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Access to Rabies Post-Exposure Prophylaxis in Tanzania: A mixed-methods and theoretically-informed study to inform
Kennedy Lushasi1, Eleanor M Rees2, Camille Baker2
1Ifakara Health Institute, Dar es Salaam, Tanzania.
Medrxiv : the Preprint Server for Health Sciences
|December 3, 2025
Summary
Barriers like vaccine stockouts, long travel distances, and high costs hinder rabies post-exposure prophylaxis (PEP) in Tanzania. Improving access requires decentralized delivery, reliable supplies, and better health worker support to prevent rabies deaths.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Systems Research
Background:
- Rabies is a fatal but preventable zoonotic disease, particularly in low- and middle-income countries.
- Access to timely post-exposure prophylaxis (PEP) is crucial for preventing rabies deaths but is often limited by various barriers.
- Gavi, the Vaccine Alliance, now supports PEP provision, making the understanding of access barriers critical for program effectiveness.
Purpose of the Study:
- To identify and analyze the barriers and facilitators to accessing and completing rabies post-exposure prophylaxis (PEP) in Tanzania.
- To assess the impact of systemic issues on PEP delivery and uptake using a comprehensive healthcare access framework.
- To inform strategies for improving PEP access and achieving the "Zero by 30" rabies elimination goal.
Main Methods:
- A mixed-methods approach was employed, synthesizing quantitative data from over 10,000 bite patients via an Integrated Bite Case Management platform.
- Qualitative data were gathered from over 3,000 health and veterinary workers through hotline calls and peer-support chats between 2018 and 2024.
- An expanded healthcare access framework (availability, accessibility, affordability, accommodation, acceptability, appropriateness) guided the analysis of PEP access barriers.
Main Results:
- Significant barriers to PEP access were identified, including recurrent vaccine stockouts (up to 9.2% regionally) and long travel distances, especially for rural populations.
- Unaffordable direct and indirect costs frequently led to PEP non-initiation, abandonment, delays, or reliance on traditional remedies.
- Inadequate management, insufficient supplies, and limited service hours increased patient risks and costs, although peer-support mechanisms showed promise in improving patient management.
Conclusions:
- Systemic barriers across all dimensions of healthcare access undermine PEP delivery in Tanzania.
- Addressing these requires decentralizing vaccine delivery, ensuring reliable stock for intradermal administration, reducing patient costs, and strengthening health worker capacity.
- Context-sensitive, equity-focused strategies are essential to maximize Gavi's investment and advance rabies elimination efforts.
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