Health system barriers affecting the implementation of collaborative TB-HIV services in Uganda
SETTING: Despite Uganda's efforts to improve tuberculosis and human immunodeficiency virus (TB-HIV) collaborative services, implementation remains low and operational barriers have not been systematically identified and documented.
OBJECTIVE: To assess barriers to implementation
of TB-HIV collaborative services in five districts in Uganda.
DESIGN: In this qualitative study, focus groups and key informant and in-depth interviews were conducted for patients (HIV, TB), health providers and community members. TB registers were also assessed for data on use of TB-HIV
RESULTS: Of 333 adult TB patients registered between July and September 2006, 185 (56%) were tested for HIV, of whom 134 were HIV-co-infected. Of these, 52% were on cotrimoxazole preventive therapy (CPT), 12% were on antiretroviral therapy (ART) and CPT, while 36%
had not received any HIV service. Health system barriers identified included poor TB-HIV planning, coordination and leadership, inadequate dissemination of policy, inadequate provider knowledge, limited TB-HIV interclinic referral, poor service integration and recording, logistical shortages,
high costs of services and provider shortages amidst high patient loads.
CONCLUSION: Implementation and utilisation of collaborative TB-HIV services remains suboptimal. The barriers identified highlight the need for TB and HIV programmes to support districts to plan, coordinate and invest
resources in TB-HIV collaborative services, especially in policy dissemination, training health providers, integration of TB-HIV services, logistical management and monitoring.
Document Type: Regular Paper
International Union Against Tuberculosis and Lung Disease, Paris, France
Regional Centre for Quality Health Care, Kampala, Uganda
National Tuberculosis and Leprosy Programme, Kampala, Uganda
National AIDS Control Programme, Kampala, Uganda
International Union Against Tuberculosis and Lung Disease, Paris, France; and US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Publication date: August 1, 2009
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