Patient- and delivery-level factors related to acceptance of HIV counseling and testing services among tuberculosis patients in South Africa: A qualitative study with community health workers and program managers

J. Christo Heunis, Edwin Wouters, Wynne E. Norton, Michelle C. Engelbrecht, N. Gladys Kigozi, Anjali Sharma, Camille Ragin

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: South Africa has a high tuberculosis (TB)-human immunodeficiency virus (HIV) coinfection rate of 73%, yet only 46% of TB patients are tested for HIV. To date, relatively little work has focused on understanding why TB patients may not accept effective services or participate in programs that are readily available in healthcare delivery systems. The objective of the study was to explore barriers to and facilitators of participation in HIV counseling and testing (HCT) among TB patients in the Free State Province, from the perspective of community health workers and program managers who offer services to patients on a daily basis. These two provider groups are positioned to alter the delivery of HCT services in order to improve patient participation and, ultimately, health outcomes.Methods: Group discussions and semistructured interviews were conducted with 40 lay counselors, 57 directly observed therapy (DOT) supporters, and 13 TB and HIV/acquired immune deficiency syndrome (AIDS) program managers in the Free State Province between September 2007 and March 2008. Sessions were audio-recorded, transcribed, and thematically analyzed.Results: The themes emerging from the focus group discussions and interviews included four main suggested barrier factors: (1) fears of HIV/AIDS, TB-HIV coinfection, death, and stigma; (2) perceived lack of confidentiality of HIV test results; (3) staff shortages and high workload; and (4) poor infrastructure to encourage, monitor, and deliver HCT. The four main facilitating factors emerging from the group and individual interviews were (1) encouragement and motivation by health workers, (2) alleviation of health worker shortages, (3) improved HCT training of professional and lay health workers, and (4) community outreach activities.Conclusions: Our findings provide insight into the relatively low acceptance rate of HCT services among TB patients from the perspective of two healthcare workforce groups that play an integral role in the delivery of effective health services and programs. Community health workers and program managers emphasized several patient- and delivery-level factors influencing acceptance of HCT services.

Original languageEnglish (US)
Article number27
JournalImplementation Science
Volume6
Issue number1
DOIs
StatePublished - Mar 23 2011
Externally publishedYes

Fingerprint

South Africa
Counseling
Tuberculosis
HIV
Health
Interviews
Delivery of Health Care
Coinfection
Directly Observed Therapy
Community-Institutional Relations
Patient Participation
Confidentiality
Workload
Focus Groups
Health Services
Fear
Motivation
Acquired Immunodeficiency Syndrome

ASJC Scopus subject areas

  • Health Policy
  • Medicine(all)
  • Public Health, Environmental and Occupational Health
  • Health Informatics

Cite this

Patient- and delivery-level factors related to acceptance of HIV counseling and testing services among tuberculosis patients in South Africa : A qualitative study with community health workers and program managers. / Heunis, J. Christo; Wouters, Edwin; Norton, Wynne E.; Engelbrecht, Michelle C.; Kigozi, N. Gladys; Sharma, Anjali; Ragin, Camille.

In: Implementation Science, Vol. 6, No. 1, 27, 23.03.2011.

Research output: Contribution to journalArticle

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