Table 5.
Barriers and enablers of uptake of antiretroviral therapy in the context of integrated therapy for TB and HIV in SSA
| Barriers to ART uptake | |
|---|---|
| Health system-related | |
| Limited staff capacity | |
| Shortage of staff | Nansera, 2010, Chileshe, 2010; Ndagijimana, 2015 |
| Staff turnover after training | Ndagijimana, 2015 |
| Insufficient knowledge and skills on integrated treatment | Nansera, 2010 |
| Limited medical supplies e.g. drug stock-outs/insufficiency | Kumwenda, 2011; Nansera, 2010; Wajanga, 2014 |
| Lack of infrastructure for provision of integrated services | Nansera, 2010; Ndagijimana, 2015 |
| Long enrolment process | Chileshe, 2010; Wajanga, 2014 |
| Poor adherence to or lack of treatment guidelines | Nansera, 2010; Wajanga, 2014 |
| Prerequisite of a guardian during initiation | Kumwenda, 2011 |
| Insufficient staff motivation | Ndagijimana, 2015 |
| Limited HIV status disclosure patterns | Chileshe, 2010 |
| Provider failing to offer ART to patient on anti-TB | Kumwenda, 2011 |
| Delayed initiation because of high CD4 | Kumwenda, 2011 |
| Poor integration of inpatient and outpatient HIV and TB Wajanga, 2014 care which limits availability of essential services for inpatients | |
| Clinical | |
| Fear of drug toxicity | Kumwenda, 2011 |
| Contraindication to ≥ 1 antiretroviral drug(s) | Kumwenda, 2011 |
| Intolerance to anti-TB drugs | Patel, 2014 |
| Socioeconomic and individual level | |
|---|---|
| Stigma | Wajanga, 2014; Chileshe, 2010; Levin, 2006 |
| Low socioeconomic status leading to financial constraints such as lack of money for transport to treatment facility | Kumwenda, 2011; Chileshe, 2010 |
| Younger age group | Kumwenda, 2011; Pepper, 2011 |
| Male gender | Pepper, 2011 |
| Denial of HIV status | Chileshe, 2010, |
| Failure to disclose status to provider | Patel, 2014 |
| Poor social support network | Pepper, 2011 |
| Negative coping such as use of alternative therapies e.g. witchcraft and faith healing | Chileshe, 2010 |
| Fear of HIV testing | Chileshe, 2010 |
| Pill burden | Kumwenda, 2011 |
| Sero-discordant HIV-negative partner | Chileshe, 2010 |
| Enablers of ART uptake | |
|---|---|
| Health system-related | |
| Strong staff capacity | |
| Enough staff for service delivery | Nansera, 2010 |
| Continuing education of staff | Wajanga, 2014, |
| Equipping staff with adequate knowledge, skills, and mentorship | Nansera, 2010, |
| Promotion of positive multidisciplinary team approach in treatment | Wajanga, 2014, Njozing, 2011 |
| Re-enforcement of procurement, supply, and dispensation | |
| Sufficient medical supplies | Nansera, 2010; Wajanga, 2014 |
| Ease policy to allow concurrent counseling and drug administration | Wajanga, 2014 |
| Providers strongly recommend and effectively prescribe drugs | Kumwenda, 2011 |
| Partnership with treatment partners and peer counsellors | Wajanga, 2014 |
| Designate teams for drug administration on weekends/urgent circumstances | Wajanga, 2014 |
| ART for TB/HIV co-infection delivered within ART/PMTCT service | Tweya, 2014 |
| Schedule ART at 2 months less likely to experience delay | Patel, 2014 |
| Convenience and accessibility of services |
Ndagijimana, 2015; Njozing, 2011; Levin, 2006 |
| Efficiency and quality in service delivery | Ndagijimana, 2015 |
| Enrolment higher in public compared to faith-based hospitals | Njozing, 2011 |
| Community level | |
|
Availability of psychosocial support Persons living with HIV group facilitating linkage to treatment, performing home visits, providing counseling, and fighting stigma |
Chileshe, 2010; Njozing, 2011 |
| Support and motivation from family or friends | Chileshe, 2010 |
| Clinical | |
| Being a retreatment patient | Tweya, 2014 |
| Patient in HIV care at the start of TB treatment | Tweya, 2014 |