Integration of tuberculosis and HIV services: Exploring the perspectives of co-infected patients in Ghana

Anku, Prince Justin; Amo-Adjei, Joshua; Doku, David Teye; Kumi-Kyereme, Akwasi

doi:10.1080/17441692.2017.1385823

Cited by 10 publications

(16 citation statements)

References 33 publications

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“…Despite the increasing burden of disease derived from TB and NCDs in LMICs and the need for TB and NCD integrated programmes, most systematic reviews on TB service integration investigate the integration of TB- and HIV-related services or the health outcomes of TB and NCD comorbidities, their syndemic interactions, and prevalence [ 25 – 34 ]. Therefore, there remains a dearth of information regarding the mechanism of integration of TB and NCDs related services in LMICs, which this systematic review aims to address.…”

Section: Introductionmentioning

confidence: 99%

Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review

et al. 2022

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Background Low- and middle-income countries (LMICs) are facing a combined affliction from both tuberculosis (TB) and noncommunicable diseases (NCDs), which threatens population health and further strains the already stressed health systems. Integrating services for TB and NCDs is advantageous in tackling this joint burden of diseases effectively. Therefore, this systematic review explores the mechanisms for service integration for TB and NCDs and elucidates the facilitators and barriers for implementing integrated service models in LMIC settings. Methods and findings A systematic search was conducted in the Cochrane Library, MEDLINE, Embase, PubMed, Bibliography of Asian Studies, and the Global Index Medicus from database inception to November 4, 2021. For our search strategy, the terms “tuberculosis” AND “NCDs” (and their synonyms) AND (“delivery of healthcare, integrated” OR a range of other terms representing integration) were used. Articles were included if they were descriptions or evaluations of a management or organisational change strategy made within LMICs, which aim to increase integration between TB and NCD management at the service delivery level. We performed a comparative analysis of key themes from these studies and organised the themes based on integration of service delivery options for TB and NCD services. Subsequently, these themes were used to reconfigure and update an existing framework for integration of TB and HIV services by Legido-Quigley and colleagues, which categorises the levels of integration according to types of services and location where services were offered. Additionally, we developed themes on the facilitators and barriers facing integrated service delivery models and mapped them to the World Health Organization’s (WHO) health systems framework, which comprises the building blocks of service delivery, human resources, medical products, sustainable financing and social protection, information, and leadership and governance. A total of 22 articles published between 2011 and 2021 were used, out of which 13 were cross-sectional studies, 3 cohort studies, 1 case–control study, 1 prospective interventional study, and 4 were mixed methods studies. The studies were conducted in 15 LMICs in Asia, Africa, and the Americas. Our synthesised framework explicates the different levels of service integration of TB and NCD services. We categorised them into 3 levels with entry into the health system based on either TB or NCDs, with level 1 integration offering only testing services for either TB or NCDs, level 2 integration offering testing and referral services to linked care, and level 3 integration providing testing and treatment services at one location. Some facilitators of integrated service include improved accessibility to integrated services, motivated and engaged providers, and low to no cost for additional services for patients. A few barriers identified were poor public awareness of the diseases leading to poor uptake of services, lack of programmatic budget and resources, and additional stress on providers due to increased workload. The limitations include the dearth of data that explores the experiences of patients and providers and evaluates programme effectiveness. Conclusions Integration of TB and NCD services encourages the improvement of health service delivery across disease conditions and levels of care to address the combined burden of diseases in LMICs. This review not only offers recommendations for policy implementation and improvements for similar integrated programmes but also highlights the need for more high-quality TB–NCD research.

