Study participants (in depth interviews).

Background
World Health Organization (WHO) recommends that active TB Dug Safety Monitoring and Management (aDSM) be adopted in countries’ programmatic management of DR-TB services. In Tanzania, the National TB Leprosy Programme (NTLP), under the ministry of health, adopted the aDSM component in 2018. The study evaluated the facilitators and barriers of aDSM implementation in Dar es Salaam.
Materials and methods
This was a process evaluation study that adapted the descriptive cross-sectional approach, conducted in Dar es Salaam region. A total of 19 respondents, including clinicians, DOT (Direct Observed Therapy) nurses and key NTLP personnel, were interviewed using interview guides. Qualitative content analysis based on Graneheim & Lundman was used to guide the analysis.
Results
For aDSM to be implemented in a health facility, tools like forms for recoding and reporting, access to a functional laboratory for carrying out the required monitoring tests are a necessity. Moreover, the NTLP monitors the implementation through received aDSM reports and DR-TB supportive supervisions. However, it was found that in many health facilities, aDSM was partially being implemented due to various barriers: inadequate trained staff for aDSM implementation, administrative burden in reporting and delaying in AE management.
Conclusion
aDSM is inadequately being implemented due to the many setbacks faced by HCWs. aDSM-specific supportive supervisions and trainings to HCWs; incorporating the current manual aDSM reporting flow into the already existing electronic (Tanzania Medicine and Medical Drugs Authority) TMDA database seems useful.