title: Healthcare worker perceived barriers to early initiation of antiretroviral and tuberculosis therapy among Tanzanian inpatients.
abstract: METHODS
  Clinical trials have shown that early initiation of antiretroviral therapy in HIV-infected patients with tuberculosis saves lives, but models for implementation of this new strategy have been under-studied in real-world settings.
  
  
  OBJECTIVE
  To identify the barriers and possible solutions for implementing concurrent early treatment with antiretroviral and anti-tuberculosis therapy in a large East African referral hospital where the prevalence of both infections is high.
  
  
  METHODS
  In-depth interviews among hospital administrators, laboratory technicians, nurses, pharmacists, and physicians.
  
  
  RESULTS
  Twenty-six hospital staff identified six key barriers and corresponding solutions to promote rapid initiation of antiretroviral therapy in HIV-infected inpatients with tuberculosis. These include revising systems of medication delivery, integrating care between inpatient and outpatient systems, training hospital nurses to counsel and initiate medications in inpatients, and cultivating a team approach to consistent guideline implementation.
  
  
  CONCLUSIONS
  Most barriers identified by hospital staff were easily surmountable with reorganization, training, and policy changes at minimal cost. Efforts to reduce mortality for HIV and tuberculosis co-infected patients in accordance with new World Health Organization guidelines are currently hampered by implementation barriers in real-world settings. Our findings suggest that these can be overcome with strategic enactment of simple, realistic interventions to promote early dual treatment for HIV/tuberculosis co-infected patients.
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania ; Department of Internal Medicine, Catholic University of Health and Allied Sciences - Bugando, Mwanza, Tanzania.
authors.forename: Bahati M K
authors.initials: BM
authors.lastname: Wajanga
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania ; Department of Internal Medicine, Catholic University of Health and Allied Sciences - Bugando, Mwanza, Tanzania ; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Peck
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania ; Department of Internal Medicine, Catholic University of Health and Allied Sciences - Bugando, Mwanza, Tanzania.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kalluvya
authors.affiliation: Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Fitzgerald
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania ; Department of Internal Medicine, Catholic University of Health and Allied Sciences - Bugando, Mwanza, Tanzania ; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Smart
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania ; Department of Internal Medicine, Catholic University of Health and Allied Sciences - Bugando, Mwanza, Tanzania ; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Downs
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003376:Counseling; D019983:Guideline Adherence; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006284:Health Plan Implementation; D006801:Humans; D007297:Inpatients; D010045:Outpatients; D017410:Practice Guidelines as Topic; D013636:Tanzania; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy*
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents