Practitioner's perspectives on access to Rabies Post-Exposure Prophylaxis in Tanzania: A mixed-methods and...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Systems Research

Background:

• Rabies is a preventable zoonotic disease with high mortality, particularly in low- and middle-income countries.
• Access to post-exposure prophylaxis (PEP) is limited by various barriers, despite Gavi, the Vaccine Alliance, supporting its provision.
• Understanding these access barriers is critical for improving PEP delivery and uptake.

Purpose of the Study:

• To identify and analyze barriers and facilitators to post-exposure prophylaxis (PEP) delivery and uptake in Tanzania.
• To assess PEP access using an expanded healthcare access framework across six dimensions.
• To inform strategies for equitable and effective PEP provision.

Main Methods:

• Mixed-methods approach synthesizing quantitative data (>10,000 bite patients) from an Integrated Bite Case Management platform.
• Qualitative data from hotline calls and peer-support chat among health and veterinary workers (2018-2024).
• Analysis guided by a six-dimensional healthcare access framework (availability, accessibility, affordability, accommodation, acceptability, appropriateness).

Main Results:

• Significant barriers identified include recurrent vaccine stockouts (up to 9.2%), long travel distances (average 34 km for rural vs 13 km for urban patients), and unaffordable costs leading to PEP abandonment.
• Incorrect patient management and unregulated private pharmacies contributed to preventable deaths.
• Peer-support mechanisms demonstrated potential for improved patient management and problem-solving.

Conclusions:

• Systemic barriers across all healthcare access dimensions undermine PEP delivery in Tanzania.
• Recommendations include decentralizing vaccine delivery, ensuring reliable stock, reducing patient costs, strengthening health worker capacity, and regulating private providers.
• Context-sensitive, equity-focused strategies are essential to maximize Gavi's investment and advance the 'Zero by 30' initiative.