title: Integrating patients' perspectives into integrated tuberculosis-human immunodeficiency virus health care.
abstract: BACKGROUND
  Escalating rates of tuberculosis-human immunodeficiency virus (TB-HIV) co-infection call for improved coordination of TB and HIV health care services in high-burden countries such as South Africa. Patient perspectives, however, are poorly understood in the context of current integration efforts.
  
  
  METHODS
  Under a qualitative research framework, we interviewed 40 HIV-positive adult TB patients and eight key-informant health care workers across three clinics in KwaZulu-Natal Province to explore non-clinical and non-operational aspects of TB-HIV health care.
  
  
  RESULTS
  Qualitative analysis highlighted critical social and ethical considerations for the concurrent delivery of TB and HIV care. Co-infected patients navigating between TB and HIV programs are exposed to missed opportunities for TB and HIV service integration, fragmented or vertical care for their dual infections and contrasting experiences within TB and HIV clinics. These intersecting issues appear to affect patients' health-related decisions, particularly nondisclosure of HIV status to non-HIV health care workers and their preferences for integrated health care.
  
  
  CONCLUSIONS
  Our study highlights the imperative to address service fragmentation, HIV medical confidentiality and provider mistrust within the health care system, and the cultural differences associated with TB and HIV disease control.
authors: ICAP, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. ad2254@columbia.edu
authors: A
authors: A
authors: Daftary
authors: N
authors: N
authors: Padayatchi
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D060085:Coinfection; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D057240:Patient Preference; D010361:Patients / Q000523:psychology*; D010465:Perception; D011369:Professional-Patient Relations; D011446:Prospective Studies; D036301:Qualitative Research; D013019:South Africa / Q000453:epidemiology; D035502:Trust; D014342:Truth Disclosure; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult