Primary healthcare providers’ attitudes and associated factors toward working with people who use substances in Rwanda

Primary healthcare providers are the cornerstone of universal health coverage and health outcomes. In Rwanda, considering the high prevalence of substance use and the plan of task-shifting harm reduction services for people who use drugs, especially those who inject drugs, from specialized clinics to primary health centres, this study serves as a baseline aimed at exploring the primary healthcare providers’ attitudes and their associated factors toward people who use substances in Rwanda. This cross-sectional study was conducted in 25 selected health centres across all 4 provinces of Rwanda and the City of Kigali. We used multi-stage sampling and included all primary healthcare providers who provided informed consent on the day of data collection. The Drug and Drug Problems Perception Questionnaire (DDPPQ) was used to examine the primary healthcare provider’s attitude toward people who use drugs. The DDPPQ consists of 22 items, with total scores ranging from 22 to 154, with higher scores indicating negative attitudes. No cut-offs were used. We assessed factors associated with primary healthcare providers’ attitudes using multivariable linear regression. In total, 350 primary healthcare providers were included in the study. The mean age of participants was 39.2 years (SD ± 8.7). Most participants were female (73.71%) and married (80.00%). The mean total DDPPQ score was 67.7 (SD ± 19.23). The role adequacy subscale had the highest mean score (21.3 ± 9.4). The only statistically significant variable was frequent interaction with people who use drugs in clinical practice (Adjusted coefficient: -9.85; 95%CI: -14.77 - -4.94; p < 0.001). Although negative attitudes towards people who use drugs are relatively high, primary healthcare providers’ attitudes are mixed, with primary healthcare providers frequently encountering people who use drugs having fewer negative attitudes. These attitudes can have significant implications for clinical practice. The evidence-based interventions, such as the didactic and value clarification and attitude transformation trainings on harm reduction services, need to be implemented.