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Section: Introductionmentioning

confidence: 99%

Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review

et al. 2022

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“…She found that NPT assisted in identifying the social influences and HCP attributes that affected patient responses to the offer of NHS Health Checks [ 38 ]. Anku et al [ 39 ] similarly included patients, as well as practitioners and providers, in their study of combining tuberculosis and HIV services in Ghana. Understanding both the patient perspective and the environment at every level is critical in understanding the overall normalizing of an intervention [ 21 , 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Acceptability of a cessation intervention for pregnant smokers: a qualitative study guided by Normalization Process Theory

et al. 2020

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Background Smoking during pregnancy has serious consequences for maternal and child health. An intervention package to embed National Institute for Health and Care Excellence guidance (babyClear©) was delivered across maternity and stop smoking services (SSS) within an English region, to support pregnant women to stop smoking. We aimed to ascertain acceptability among pregnant smokers receiving the intervention. Methods Pregnant smokers who received the intervention and participated in the study were interviewed, first at around 16 weeks of pregnancy (n = 17) and again several weeks later (n = 8) or postpartum (n = 3). Interview schedules were informed by Normalization Process Theory (NPT) and Theoretical Domains Framework; interviews were audio-recorded, transcribed and analysed thematically, using the Framework method and NPT. Findings are grouped according to the four NPT concepts. Results Coherence: Carbon monoxide monitoring appeared to make sense; women were motivated to quit by being monitored. Cognitive participation: When linked to a professional discourse of caring and concern, some women were prompted to engage with the SS message. Women were more guarded in their reaction to initial contact from the SSS; reporting attending appointments successfully, or in some cases, experiencing problems that decreased engagement and made quitting harder. Collective action: Where women continued to smoke or failed to attend SSS appointments, an extra intervention was delivered, the Risk Perception Tool (RPT), which often prompted pregnant women to act. Reflexive monitoring: Most women accepted the need for a hard-hitting approach (RPT) and, while it distressed them at the time, they claimed they were subsequently grateful for it. SSS intervention post-RPT was seen as supportive, partly because it often involved home visits. Aspects of family inclusion in babyClear© were reported as beneficial. In Trusts where women experienced services as less focused on prioritising the stop smoking message, less well integrated or reported maternity staff as less adept at delivering the RPT, women found babyClear© less acceptable overall. Conclusions The babyClear© package was acceptable to pregnant smokers interviewed during and shortly after pregnancy and, in some cases, to promote quitting. However, some contexts were more optimal than others, leading to variation in acceptability overall.

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“…These challenges can, however, be addressed through service delivery in a better integrated (more complex) system [28]. There is evidence to show that full integration of TB-HIV services is considered most appropriate and acceptable among clients, especially co-infected clients [32].…”

Section: Discussionmentioning

confidence: 99%

Challenges of scaling-up of TB-HIV integrated service delivery in Ghana

et al. 2020

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Integration of tuberculosis and HIV services in many resource-limited settings, including Ghana, has been far from optimal despite the existence of policy frameworks for integration. A previous study among programme managers and other stakeholders at the national level has documented tardiness in committing to the integration of services. In this paper, we aimed at unravelling pertinent challenges that confront TB-HIV integrated service delivery. Data were obtained from interviews with 31 individual health care providers operating under different models of TB-HIV service delivery. The study is framed around the Complexity Theory. We applied inductive and deductive techniques to code the data and validations were done through inter-rater mechanisms. The analysis was done with the assistance of QSR NVivo version 12. We found evidence of a convivial working relationship between TB-HIV service providers at the facility level. However, the interactions vary across models of care-the lesser the level of integration, the lesser the complexities for interactions that ensued. This had resulted in operational challenges on account of how the two-disease environment interacts with the other components of the health system. These challenges included; weak/inappropriate infrastructure, frail coordination between the two programmes and hospital administrators, under-staffing in comprehensive TB-HIV management, use of community facility under the Directly-Observed Treatment (DOT) protocols, and financial constraints. To fully appropriate the enormous benefits of TB-HIV service integration, there is a need to address these challenges.

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Integration of tuberculosis and HIV services: Exploring the perspectives of co-infected patients in Ghana

Cited by 10 publications

References 33 publications

Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review

Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review

Acceptability of a cessation intervention for pregnant smokers: a qualitative study guided by Normalization Process Theory

Challenges of scaling-up of TB-HIV integrated service delivery in Ghana

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