Trends and factors associated with condom use among Tanzanian men before and after introduction of pre-exposure prophylaxis: evidence from TDHS 2010-2022 Tanzania Demographic and Health Surveys.

INTRODUCTION

Male condoms are widely available and cost-effective; in recent years, pre-exposure prophylaxis (PrEP), a biomedical prevention choice, has gained more recognition. Recognising that heterosexual men are often under-represented in HIV-prevention research, this study examines trends and factors of condom use among Tanzanian men aged 15-49 before and after PrEP rollout, using three Tanzania Demographic and Health Surveys (TDHS) (2010, 2015/2016, 2022).

METHODS

We conducted a secondary analysis of men's datasets from the TDHS for the years 2010 (N=1858), 2015/16 (N=2728) and 2022 (N=4337), yielding a combined weighted sample of 8925 men. The primary outcome was self-reported condom use during last sexual intercourse with the most recent partner. Multivariable logistic regression models were used to examine associations between condom use and sociodemographic, behavioural and HIV prevention-related factors. Analysis was stratified by survey year to capture temporal trends.

RESULTS

Overall, reported condom use declined from 22.2% in 2010 to 20.3% in 2015/2016 and further to 18.5% in 2022. Higher odds of condom use were associated with secondary education in 2010 (adjusted OR (AOR)=2.12; 95% CI 1.03 to 4.33) and with primary (AOR=2.21; 95% CI 1.34 to 3.64) and higher education (AOR=2.79; 95% CI 1.63 to 4.76) in 2022. Media exposure was also positively associated with condom use, including newspaper exposure in 2010 (AOR=2.18; 95% CI 1.48 to 3.20), television (AOR=1.38; 95% CI 1.38 to 2.48) and newspaper (AOR=1.53; 95% CI 1.02 to 2.31) in 2015/2016, and radio (AOR=1.33; 95% CI 1.01 to 1.76) and newspaper (AOR=1.41; 95% CI 1.04 to 1.91) in 2022. In 2022, richer (AOR=1.63; 95% CI 1.01 to 2.63) and richest men (AOR=1.74; 95% CI 1.04 to 2.92), never-married men (AOR=2.01; 95% CI 1.31 to 3.07) and those approving daily PrEP use (AOR=1.42; 95% CI 1.01 to 2.00) had higher odds of condom use, while divorced/widowed men had lower odds across all survey waves. The spatial analysis revealed variations in condom use over time, with some urban areas showing a decline post-PrEP introduction.

CONCLUSION

Condom use among men in Tanzania has steadily declined over the past decade after the introduction of PrEP. Targeted interventions are needed to reinforce condom use alongside PrEP to sustain comprehensive HIV prevention efforts.