Management of Tuberculosis and HIV in selected health facilities in Ghana

Abstract

Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are the two leading causes of death from infectious diseases globally. The World Health Organization has recommended integration of TB-HIV services in the management of the syndemic. However, scaling up of integrated TB-HIV services remain sub-optimal in Ghana, despite a nationally accepted collaborative policy. This study, therefore explored issues surrounding TB HIV services integration towards effective management of the syndemic. The study drew evidence from 31 service providers and 30 co-infected patients from 12 health facilities across four regions of Ghana. Using Normalization Process Theory as a framework, qualitative analysis was done with the assistance of NVivo 10. The findings of the study revealed a unanimous endorsement of a full integration model of service delivery. Service providers suggested intensified case finding, health education, and the use of mobile phone technology as additional strategies for TB-HIV management. The study also identified lack of commitment from programme managers, inadequate infrastructure, inadequate staff, Directly Observed Treatment (DOT) strategy, and funding constraints as key barriers to integration of services. Experiences of co-infected patients with regard to treatment access include inconsistencies in therapy administration, separate clinic appointment dates for TB and HIV, late diagnosis and prolonged TB treatment due to drug resistance. The conclusion drawn is that, co-infected patients and health care providers at the point of care are open to integration, but this will require commitment from all stakeholders, especially programme leaders at the national level so as to derive the full benefits associated with service integration.