SETTING: In Malawi, human immunodeficiency virus (HIV) prevalence among newly registered tuberculosis (TB) patients is 60-70%. In 2008, an integrated TBHIV clinic was established at a central hospital in Zomba. Despite the integration of TB-HIV activities and improved HIV service uptake, unacceptably high proportions of HIV-positive TB patients are still not receiving antiretroviral therapy (ART). OBJECTIVE: To identify factors that motivate or discourage TB patients from accepting HIV services. DESIGN: Retrospective analysis of patients registered for TB treatment (not yet on ART) between April 2008 and March 2009; qualitative interviews of 99 patients on TB treatment. RESULTS: Of 1773 newly registered TB patients who were not already on ART at the time of TB registration, 86% accepted HIV testing and counselling. Among HIV-positive TB patients, 38% started ART during or after anti-tuberculosis treatment. Young adults aged 15- 24 years were least likely to initiate ART. Motivation for accepting ART during TB treatment included prospects of regaining good health and longer life, and counselling by health care providers. Barriers to ART uptake included not being offered ART, high CD4 count, drug stockouts and fear of drug toxicities/interactions. CONCLUSION: Several factors that undermine uptake of ART have been highlighted; targeted measures urgently need to be addressed by TB-HIV programmes to overcome these barriers.
SETTING: In Malawi, human immunodeficiency virus (HIV) prevalence among newly registered tuberculosis (TB) patients is 60-70%. In 2008, an integrated TBHIV clinic was established at a central hospital in Zomba. Despite the integration of TB-HIV activities and improved HIV service uptake, unacceptably high proportions of HIV-positive TB patients are still not receiving antiretroviral therapy (ART). OBJECTIVE: To identify factors that motivate or discourage TB patients from accepting HIV services. DESIGN: Retrospective analysis of patients registered for TB treatment (not yet on ART) between April 2008 and March 2009; qualitative interviews of 99 patients on TB treatment. RESULTS: Of 1773 newly registered TB patients who were not already on ART at the time of TB registration, 86% accepted HIV testing and counselling. Among HIV-positive TB patients, 38% started ART during or after anti-tuberculosis treatment. Young adults aged 15- 24 years were least likely to initiate ART. Motivation for accepting ART during TB treatment included prospects of regaining good health and longer life, and counselling by health care providers. Barriers to ART uptake included not being offered ART, high CD4 count, drug stockouts and fear of drug toxicities/interactions. CONCLUSION: Several factors that undermine uptake of ART have been highlighted; targeted measures urgently need to be addressed by TB-HIV programmes to overcome these barriers.
Authors: M van Lettow; A K Chan; A S Ginsburg; H Tweya; D Gareta; J Njala; H Kanyerere; S Phiri; I Idana Journal: Public Health Action Date: 2011-09-21
Authors: H Muttai; K F Laserson; I Akello; L Nyabiage; J Gondi; J Mutegi; J Williamson; A K Nakashima; M-L Ackers Journal: Public Health Action Date: 2013-12-21
Authors: H S Kanyerere; J Mpunga; H Tweya; M Edginton; A D Harries; S G Hinderaker; F Chimbwandira; A Gonani; K Mbendera Journal: Public Health Action Date: 2012-10-30
Authors: George Alemnji; Peter Fonjungo; Barbara Van Der Pol; Trevor Peter; Rami Kantor; John Nkengasong Journal: AIDS Patient Care STDS Date: 2014-04-17 Impact factor: 5.078
Authors: Rein M G J Houben; Thomas P Van Boeckel; Venance Mwinuka; Peter Mzumara; Keith Branson; Catherine Linard; Frank Chimbwandira; Neil French; Judith R Glynn; Amelia C Crampin Journal: Int J Health Geogr Date: 2012-11-15 Impact factor: 3.918
Authors: Monique van Lettow; Ann Åkesson; Alexandra L C Martiniuk; Andrew Ramsay; Adrienne K Chan; Suzanne T Anderson; Anthony D Harries; Elizabeth Corbett; Robert S Heyderman; Rony Zachariah; Richard A Bedell Journal: PLoS One Date: 2012-11-19 Impact factor: 3.240
Authors: Brian Abel Maponga; Daniel Chirundu; Notion Tafara Gombe; Mufuta Tshimanga; Donewell Bangure; Lucia Takundwa Journal: Pan Afr Med J Date: 2015-05-13