SETTING:
Namibia
faces a high burden of tuberculosis (TB) and HIV-infection. In 2011, 50% of the
TB patients were co-infected with HIV. While all patients co-infected with TB
and HIV are eligible for antiretroviral treatment (ART), only 54% were reported
to have received ART according to national data.
OBJECTIVE:
To
explore the perspective of healthcare professionals on barriers to access to
ART for HIV-positive TB patients.
DESIGN:
Nine
semi-structured qualitative interviews were conducted with healthcare
professionals from TB and HIV services in Windhoek in 2012 to investigate access
barriers to ART for HIV-positive TB patients in Namibia.
RESULTS:
Many
barriers known from other African countries were also present in Namibia. The
barriers rated as most important were: staff shortage (health system level);
limited training (healthcare worker level); and fear of stigma and
discrimination (patient/community level). Direct treatment costs and limited
availability of antiretroviral medication were not observed as barriers.
Interference with TB treatment and ART by some Pentecostal churches was
revealed as an important barrier that has not yet received sufficient attention.
CONCLUSION:
The
study identified access barriers to ART for HIV-positive TB patients and their
relevance in Namibia. The findings provide evidence for tailored interventions
to increase ART-uptake among HIV-positive TB patients.
Below: Rating of barriers at the health system level
Below: Rating of barriers at the healthcare worker level
Below: Rating of barriers at the patient and community level
- 1Charité-Universitätsmedizin Berlin, Berlin School of Public Health, Seestr. 73, 13347 Berlin, Germany. Electronic address: s.seeling@yahoo.com.
- 2Ministry of Health and Social Services, Ministerial Bldg, Harvey Street, P/Bag: 13198, Windhoek, Namibia. Electronic address: mavhunga@hotmail.com.
- 3Ministry of Health and Social Services, Ministerial Bldg, Harvey Street, P/Bag: 13198, Windhoek, Namibia. Electronic address: thomasa@nacop.net.
- 4Charité-Universitätsmedizin Berlin, Berlin School of Public Health, Seestr. 73, 13347 Berlin, Germany. Electronic address: nina.adelberger@charite.de.
- 5Koch-Metchnikov-Forum, Langenbeck-Virchow-Haus, Luisenstr. 58/59, 10117 Berlin, Germany; Akkon College of Human Sciences, Am Köllnischen Park 1, 10179 Berlin, Germany. Electronic address: timo.ulrichs@akkon-hochschule.de.
