Facilitating factors and barriers to the uptake of HIV counselling and testing among tuberculosis patients in the Free State Province
Kingozi, Nanteza Gladys
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Counselling and testing is an integral part of the prevention, care and treatment of the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). For tuberculosis (TB) patients, HIV counselling and testing (HCT) is a point of entry to services that include access to information about primary prevention of HIV amongst HIV-negative TB patients, and further to cotrimoxazole prophylaxis treatment (CPT), antiretroviral treatment (ART) and welfare support for those testing HIV positive. Despite the high TB-HIV/AIDS co-infection rate in South Africa, few TB patients know their HIV status. It is also disconcerting that although HCT services are readily available and moreover free of charge at primary health care (PHC) facilities in many parts of the country, few TB patients make use of them. This study has attempted to address this gap by investigating not only the facilitating factors but also the barriers to uptake of HCT amongst TB patients in the Free State Province. This study formed part of a larger “fact-finding” project aimed at designing, implementing and evaluating an intervention to improve uptake of HCT by TB patients in the Free State. The research was exploratory and cross-sectional, and was conducted in the Thabo Mofutsanyana and Lejweleputswa Districts, which were randomly selected from a total of five in the province. In each of the districts, two sub-districts ‒ one predominantly a city/large town and the other mostly a rural/small town area ‒ were purposively selected. The Maluti-a-Phofung (city/large town) and Nketoana (rural/small town) sub-districts were selected from Thabo Mofutsanyana, while Matjhabeng (city/large town) and Masilonyana (rural/small town) were chosen from Lejweleputswa. Data were gathered during February and March 2008. A structured interview schedule was administered in face-to-face interviews among a convenience sample of 600 TB patients. The patients were selected in proportion to the average number of registered TB patients at each of the 61 PHC facilities included in the study. Data analysis employed quantitative and qualitative approaches, including measures of central tendency (e.g. mean), measures of dispersion (e.g. range), tests of association (e.g. chi-square tests, t-tests, logistic regression analysis), as well as content analysis of open-ended questions. Overall, results indicate that both patient-/individual- and health system-level factors interact in facilitating or impeding TB patients’ uptake of HCT. More specific findings are presented in the form of five journal articles, in accordance with the regulations of the University of the Free State. From this study, it would seem that no single solution is able to resolve the problem of non-uptake of HCT amongst TB patients in the Free State. Instead, a multifaceted intervention is called for, one that will both promote/facilitate increased uptake and also overcome barriers at the patient-/individual and health systems levels.