What Are the Barriers for Uptake of Antiretroviral Therapy in HIV-Infected Tuberculosis Patients? A Mixed-Methods Study from Ayeyawady Region, Myanmar
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Setting
2.3. Study Population, Sampling and Sample Size
2.4. Data Variables, Data Sources and Data Collection Procedure
2.5. Data Analysis
2.6. Ethics and Consent
3. Results
3.1. Quantitative
3.2. Qualitative
“Some patients came in severely ill stage... very ill... terminal stage... after anti-TB treatment, we could not even start ART, many cases expired”(Specialist).
“Mainly the patients who were migrants... they came to work as salt workers, fisher men. They went back to their places before getting ART”(TB coordinator).
“… they (HIV unit) asked me to come back... but...(sadly) I was unable to afford transportation charges in the third time… so... I could not go to them regularly… but I ate some hearsay leaves to cure my disease”(Patient).
“It is the worst in the raining season, boats were prohibited for transportation, patients failed to come back to health facilities in time”(Specialist).
“Because of the boats schedule (12:00 noon)… if patients were asked to visit ART clinics, they did not want to go as they had to catch the boats to be able to go back their homes... to stay overnight here, they did not have money”(TB coordinator).
“We referred the patients to HIV unit next to our clinics for further ART management, but, patients were shy to sit and wait at HIV unit… and they went back without visiting”(TB team leader).
“Patients from remote areas with difficult transportation, they took treatment at their villages with quacks, they did not know TB or HIV, only when they were severely ill... they reached to hospitals”(Specialist).
“At the first time, I reached to the wrong health facility… as I have not visited this town before… It was very difficult for me to find the place”(Patient).
“I would say straight. I did not believe in hospitals… that’s why I did not come back for next visit”(Patient).
“Although we (doctors) counseled the patients the need of ART, patients refused… they would like to finish anti-TB first for six months, then would continue ART… as they were afraid”(TB team leader).
“I did not know who was the focal person from HIV unit, I heard that THN (Township health nurse) was the focal person, but there were frequent turnover of nurses... I did not know who were responsible for recording and reporting for HIV patients, so difficult to receive feedback”(TB coordinator).
“They (HIV unit) received patients for ART at the second WEDNESDAY and last WEDNESDAY, two times a month. When we referred our patients for ART, and it was not ART provision day, patients were given the scheduled appointment, but, patients couldn’t come back because of their difficulties”(TB coordinator).
“They (TB and HIV focal persons) met only once in three months to track the HIV and ART status of TB HIV”(District Medical Officer).
“As (TB and HIV units) were close, we did not use cross-referral forms when transferring TB-HIV patients. We just made verbal communication”(TB coordinator).
“Some patients would like to take ART, but CD4 count was below 50, so, to avoid IRIS we waited for some time to initiate ART”(Specialist).
