, 95% CI: 1.08-1.71, p = 0.009). Conclusion Optimal use of the Jichunge app was substantially higher among women with higher age, higher education, higher PrEP awareness, less social support, and experience using common social media applications. Individual and interpersonal factors should be considered in planning mHealth interventions. Further studies to determine predictors of longer-term mHealth engagement are needed.
Predictors of mHealth use in promoting adherence to pre‑exposure prophylaxis among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania
(Springer Nature, 2021-07-04) Mbotwa, Christopher; Method, Kazaura; Moen, Kåre; Leshabari, Melkizedeck; Metta, Emmy; Leyna, Germana; Mmbaga, Elia J.
Background There is evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, and PrEP is recommended by the World Health organization (WHO) for use by individuals at high risk of HIV infection. However, low adherence has been reported to hamper its effectiveness. Some evidence indicates that mHealth interventions may be a promising way of promoting PrEP adherence. Nevertheless, evaluations of mHealth interventions in Africa, the region most affected by HIV, are scarce. This study aimed at identifying the extent of and predictors for use of a smartphone based mHealth application among female sex workers in Dar es Salaam, Tanzania. Methods As part of a quasi-experimental study in Tanzania, 470 female sex workers who were eligible for PrEP and who owned a smartphone were recruited using respondent driven sampling. All participants were provided with an mHealth application called Jichunge, a smartphone-based app designed to promote adherence to PrEP by offering users information, advise and support during start-up and use of PrEP. We collected data through structured interviews at baseline and extracted user data from the app for a period of 30 days. Modified Poisson regression model with robust standard errors was used to identify predictors for the optimal use of the Jichunge app. Results Overall, the optimal use of the Jichunge app was 46.4%. Optimal use was significantly higher among women who were older (aPR = 1.3, 95% CI: 1.10-1.65, p = 0.004 for age 25-34 years, and aPR = 1.6, 95% CI: 1.19-2.07, p = 0.001 for age at least 35 years), who had secondary education or higher (aPR = 1.8, 95% CI: 1.08-2.94, p = 0.023), who had suboptimal social support (aPR = 1.2, 95% CI: 1.02-1.48, p = 0.030), who had high awareness of PrEP (aPR = 1.3, 95% CI: 1.08-1.55, p = 0.005), and who had experience using common mainstream social media applications (aPR = 1.4, 95% CI: 1.08-1.71, p = 0.009). Conclusion Optimal use of the Jichunge app was substantially higher among women with higher age, higher education, higher PrEP awareness, less social support, and experience using common social media applications. Individual and interpersonal factors should be considered in planning mHealth interventions. Further studies to determine predictors of longer-term mHealth engagement are needed.
Principal Components and Factor Analysis of Fertility Differentials in Tanzania
(Refaad, 2018-04-01) Mbotwa, Christopher; Akarro, Rocky R.
The objective of this paper is to apply principal components and factor analysis techniques in assessing factors associated with fertility differentials in Tanzania. The study utilized secondary data from 2010 Tanzania Demographic and Health Survey (2010 TDHS) dataset. Three factors were identified as the main factors associated to fertility differentials in Tanzania. The first factor was woman’ education and awareness, the second factor was woman’ demographic characteristics and the third factor was woman’ economic status. Among those factors, woman’ education and awareness was found to contribute more than all other factors in explaining fertility differentials in Tanzania. The study concluded that, in order to attain a desirable fertility level in the country, woman’ education especially on the issue of family planning needs to be improved.
Sexual harassment in public transport among female university students in Dar es Salaam, Tanzania
(National Insititute of Medical Research (NIMR), 2022-09-27) Mosha, Idda; Mapunda, Grace; Mbotwa, Christopher; Nyamhanga, Tumaini
Background: Globally, women and girls are subjected to various forms of sexual harassment while using public transport daily. Objective: To determine the prevalence of sexual harassment and identify different forms and associated risk factors among female university students who use public transport in Dar es Salaam, Tanzania. Methods: A cross-sectional study design using a questionnaire was employed to collect data. Data were collected from female first-year undergraduate students, who use public transport and are aged 18 years and above studying at the University of Dar es Salaam and Muhimbili University of Health and Allied Sciences. Results: The overall prevalence of sexual harassment on public transport was 88%. Study participants reported the highest levels of sexual harassment (91%). Verbal harassment was the most common form of sexual harassment (95%), and being called names such as baby, sweet, honey or love was reported by most students (78%). Factors associated with sexual harassment on public transport were: overcrowded vehicles (AOR=2.90, 95% CI: 0.09-4.50) and use of public transport as a form of transport (AOR=4.54, 95% CI: 0.40-8.90). Conclusion: The study findings highlight the need for the implementation of plausible interventions on the issue of sexual harassment through awareness campaigns and the implementation of modern surveillance and reporting systems in public spaces.
Use of mHealth to improve retention to pre-exposure prophylaxis for HIV prevention among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania.
(National Insititute of Medical Research (NIMR), 2022-05-19) Mbotwa, Christopher; Kazaura, Method; Mmbaga, Elia J.
Abstract: Background: Female sex workers are among groups at increased risk of HIV infection. Pre-exposure prophylaxis (PrEP) has been proven to be effective in preventing HIV transmission, but low retention to services poses a challenge to its effectiveness. Innovative interventions to tackle the problem and help achieve universal health coverage goals are called for. Objective: To determine the effect of smartphone based mHealth application on retention to PrEP among female sex workers in Dar es Salaam. Methods: Using respondent driven sampling, 470 female sex workers eligible for PrEP and who owned a smartphone were recruited. All participants were provided with a smartphone-based mHealth app (Jichunge app) which has multiple functionalities designed to promote PrEP use and retention among HIV at risk population. We utilized information collected during the baseline, month 1 follow-up, and data on the use of Jichunge app for a period of 30 days. Associations between PrEP retention and optimal use of different functionalities of the app was assessed using modified Poisson regression model with robust standard errors. Results: Of 470 recruited participants, 253 (53.8%) were retained to PrEP services at month 1. Retention to PrEP services was significantly higher among those who opened the Jichunge app after installation (APR=1.4, 95% CI: 1.13-1.85), used gamification functions (APR=1.5, 95% CI: 1.18-1.89), visited PrEP editorial contents (APR=1.4, 95% CI:1.16-1.67), consulted a doctor or peer educator (APR=1.5, 95% CI:1.29-1.79), or engaged in the discussion with other PrEP users (APR=1.4, 95% CI:1.17-1.62). Conclusion: The use of Jichunge mHealth application significantly increased retention to PrEP among female sex workers in Dar es Salaam. The results indicate that use of mHealth interventions hold potential to promote universal health coverage in a cascade of PrEP and other related interventions.

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