title: Patients infected by tuberculosis and human immunodeficiency virus facing their disease, their reactions to disease diagnosis and its implication about their families and communities, in Burkina Faso: a mixed focus group and cross sectional study.
abstract: BACKGROUND
  Patients facing tuberculosis (TB) and human immunodeficiency virus (HIV) infection receive particular care. Despite efforts in the care, misconceptions about TB and HIV still heavily impact patients, their families and communities. This situation severely limits achievement of TB and HIV programs goals. This study reports current situation of TB patients and patients living with HIV/AIDS (PLWHA) facing their disease and its implications, by comparing results from both qualitative and quantitative study design.
  
  
  METHODS
  Cross sectional study using mixed methods was used and excluded patients co-infected by TB and HIV. Focus group included 96 patients (6 patients per group) stratified by setting, disease profile and gender; from rural (Orodara Health District) and urban (Bobo Dioulasso) areas, all from Hauts-Bassins region in Burkina Faso. Quantitative study included 862 patients (309 TB patients and 553 PLWHA) attending TB and HIV care facilities in two main regions (Hauts-Bassins and Centre) of Burkina Faso.
  
  
  RESULTS
  A content analysis of reports found TB patients and PLWHA felt discriminated and stigmatized because of misconceptions with its aftermaths (rejection, emotional and financial problems), mainly among PLWHA and women patients. PLWHA go to healers when facing limited solutions in health system. There are fewer associations for TB patients, and less education and sensitization sessions to give them opportunity for sharing disease status and learning from other TB patients. TB patients and PLWHA still need to better understand their disease and its implication. Access to care (diagnosis and treatment) remains one of the key issues in health system, especially for PLWHA. Individual counseling is centered among PLWHA but not for TB patients. With research progress and experiences sharing, TB patients and PLWHA have some hope to implement their life project, and to receive psychosocial and nutritional support.
  
  
  CONCLUSIONS
  Despite international aid, TB patients and PLWHA are facing misconceptions effects. There is a need to reinforce health education towards patients and healers, inside community, health centers and associations, and for specific settings. International aid must be adapted to specific targets and strategies implementing programs. Maintaining psychosocial and nutritional support is crucial for better outcomes of medication adherence. Individual counseling has to be centered among TB patients and PLWHA.
authors.affiliation: Ministry of Health, Ouagadougou, Burkina Faso.|International Health Program, Institute of Public Health, Bobo Dioulasso, Burkina Faso.
authors.forename: Ziemlé Clément
authors.initials: ZC
authors.lastname: Méda
authors.affiliation: Muraz Research Center, Bobo Dioulasso, Burkina Faso.
authors.forename: Télesphore
authors.initials: T
authors.lastname: Somé
authors.affiliation: Research Office of West African Health Organization (WAHO), Bobo Dioulasso, Burkina Faso.|National Institute of Health Sciences, Polytechnic University, Bobo Dioulasso, Burkina Faso.
authors.forename: Issiaka
authors.initials: I
authors.lastname: Sombié
authors.affiliation: Association Responsabilité-Espoir-Vie-Solidarité (REVS+), Bobo Dioulasso, Burkina Faso.
authors.forename: Daouda
authors.initials: D
authors.lastname: Maré
authors.affiliation: Department of Community Health Sciences, University of California Los Angeles (UCLA), School of Public Health, Los Angeles, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Morisky
authors.affiliation: Department of Microbiology and Institute of Medical Research, Kaohsiung Medical University, Kaohsiung City, Taiwan. arthur@kmu.edu.tw.|Center for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical University, Kaohsiung City, Taiwan. arthur@kmu.edu.tw.
authors.forename: Yi-Ming Arthur
authors.initials: YM
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D002050:Burkina Faso; D060085:Coinfection; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D006678:HIV / Q000502:physiology; D015658:HIV Infections / Q000175:diagnosis / Q000523:psychology*; D006297:Health Services Accessibility / Q000941:ethics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000502:physiology; D010353:Patient Education as Topic / Q000458:organization & administration; D011287:Prejudice / Q000523:psychology; D012424:Rural Population; D012934:Social Isolation / Q000523:psychology*; D057545:Social Stigma; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000523:psychology*; D014505:Urban Population
keywords: Discrimination; Gender; Global health; HIV; Healer; Preventive medicine; Stigmatization; Tuberculosis