Healthcare worker perceived barriers to early initiation of antiretroviral and tuberculosis therapy among Tanzanian inpatients. Academic Article uri icon

Overview

abstract

  • SETTING: Clinical trials have shown that early initiation of antiretroviral therapy in HIV-infected patients with tuberculosis saves lives, but models for implementation of this new strategy have been under-studied in real-world settings. OBJECTIVE: To identify the barriers and possible solutions for implementing concurrent early treatment with antiretroviral and anti-tuberculosis therapy in a large East African referral hospital where the prevalence of both infections is high. DESIGN: In-depth interviews among hospital administrators, laboratory technicians, nurses, pharmacists, and physicians. RESULTS: Twenty-six hospital staff identified six key barriers and corresponding solutions to promote rapid initiation of antiretroviral therapy in HIV-infected inpatients with tuberculosis. These include revising systems of medication delivery, integrating care between inpatient and outpatient systems, training hospital nurses to counsel and initiate medications in inpatients, and cultivating a team approach to consistent guideline implementation. CONCLUSION: Most barriers identified by hospital staff were easily surmountable with reorganization, training, and policy changes at minimal cost. Efforts to reduce mortality for HIV and tuberculosis co-infected patients in accordance with new World Health Organization guidelines are currently hampered by implementation barriers in real-world settings. Our findings suggest that these can be overcome with strategic enactment of simple, realistic interventions to promote early dual treatment for HIV/tuberculosis co-infected patients.

publication date

  • February 14, 2014

Research

keywords

  • Anti-HIV Agents
  • Antitubercular Agents
  • Attitude of Health Personnel
  • HIV Infections
  • Tuberculosis

Identity

PubMed Central ID

  • PMC3925080

Scopus Document Identifier

  • 84895797383

Digital Object Identifier (DOI)

  • 10.1371/journal.pone.0087584

PubMed ID

  • 24551061

Additional Document Info

volume

  • 9

issue

  • 2