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 | Â |
 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 | Â |
 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 | Â |
 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 | Â |
 Being a retreatment patient | Tweya, 2014 |
 Patient in HIV care at the start of TB treatment | Tweya, 2014 |