Acceptability of Haart by HIV-Positive Tuberculosis Patients in Livingstone District
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The convergence of TB and HIV epidemics is a deadly threat to gains In survival among populations (Corbett et al., 2003). The dual epidemics are particularly pervasive in Africa, where HIV has been the single most Important factor contributing to the incidence of TB over the last 10 years. In Zambia, approximately 70% of the people with TB are co-Infected with HIV (MOH, 2006). With the high TB/HIV co-infection prevalence In Zambia, the majority of the population is at a great risk of dying unless the TB/HIV control measures are supported. TB/HIV co-Infected persons also have a higher chance of TB recurrence (Zambia AIDS law Research and Advocacy Network, 2007). In response to the effect of the TB/HIV co-Infection, WHO established the TB/HIV working group of the Stop TB Partnership In 2001 with the aim of coordinating the global response to the HIV associated TB epidemic (WHO, 2005). Four critical program components that serve as entry points for HIV case detection and treatment were identified as part of the TB/HIV collaborative activities. One of these components Is people diagnosed with TB as TB Is the most common opportunistic Infection in HIV patients worldwide (WHO, 2005). According to the British HIV Association (2005), starting Highly Active Antiretroviral Therapy (HAART) early in severely immunosuppressed HIV positive patients presenting with TB is associated with decreased mortality and a lowering of the rates of progression from HIV to Acquired Immune Deficiency Syndrome (AIDS).The TB/HIV collaborative activities were initiated In Livingstone district in 2004. Despite that the percentage of TB patients who accepted HIV counseling and testing Increased drastically in the district, those accepting and utilizing HAART is as low as 17% (Livingstone District Health Management Team - LDHMT, 2007). This study was therefore conducted in Livingstone district to explore the factors that Influence acceptability of HAART by eligible TB patients. An explorative descriptive study was conducted among the HIV/TB co-infected clients aged between 18 and 49 years In Livingstone district. Systematic sampling method was used to come up with individual respondents and a sample size of 131 HIV/TB co-Infected clients was selected. Data were collected using a structured interview schedule and a focus group discussion guide for a period of one month. Participants for the focus group discussion were selected purposlvely from among the other TB/HIV co-infected patients who met the inclusion criteria and were not be part of those interviewed Individually. A total number of six focus group discussions were held, two at each of the three ART sites. The first group for the focus group discussion involved participants aged between 18 and 32 years while the second group included participants aged between 33 and 49 years to facilitate free discussion. At Livingstone General Hospital, the first group was composed of four males and two females while the second group comprised five females and four males. The first group at Sepo health centre comprised five males and two females while in the second group, there were six males and two females. At Mahatma Gandhi health centre, the first group had five males and one female participants while the second group had six females and four males. The total number of participants for all the six focus group discussions was forty six (46). Epi-info version 6 and SPSS 12.0 for windows software computer packages were used to analyze the quantitative data. Chi-square was used to measure association between the dependent variable (acceptability of HAART by TB patients) and the Independent variables (TB/HIV and HAART knowledge, TB- and HIV-associated stigma and discrimination, amount and depth of counseling, support from health care providers, sex, age, marital status and educational level). With the confidence Interval set at 95%, the p value was used to ascertain the degree of significance by using the decision rule which rejects the null hypothesis If p value Is equal or less than 0.05. Qualitative data was presented in narrative form and a full report of the focus group discussions was written using the participants' own words. Key statements and Ideas expressed for each topic of discussion were listed down. Data was categorized and responses from the two subgroups (participants aged between 18 and 32; and those aged between 33 and 49) were compared. A summary was then written in narrative form. The most useful quotations that emerged from the discussion were selected to illustrate the main Ideas. The study revealed low levels of knowledge on TB and HIV relationship (28.1%) and safety of taking HAART while on TB treatment (42.3%). Majority (93.3%) of the respondents also felt that they were being stigmatized by health workers because they had TB disease while 66.7% noted that their concerns regarding HAART were not addressed by health care providers. In this study, the most significant factors found to be associated with acceptability of HAART by TB patients and accessibility of HAART were knowledge of TB and HIV relationship Including HAART, HIV-related stigma and discrimination and support from health care providers regarding HAART. A significant association was found between knowledge of TB and HIV relationship and safety of taking HAART while on TB treatment, 77.9% of the respondents who did not know the relationship between TB and HIV Indicated that It was not safe to take HAART concurrently with TB treatment (Chi square value = 13.585; df = 1; 2 value 0.000). there was also a significant association knowledge of commencement of HAART in TB patients and discussion of HAART and Its benefits with the counselor. Of the 52 respondents who did not know that HAART could be commenced in TB patients, majority (71.2%) did not discuss HAART and its benefits with the counselor (Chi square value = 10.880; df = 1; e value 0.001). In addition, there was a significant association between HIV-related stigma and discrimination and acceptability of HAART. Majority (78.7%) of the respondents who were treated differently because of HIV reported that they would not go back to the ART clinic for medication (Chi square value = 9.270; df = 1; e value 0.002). Furthermore, respondents whose HAART concerns were not addressed (74.1%) would not go back to the ART clinic for HAART (Chi square value = 9.785; df = 2; rvalue 0.008). The results further showed that factors such as TB-related stigma and discrimination, sex, age, marital status and level of education were not significantly associated with acceptability of HAART. Probably, TB-related stigma and discrimination is not associated to acceptability of HAART because TB is curable. The demographic characteristics were also not associated with acceptability of HAART probably because of personality attributes of an individual. Key words: Acceptability, Highly Active Antiretroviral Therapy (HAART), HIV positive. Tuberculosis, Eligible.
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