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Patient- and delivery-system factors related to acceptance of HIV counseling and testing services among tuberculosis patients in South Africa: a qualitative study with community health workers and program managers

By Yue Guan | 01 Apr, 2011

Abstract

Background

South Africa has a high tuberculosis (TB)-human immunodeficiency virus (HIV) coinfection rate of 73%, yet only 46% of tuberculosis TB patients are tested for HIV. To date, relatively little work has focused on understanding why TB patients may not accept effective services or participate in programs that are readily available in health care delivery systems. The objective of the study was to explore barriers to and facilitators of participation in HIV counseling and testing (HCT) among TB patients in the Free State Province, from the perspective of community health workers and program managers who offer services to patients on a daily basis. These two provider groups are positioned to alter the delivery of HCT services in order to improve patient participation and, ultimately, health outcomes.

Methods

Group discussions and semistructured interviews were conducted with 40 lay counselors, 57 directly-observed therapy (DOT) supporters and 13 TB and HIV/acquired immune deficiency syndrome (AIDS) program managers in the Free State Province between September 2007 and March 2008. Sessions were audio-recorded, transcribed, and thematically analyzed.

Results

The themes emerging from the focus group discussions and interviews included four main suggested barrier factors: (1) fear of HIV/AIDS, TB-HIV coinfection, death and stigma; (2) perceived lack of confidentiality of HIV test results; (3) staff shortages and high workload; and (4) poor infrastructure to encourage, monitor, and deliver HCT. The four main facilitating factors emerging from the group and individual interviews were (1) encouragement and motivation by health workers; (2) alleviation of health worker shortages; (3) improved HCT training of professional and lay health workers; and (4) community outreach activities.

Conclusions

Our findings provide insight into the relatively low acceptance rate of HCT services among TB patients from the perspective of two health care workforce groups that play an integral role in the delivery of effective health services and programs. Community health workers and program managers emphasized several patient- and delivery-level factors influencing acceptance of HCT services.

Attached resource:
  • Patient- and delivery-system factors related to acceptance of HIV counseling and testing services among tuberculosis patients in South Africa: a qualitative study with community health workers and program managers (external URL)

    Link leads to: http://www.implementationscience.com/content/6/1/27/abstract

    Summary: Abstract

    Background

    South Africa has a high tuberculosis (TB)-human immunodeficiency virus (HIV) coinfection rate of 73%, yet only 46% of tuberculosis TB patients are tested for HIV. To date, relatively little work has focused on understanding why TB patients may not accept effective services or participate in programs that are readily available in health care delivery systems. The objective of the study was to explore barriers to and facilitators of participation in HIV counseling and testing (HCT) among TB patients in the Free State Province, from the perspective of community health workers and program managers who offer services to patients on a daily basis. These two provider groups are positioned to alter the delivery of HCT services in order to improve patient participation and, ultimately, health outcomes.

    Methods

    Group discussions and semistructured interviews were conducted with 40 lay counselors, 57 directly-observed therapy (DOT) supporters and 13 TB and HIV/acquired immune deficiency syndrome (AIDS) program managers in the Free State Province between September 2007 and March 2008. Sessions were audio-recorded, transcribed, and thematically analyzed.

    Results

    The themes emerging from the focus group discussions and interviews included four main suggested barrier factors: (1) fear of HIV/AIDS, TB-HIV coinfection, death and stigma; (2) perceived lack of confidentiality of HIV test results; (3) staff shortages and high workload; and (4) poor infrastructure to encourage, monitor, and deliver HCT. The four main facilitating factors emerging from the group and individual interviews were (1) encouragement and motivation by health workers; (2) alleviation of health worker shortages; (3) improved HCT training of professional and lay health workers; and (4) community outreach activities.

    Conclusions

    Our findings provide insight into the relatively low acceptance rate of HCT services among TB patients from the perspective of two health care workforce groups that play an integral role in the delivery of effective health services and programs. Community health workers and program managers emphasized several patient- and delivery-level factors influencing acceptance of HCT services.

    Source: Implementation Science

    Publication Date: March 23, 2011

    Language: English

    Keywords: Community Health Workers, HCT, TB-HIV coinfection

 

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.