Facilitators and barriers for healthcare workers' adherence to the national nutritional guidelines for people living with HIV in Dar-es-Salaam: A mixed-method study

Abstract

The dual burden of HIV and malnutrition is a significant public health issue in Sub-Saharan Africa. In Tanzania, with an HIV prevalence of 4.9% among adults, malnutrition among People Living with HIV (PLHIV) remains high. This study evaluated adherence to nutritional guidelines for PLHIV in Care and Treatment Centers (CTCs) in Dar es Salaam and identified influencing factors. A mixed-method design was used among PLHIV, health facility administrators, and healthcare providers. Data were collected through observational checklists, structured questionnaires, and in-depth interviews. Statistical and qualitative analyses were performed to assess adherence and determinants. Among 478 participants who received care, only 19.46% were managed with fully adherence to the nutritional guidelines. Universally, anthropometric assessments were observed, however, micronutrient supplementation was minimal (1%). Higher education (AOR=5.08, p=0.019) and attendance at referral hospitals (AOR=8.23, p=0.032) positively influenced adherence. Conversely, nurse attendance (AOR=0.34, p=0.038), adequate staffing (AOR=0.31, p=0.010), and urban residence (AOR=0.47, p=0.009) negatively influenced adherence. Key facilitators included consistent training and supportive leadership, while barriers involved financial constraints and high staff turnover. The study reveals a significant gap in adherence to nutritional guidelines among PLHIV in Dar es Salaam, highlight the need for improved resource distribution, staff training, and patient education. Findings from this study aim to bridge the knowledge gap in adherence to nutritional guidelines for PLHIV, support evidence-based decision-making, and ultimately improve health outcomes.