title: Reasons for accepting or refusing HIV services among tuberculosis patients at a TB-HIV integration clinic in Malawi.
abstract: METHODS
  In Malawi, human immunodeficiency virus (HIV) prevalence among newly registered tuberculosis (TB) patients is 60-70%. In 2008, an integrated TBHIV clinic was established at a central hospital in Zomba. Despite the integration of TB-HIV activities and improved HIV service  uptake, unacceptably high proportions of HIV-positive TB patients are still not receiving antiretroviral therapy (ART).
  
  
  OBJECTIVE
  To identify factors that motivate or discourage TB patients from accepting HIV services.
  
  
  METHODS
  Retrospective analysis of patients registered for TB treatment  (not yet on ART) between April 2008 and March 2009; qualitative interviews of 99 patients on TB treatment.
  
  
  RESULTS
  Of 1773 newly registered TB patients who were not already on ART at the time of TB registration, 86% accepted HIV testing and counselling. Among HIV-positive TB patients,  38% started ART during or after anti-tuberculosis treatment. Young adults aged 15- 24 years were least likely to initiate ART. Motivation for accepting ART during TB treatment included prospects of regaining good health and longer life, and counselling by health care providers. Barriers  to ART uptake included not being offered ART, high CD4 count, drug stockouts and fear of drug toxicities/interactions.
  
  
  CONCLUSIONS
  Several factors that undermine uptake of ART have been highlighted; targeted measures urgently need to be addressed by TB-HIV programmes to overcome these  barriers.
authors: Dignitas International, Zomba, Malawi.
authors: M
authors: M
authors: Kumwenda
authors: S
authors: S
authors: Tom
authors: A K
authors: AK
authors: Chan
authors: E
authors: E
authors: Mwinjiwa
authors: S
authors: S
authors: Sodhi
authors: M
authors: M
authors: Joshua
authors: M
authors: M
authors: van Lettow
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003376:Counseling / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D015995:Prevalence; D012189:Retrospective Studies; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents