Training Healthcare Professionals to Address Reproductive Health for Persons with Disabilities in Tanzania

PROJECT SUMMARY Training of healthcare providers in the reproductive and sexual health (RSH) needs of persons with disabilities (PWD) is critical to addressing a broad array of RSH concerns. Rigorous trials evaluating the effects of curricula on provider behavior are rare. Specifically, we could find no formalized training of healthcare providers in RSH for PWD in sub-Saharan Africa, an environment with the highest rates of human immunodeficiency virus (HIV), sexually transmitted infection (STI), and unintended pregnancy in the world; and where RSH challenges are common and particularly dire for PWD. Reproductive healthcare is a sensitive issue in Africa and PWD are often excluded from consideration. Consequently, a rigorous study of PWD RSH education for healthcare providers is needed if such education is to be widely adopted. Currently, at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, we are conducting a rigorous randomized controlled trial (RCT) of an Afrocentric RSH curriculum training for healthcare providers which was partly adapted from PAHO/WHO for implementation in Tanzania. When we assessed the need for training in RSH needs of PWD in our participants in this trial, nursing, midwifery, and medical students indicated RSH curriculum for PWD to be highly acceptable, needed, and desired by students, and our current NIH-funded RCT has clearly indicated the feasibility of implementation. The next logical step is to create a culturally relevant RSH curriculum to improve student knowledge, attitudes, and skills in providing RSH care for PWD. There are three specific aims. Aim 1 is to conduct a social ecological needs assessment of RSH care delivery for PWD in Tanzania. To determine the most important content when accessing RSH care, we will interview ~20 PWD and ~20 PWD caregivers (total of ~40 interviews) on their experience accessing RSH care. To determine the needs from the perspective of the healthcare workers, we will conduct focus groups of midwifery, nursing, and medical students (3 from each discipline). We will also conduct individual interviews with 12 key informants. In Aim 2, we will further adapt our curriculum, ensure it is culturally tailored to the Tanzanian/sub-Saharan context, and pilot test it. Aim 3 is to evaluate the effectiveness of an Afrocentric, culturally appropriate RSH curriculum for health providers focused on caring for PWD. We will conduct a randomized, controlled, single blinded trial of the curriculum against a waitlist control assessing effects on RSH for PWD knowledge, attitudes, and counseling skills (n=206 students per arm; 412 in total). Hypotheses will test efficacy of the curriculum. We will consult an advisory board of PWD in Tanzania to address structural and cultural issues throughout and use Universal Design (UD)/Universal Design for Learning (UDL) consultant for all study materials. If effective, MUHAS has committed to implement the curriculum for all health students. Given MUHAS is preeminent in health student education across Africa, the curriculum assessed in this study has high potential to be widely adopted as a new standard of training for health professionals across Africa.