Barriers to Accessing HIV Care and Treatment Services by TB patients who are co-Infected with HIV in Lusaka District Clinics

Abstract

The objective of the study was to identify barriers to accessing HIV services by TB patients who are co-infected with HIV in Lusaka District clinics. CIDRZ program monitoring data shows that 30% of TB patients refuse HIV testing and that 45% of HIV-positive TB patients identified through DCT do not enrol in HIV care (Harris et al., 2007).This was a cross-sectional qualitative study using free listing and interview guides. The first part of the study involved 32 TB patients who attended a TB clinic. The criteria for selection included: those who refused DCT, those who accepted DCT but tested HIV negative, those who accepted DCT and tested HIV positive and were referred as well as those who refused referral to an ART clinic. The data was collected using free-listing technique which entails that the patient lists all the possible responses and gives a small description to each of those responses. The study further collected information from 31 key informants using an unstructured interview guide. These informants were selected by the respondents in during the free listing exercise. The study was conducted in 8 Lusaka Urban District Clinics and analysed using thematic analysis.Both free listing and key informants‟ questions were based on people‟s understanding of causes of TB/HIV co-infection and how these can be reduced. The respondents associated TB/HIV co-infection to a lot of issues, notably prostitution and poor diet. They emphasized the need for provision of more information on TB/HIV to patients as a way of the spread of these diseases.The study revealed that lack of confidentiality was seen as a barrier for most respondents. Many people do not access TB/HIV services because of fear of lack of confidentiality on the part of the health workers which is associated with stigma and discrimination by the general public. Suggestions to curb this vice included calling for Government to merge the services for both TB and HIV patients. Taking of TB/HIV treatment at the same time is seen as a „good thing‟ by the general community but there is need to sensitize the people affected on its importance. Many people avoid taking drugs for these diseases at the same time because they believe the drugs are too strong to be taken together‟ and can kill a patient‟.The results of this survey have helped identify community perceptions that contribute to the under-utilization of HIV services by TB patients who are co-infected with HIV in Lusaka District clinics. The hypothesis generated from this study is that underutilization of TB/HIV co-treatment services is associated to the barriers identified in this study.