Sexual and reproductive health (SRH) concerns are among the most major public health concerns in the Tanzanian health system. Important SRH issues in Tanzania include HIV infection, non- HIV STIs, unintended pregnancy, unsafe abortions, and lack of access to quality SRH care.1, 2, 3, 4, 5 Adult HIV prevalence in Tanzania is 4.4 % and is higher among women (5.6 %) than men (3.0 %).1 Rates of non-HIV STIs are of concern as well; a study of pregnant adolescent girls from Mwanza, Tanzania, found that 49.4 % of the 403 participants had at least one STI,2 and in another study of older adults in Tanzania, 17.8 % of participants had an STI in the past year.3

A cross-sectional survey in 2014 covering three Tanzanian districts found that 54.1 % of their participants reported their most recent pregnancy to be unintended, and 13.4 % said their most recent pregnancy was unwanted.4 Abortion laws are restrictive in East Africa and illegal in Tanzania unless to save a woman's life.5 Nevertheless, abortion is common: nationwide, there were approximately 405,000 abortions reported in 2013 – at least 36 for every 1000 women of reproductive age.6 The absence of proper care for many of these women results in devastating outcomes. In 2013, unsafe abortions were responsible for 18 % of maternal deaths in East Africa.7

Accessibility to SRH services and resources is limited in East Africa,8 particularly in rural areas. Mbeba et al., 2012 gathered narratives from adolescent girls from a rural Mtwara district.9 While almost all their participants reported becoming sexually active between the ages of 9 and 12, they stated that their community did not have the resources necessary to discuss their SRH needs, and the services they could access lacked privacy, confidentiality, and skilled providers.

Tanzania's SRH crisis extends to people with disabilities (PWD) who have limited access to SRH education and resources to engage in healthy sexual relationships and often face adverse SRH outcomes due to their vulnerability and sexual trauma.10, 11, 12 In Tanzanian households, 13.2 % have at least one member with a disability, and this group faces significant SRH barriers at the age where sexual health education is most important.13 However, Tanzania has recently demonstrated a commitment to improving PWD rights by enacting national disability policies, improving disability research, and ratifying the United Nations Convention on the Rights of Persons with Disabilities.14 Thus, there is a promise for a country-wide movement toward support for improving care for this marginalized group.

Globally, PWD are as likely to be sexually active as their peers without disabilities but are at increased risk for unintended pregnancy, STIs, and sexual violence, and their SRH care options are often inaccessible and inattentive to their experiences and desires.15, 16, 17, 18, 19 While Tanzania law recognizes PWD as having equal rights to SRH services,20 PWDs face significant challenges in accessing these services.11,12 When seeking SRH care, PWDs in Tanzania and other sub-Saharan African countries experience financial and physical barriers, communication barriers, confidentiality concerns, and provider mistreatment.11,21,22 Moreover, they tend to possess less SRH knowledge than the general population12,23 and live within a culture (both globally and East African-specific) with several harmful myths about PWD.24,25

The literacy rate is nearly half for PWD in Tanzania compared to their non-disabled peers, and 41.7 % of PWD in Tanzania do not complete any formal education.21 Many of them rely on their healthcare providers to cover SRH. Yet, SRH education catered to PWD on African health providers’ comfort, knowledge, and skills to address the SRH needs of PWD has not been studied. Therefore, there is a critical need for healthcare workers trained in PWD-focused SRH care.

The current study aimed to assess the feasibility and acceptability of the creation and implementation of curriculum catered to healthcare workers to serve the SRH needs of PWD. An SRH training curriculum for healthcare students in Tanzania was developed and evaluated at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, Tanzania, as part of a larger project during 2018–2022.26, 27, 28, 29, 30 This curriculum was informed by a multi-step curriculum development protocol and concluded with a rigorous randomized controlled trial (RCT) to evaluate the SRH curriculum.31 The curriculum included training on topics such as HIV/AIDS, STIs, sexual violence, early and unwanted pregnancy, sexual dysfunctions, and nonprocreative sexual behaviors. Data for the current feasibility study was collected during the 3-month follow-up of this RCT to determine the feasibility, acceptability, and need for adding a one-day PWD-focused SRH training to the overall curriculum. The short-term goal for the project is the adoption of this curriculum as a standard at MUHAS. In the long term, we hope to offer the curriculum across Tanzania and sub-Saharan Africa.