MANAGEMENT OF TUBERCULOSIS AND HIV IN SELECTED HEALTH FACILITIES IN GHANA

ABSTRACT 

Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are the two  leading  causes  of  death  from  infectious  diseases  globally.  The  World Health Organization has recommended integration of TB-HIV services in the management  of  the  syndemic.  However,  scaling  up  of  integrated  TB-HIV services  remain  sub-optimal  in  Ghana,  despite  a  nationally  accepted collaborative  policy.  This  study,  therefore  explored  issues  surrounding  TBHIV services integration towards effective management of the syndemic. The study  drew  evidence  from  31  service  providers  and  30  co-infected  patients from  12  health  facilities  across  four  regions  of  Ghana.  Using  Normalization Process  Theory  as  a  framework,  qualitative  analysis  was  done  with  the assistance  of  NVivo  10.  The  findings  of  the  study  revealed  a  unanimous endorsement of a full integration model of service delivery. Service providers suggested  intensified  case  finding,  health  education,  and  the  use  of  mobile phone technology as additional strategies for TB-HIV management. The study also  identified  lack  of  commitment  from  programme  managers,  inadequate infrastructure, inadequate staff, Directly Observed Treatment (DOT) strategy, and funding constraints as key barriers to integration of services. Experiences of co-infected patients with regard to treatment access include inconsistencies in therapy administration, separate clinic appointment dates for TB and HIV, late  diagnosis  and  prolonged  TB  treatment  due  to  drug  resistance.  The conclusion drawn is that, co-infected patients and health care providers at the point of care are open to integration, but this will require commitment from all stakeholders, especially programme leaders at the national level so as toderive the full benefits associated with service integration