Health system barriers affecting the implementation of collaborative TB-HIV services in Uganda.

SETTING

Despite Uganda's efforts to improve tuberculosis and human immunodeficiency virus (TB-HIV) collaborative services, implementation remains low and operational barriers have not been systematically identified and documented.

OBJECTIVE

To assess barriers to implementation of TB-HIV collaborative services in five districts in Uganda.

DESIGN

In this qualitative study, focus groups and key informant and in-depth interviews were conducted for patients (HIV, TB), health providers and community members. TB registers were also assessed for data on use of TB-HIV collaborative services.

RESULTS

Of 333 adult TB patients registered between July and September 2006, 185 (56%) were tested for HIV, of whom 134 were HIV-co-infected. Of these, 52% were on cotrimoxazole preventive therapy (CPT), 12% were on antiretroviral therapy (ART) and CPT, while 36% had not received any HIV service. Health system barriers identified included poor TB-HIV planning, coordination and leadership, inadequate dissemination of policy, inadequate provider knowledge, limited TB-HIV interclinic referral, poor service integration and recording, logistical shortages, high costs of services and provider shortages amidst high patient loads.

CONCLUSION

Implementation and utilisation of collaborative TB-HIV services remains suboptimal. The barriers identified highlight the need for TB and HIV programmes to support districts to plan, coordinate and invest resources in TB-HIV collaborative services, especially in policy dissemination, training health providers, integration of TB-HIV services, logistical management and monitoring.