Barriers to access to antiretroviral treatment for HIV-positive tuberculosis patients in Windhoek, Namibia

Stefanie Seeling; Farai Mavhunga; Albertina Thomas; Bettina Adelberger; Timo Ulrichs

doi:10.1016/j.ijmyco.2014.07.009

Barriers to access to antiretroviral treatment for HIV-positive tuberculosis patients in Windhoek, Namibia

Int J Mycobacteriol. 2014 Dec;3(4):268-75. doi: 10.1016/j.ijmyco.2014.07.009. Epub 2014 Sep 4.

Authors

Stefanie Seeling¹, Farai Mavhunga², Albertina Thomas³, Bettina Adelberger⁴, Timo Ulrichs⁵

Affiliations

¹ Charité-Universitätsmedizin Berlin, Berlin School of Public Health, Seestr. 73, 13347 Berlin, Germany. Electronic address: s.seeling@yahoo.com.
² Ministry of Health and Social Services, Ministerial Bldg, Harvey Street, P/Bag: 13198, Windhoek, Namibia. Electronic address: mavhunga@hotmail.com.
³ Ministry of Health and Social Services, Ministerial Bldg, Harvey Street, P/Bag: 13198, Windhoek, Namibia. Electronic address: thomasa@nacop.net.
⁴ Charité-Universitätsmedizin Berlin, Berlin School of Public Health, Seestr. 73, 13347 Berlin, Germany. Electronic address: nina.adelberger@charite.de.
⁵ Koch-Metchnikov-Forum, Langenbeck-Virchow-Haus, Luisenstr. 58/59, 10117 Berlin, Germany; Akkon College of Human Sciences, Am Köllnischen Park 1, 10179 Berlin, Germany. Electronic address: timo.ulrichs@akkon-hochschule.de.

PMID: 26786626
DOI: 10.1016/j.ijmyco.2014.07.009

Abstract

Setting: Namibia faces a high burden of tuberculosis (TB) and HIV-infection. In 2011, 50% of the TB patients were co-infected with HIV. While all patients co-infected with TB and HIV are eligible for antiretroviral treatment (ART), only 54% were reported to have received ART according to national data.

Objective: To explore the perspective of healthcare professionals on barriers to access to ART for HIV-positive TB patients.

Design: Nine semi-structured qualitative interviews were conducted with healthcare professionals from TB and HIV services in Windhoek in 2012 to investigate access barriers to ART for HIV-positive TB patients in Namibia.

Results: Many barriers known from other African countries were also present in Namibia. The barriers rated as most important were: staff shortage (health system level); limited training (healthcare worker level); and fear of stigma and discrimination (patient/community level). Direct treatment costs and limited availability of antiretroviral medication were not observed as barriers. Interference with TB treatment and ART by some Pentecostal churches was revealed as an important barrier that has not yet received sufficient attention.

Conclusion: The study identified access barriers to ART for HIV-positive TB patients and their relevance in Namibia. The findings provide evidence for tailored interventions to increase ART-uptake among HIV-positive TB patients.

Keywords: Pentecostal religion; Qualitative research; Sub-Saharan Africa; TB/HIV co-infection; TB/HIV collaborative activities.