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Table 5 Barriers and enablers of uptake of antiretroviral therapy in the context of integrated therapy for TB and HIV in SSA

From: Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis

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