Exploring perceptions of the services offered in Tanzanian sober houses: a mixed- methods study among service users and providers.

Background: In Tanzania, residential treatment centers for alcohol and other drugs, locally known as "sober houses," play a critical role in the treatment of people living with a substance use disorder (SUD), but little is known about the services they offer and service users' and providers' perceptions of those services. We aimed to address these gaps in knowledge and to better understand where evidence-based interventions may be able to address gaps in service provision.

Materials and methods: This study used a mixed-methods approach across four sober houses in Dar es Salaam, Tanzania. We conducted 48 semi-structured interviews with a sub-sample of sober house service users (n = 38) and service providers (n = 10). Eighty-six (86) service users also completed a written survey to capture demographic information and assess knowledge of HIV and willingness to use HIV preventive care. All interviews were audio-recorded, translated into English, and then coded according to constructs developed with the Recovery Capital Framework. Following coding, a thematic analysis was conducted for the qualitative data using the framework developed by Braun and Clarke.

Results: Service users were generally positive about the treatment they were receiving but identified gaps in health service provision related to HIV, as well as a lack of preparation to address the employment-related challenges they face in the community after completing treatment. Service providers largely agreed with users' perceptions of needs and identified a lack of clinical personnel in sober houses and funding challenges as barriers to meeting these needs.

Conclusion: Sober houses provide treatment services to Tanzanians with SUD that service users largely view as positive. This evaluation identified employment challenges after treatment completion and gaps related to HIV care in the sober house. Further research is needed to investigate how interventions can be adapted to the sober house setting to meet these needs.