The politics of tuberculosis and HIV service integration in Ghana

Amo-Adjei, Joshua; Kumi-Kyereme, Akwasi; Amo, Hannah Fosuah; Awusabo–Asare, Kofi

doi:10.1016/j.socscimed.2014.07.008

Cited by 8 publications

(4 citation statements)

References 42 publications

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“…However, TB and HIV service integration in Ghana is far from optimum, even though some progress has been made in recent years. A previous study among programme managers for both TB and HIV revealed some level of reluctance to commit to the integration of services due to various reasons, including the potential for leadership crises and increased workload [12]. In some sub-Saharan Africa countries where there is evidence of inadequate infection control protocol, there is a reluctance to commit to TB-HIV integration due to concerns about nosocomial infection [37,35].…”

Section: Discussionmentioning

confidence: 99%

“…In many resource-limited settings like Ghana, achieving widespread integration of TB-HIV care is still unsatisfactory [12], regardless of a documented intent towards full integration [13]. While this is not the first empirical discourse on TB-HIV integration in the country, this, to the best of our knowledge, marks the first attempt to investigate operational challenges of TB-HIV integration from the perspectives of service providers at the facility level.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…In Ghana, the treatment of TB is sponsored by the National Tuberculosis Program, and no medication costs are imposed on the patients [23]. This implies that the TB patients in this country have access to TB treatment regardless of their income status.…”

Section: Treatment Costsmentioning

confidence: 99%

Influential Factors in the Treatment Outcomes of Tuberculosis in Directly Observed Therapy at the La General Hospital in the Greater Accra Region, Ghana

Tagoe

Agbadi

Adomah-Afari

2018

J. Hum. Environ. Health Promot.

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However, the epidemic remains a global health threat considering the increasing comorbidity and multidrug resistance of TB. The WHO has reported that approximately 1.8 million deaths result from TB, while about 10.4 million new cases of the disease occurred worldwide in 2015, affecting 56% of men and 10% of children. China, Indonesia, Nigeria, India, Pakistan, and South Africa constitute 60% of 10.4 million new cases of TB [1]. Globally, the disease incidence was reported to decline by 1.5% from 2014 to 2015 [4].

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“…In most settings, HIV and TB programmes remain vertical programmes with separate organizational structures, separate policies and guidelines, separate budgeting, and separate monitoring and evaluation systems. There are often historical and cultural differences between TB and HIV programmes that provide challenges to integration [ 53 ▪ , 54 ]. In many countries, HIV and TB programmes are also dependent on funding from international donors and may be somewhat restricted in how services can be developed.…”

Section: Models Of Tuberculosis and Hiv Service Integrationmentioning

confidence: 99%

HIV treatment cascade in tuberculosis patients

Lessells

Swaminathan²,

Godfrey‐Faussett

2015

Current Opinion in HIV and AIDS

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Purpose of reviewGlobally, the number of deaths associated with tuberculosis (TB) and HIV coinfection remains unacceptably high. We review the evidence around the impact of strengthening the HIV treatment cascade in TB patients and explore recent findings about how best to deliver integrated TB/HIV services.Recent findingsThere is clear evidence that the timely provision of antiretroviral therapy (ART) reduces mortality in TB/HIV coinfected adults. Despite this, globally in 2013, only around a third of known HIV-positive TB cases were treated with ART. Although there is some recent evidence exploring the barriers to achieve high coverage of HIV testing and ART initiation in TB patients, our understanding of which factors are most important and how best to address these within different health systems remains incomplete. There are some examples of good practice in the delivery of integrated TB/HIV services to improve the HIV treatment cascade. However, evidence of the impact of such strategies is of relatively low quality for informing integrated TB/HIV programming more broadly. In most settings, there remain barriers to higher-level organizational and functional integration.SummaryThere remains a need for commitment to patient-centred integrated TB/HIV care in countries affected by the dual epidemic. There is a need for better quality evidence around how best to deliver integrated services to strengthen the HIV treatment cascade in TB patients, both at primary healthcare level and within community settings.

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The politics of tuberculosis and HIV service integration in Ghana

Cited by 8 publications

References 42 publications

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

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

Influential Factors in the Treatment Outcomes of Tuberculosis in Directly Observed Therapy at the La General Hospital in the Greater Accra Region, Ghana

HIV treatment cascade in tuberculosis patients

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