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.
