title: Correlates of health care seeking behaviour among people who inject drugs in Dar es Salaam, Tanzania.
abstract: BACKGROUND
  People who inject drugs (PWID) suffer from a high burden of infectious disease. At the same time, they often have poor access to health care. As in other East African countries, the population of PWID is growing in Tanzania, but little is known about their contact with health care services. In this paper we examine patterns of health care use among PWID in Dar es Salaam and identify what factors are associated with regular contact with clinicians during illness.
  
  
  METHODS
  We conducted a baseline cross-sectional study as part of a prospective cohort study involving PWID. We recruited 578 PWID, of whom 273 were newly enrolled on an integrated methadone-assisted treatment (MAT) program and 305 were community-recruited. At baseline, we interviewed the MAT program enrollees before they received services at the program clinics. We used bivariate and multiple logistic regression analyses to identify the factors associated with seeking medical care when ill.
  
  
  RESULTS
  Only 25.4% of 578 participants reported seeing clinicians regularly when they needed medical care. Participants were more likely to see clinicians regularly if they were employed, (OR: 2.25, 95% CI: 1.28-3.98), had higher income levels (OR: 1.10, 95% CI: 1.00-1.22), were parents (OR: 1.71, 95% CI: 1.09-2.68), or knew where to seek affordable care (OR: 3.42, 95% CI: 2.12-5.52).
  
  
  CONCLUSIONS
  PWID in Dar es Salaam generally did not seek health care when needed. To improve their health care seeking behaviour, it is important to advise PWID about where to seek affordable health care and to increase their income-generating skills.
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Electronic address: lindasozy@gmail.com.
authors.forename: Linda Beatrice
authors.initials: LB
authors.lastname: Mlunde
authors.affiliation: Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania. Electronic address: sunguya@gmail.com.
authors.forename: Bruno Fokas
authors.initials: BF
authors.lastname: Sunguya
authors.affiliation: Department of Psychiatry and Mental Health, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania. Electronic address: jmbwambo@gmail.com.
authors.forename: Jessie Kazeni Kilonzo
authors.initials: JK
authors.lastname: Mbwambo
authors.affiliation: Department of Psychiatry and Mental Health, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania. Electronic address: oubuguyu@yahoo.com.
authors.forename: Omary Said
authors.initials: OS
authors.lastname: Ubuguyu
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Electronic address: shibanuma@m.u-tokyo.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Shibanuma
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Electronic address: jyasuoka@post.harvard.edu.
authors.forename: Junko
authors.initials: J
authors.lastname: Yasuoka
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Electronic address: mjimba@m.u-tokyo.ac.jp.
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000534:rehabilitation; D013636:Tanzania / Q000453:epidemiology
chemical_list: D008691:Methadone
keywords: Health care; Illness; People who inject drugs; Tanzania