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


METHODS
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.


CONCLUSIONS
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.
Okot-Chono
R
R
International Union Against Tuberculosis and Lung Disease, Paris, France. rokotchono@theunion.org
Mugisha
F
F
Adatu
F
F
Madraa
E
E
Dlodlo
R
R
Fujiwara
P
P
D000328:Adult; D003153:Community Health Services / Q000458:organization & administration*; D017144:Focus Groups; D006801:Humans; D014376:Tuberculosis / Q000628:therapy*; D014454:Uganda