Table 1. Key Barriers and Solutions to Implementing Prompt and Concurrent HAART and Anti- Tuberculosis Therapy Identified by Bugando Medical Centre Staff Members in Mwanza, Tanzania.

Barriers	Solutions
Physical unavailability of medications for inpatients – ART and anti-TB medications are considered outpatient drugs and are kept in separate outpatient pharmacy	•Make ART and anti-TB medications available in inpatient pharmacy
	•Place emergency supply of medications “like PEP” (post-exposure prophylaxis) in wards
Poor integration between inpatient and outpatient HIV and TB careleading to unavailability of some essential services for inpatients	•Train inpatient nurses to perform traditionally outpatient jobs (medication counseling, ART training sessions, medication distribution)
Requirement for three counseling sessions to be completedprior to initiation of ART	•Train inpatient nurses to perform counseling
	•Ease policy to allow concurrent counseling with medication administration
Shortage of staff during weekends and holidays	•Create responsible on-call team (“like PEP”) for TB and ART medication administration
	•Train inpatient nurses
Lack of awareness and/or acceptance of new guidelines forearly ART initiation	•Continuing education for inpatient nurses, pharmacists, physicians, and other healthcare providers
Patients’ fear of stigma may lead those with TB not todisclose their HIV status	•Cultivation of positive multidisciplinary team approach to patient care
	•Partnership with treatment partners and peer counselors

Key: ART: antiretroviral therapy. HAART: highly active anti-retroviral therapy. PEP: post-exposure prophylaxis. TB: tuberculosis.