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | N | (%) |
---|---|---|
Total | 627 | (100) |
Age | ||
0–14 years | 53 | (8.5) |
15–34 years | 218 | (34.8) |
35–54 years | 302 | (48.2) |
≥55 years | 54 | (8.6) |
Sex | ||
Male | 415 | (66.2) |
Female | 212 | (33.8) |
Referred Person * | ||
Health Staff | 526 | (83.9) |
Private Practitioner | 46 | (7.3) |
Self-referral | 53 | (8.5) |
Other | 2 | (0.3) |
Type of TB | ||
New | 573 | (91.4) |
Previously treated | 54 | (8.6) |
Site of TB | ||
Pulmonary | 594 | (94.7) |
Extra pulmonary | 33 | (5.3) |
CD4 Count (cells/µL) | ||
<50 | 54 | (8.6) |
50–199 | 100 | (15.9) |
200–349 | 38 | (6.1) |
350–499 | 16 | (2.6) |
≥500 | 14 | (2.2) |
Missing | 405 | (64.6) |
Variables | Total | Non-Initiation of ART | uRR (95% CI) | aRR (95% CI) | |
---|---|---|---|---|---|
N | (%) | ||||
Total | 541 | 181 | (33.5) | ||
Age | |||||
0–14 years | 46 | 19 | (41.3) | 1.35 (0.92–1.99) | 1.07 (0.86–1.33) |
15–34 years | 182 | 63 | (34.6) | 1.13 (0.86–1.48) | 1.09 (0.92–1.28) |
35–54 years | 265 | 81 | (30.6) | Ref | Ref |
≥55 years | 48 | 18 | (37.5) | 1.23 (0.82–1.85) | 1.08 (0.91–1.27) |
Sex | |||||
Male | 365 | 110 | (30.1) | Ref | Ref |
Female | 176 | 71 | (40.3) | 1.34 (1.06–1.70) | 1.36 (1.13–1.64) |
Referred Person * | |||||
Health Staff | 456 | 147 | (32.2) | Ref | Ref |
Private Practitioner | 33 | 9 | (27.3) | 0.85 (0.48–1.50) | 1.01 (0.58–1.78) |
Self-referral | 50 | 24 | (48.0) | 1.49 (1.08–2.05) | 2.00 (1.68–2.39) |
Other | 2 | 1 | (50.0) | 1.55 (0.39–6.24) | 1.35 (0.22–8.19) |
Type of TB | |||||
New | 503 | 168 | (33.4) | Ref | Ref |
Previously treated | 38 | 13 | (34.2) | 1.02 (0.65–1.62) | 0.99 (0.99–0.99) |
Site of TB | |||||
Pulmonary | 514 | 171 | (33.3) | Ref | Ref |
Extra pulmonary | 27 | 10 | (37.0) | 1.11 (0.67–1.85) | 1.14 (0.74–1.76) |
CD4 count (cells/µL) | |||||
<200 | 134 | 24 | (17.9) | Ref | Ref |
≥200 | 59 | 10 | (16.9) | 0.95 (0.48–1.85) | 0.89 (0.45–1.77) |
Missing | 348 | 147 | (42.2) | 2.36 (1.61–3.46) | 2.54 (1.73–3.72) |
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Aung, N.H.H.L.; Soe, K.T.; Kumar, A.M.V.; Saw, S.; Aung, S.T. What Are the Barriers for Uptake of Antiretroviral Therapy in HIV-Infected Tuberculosis Patients? A Mixed-Methods Study from Ayeyawady Region, Myanmar. Trop. Med. Infect. Dis. 2020, 5, 41. https://doi.org/10.3390/tropicalmed5010041
Aung NHHL, Soe KT, Kumar AMV, Saw S, Aung ST. What Are the Barriers for Uptake of Antiretroviral Therapy in HIV-Infected Tuberculosis Patients? A Mixed-Methods Study from Ayeyawady Region, Myanmar. Tropical Medicine and Infectious Disease. 2020; 5(1):41. https://doi.org/10.3390/tropicalmed5010041
Chicago/Turabian StyleAung, Naychi Htet Htet Lin, Kyaw Thu Soe, Ajay M.V. Kumar, Saw Saw, and Si Thu Aung. 2020. "What Are the Barriers for Uptake of Antiretroviral Therapy in HIV-Infected Tuberculosis Patients? A Mixed-Methods Study from Ayeyawady Region, Myanmar" Tropical Medicine and Infectious Disease 5, no. 1: 41. https://doi.org/10.3390/tropicalmed5010041
APA StyleAung, N. H. H. L., Soe, K. T., Kumar, A. M. V., Saw, S., & Aung, S. T. (2020). What Are the Barriers for Uptake of Antiretroviral Therapy in HIV-Infected Tuberculosis Patients? A Mixed-Methods Study from Ayeyawady Region, Myanmar. Tropical Medicine and Infectious Disease, 5(1), 41. https://doi.org/10.3390/tropicalmed5010041