title: Barriers to access to antiretroviral treatment for HIV-positive tuberculosis patients in Windhoek, Namibia.
abstract: METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Charité-Universitätsmedizin Berlin, Berlin School of Public Health, Seestr. 73, 13347 Berlin, Germany. Electronic address: s.seeling@yahoo.com.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Seeling
authors.affiliation: Ministry of Health and Social Services, Ministerial Bldg, Harvey Street, P/Bag: 13198, Windhoek, Namibia. Electronic address: mavhunga@hotmail.com.
authors.forename: Farai
authors.initials: F
authors.lastname: Mavhunga
authors.affiliation: Ministry of Health and Social Services, Ministerial Bldg, Harvey Street, P/Bag: 13198, Windhoek, Namibia. Electronic address: thomasa@nacop.net.
authors.forename: Albertina
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Charité-Universitätsmedizin Berlin, Berlin School of Public Health, Seestr. 73, 13347 Berlin, Germany. Electronic address: nina.adelberger@charite.de.
authors.forename: Bettina
authors.initials: B
authors.lastname: Adelberger
authors.affiliation: 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.
authors.forename: Timo
authors.initials: T
authors.lastname: Ulrichs
keywords: Pentecostal religion; Qualitative research; Sub-Saharan Africa; TB/HIV co-infection; TB/HIV collaborative activities