What Are the Barriers for Uptake of Antiretroviral Therapy in HIV-Infected Tuberculosis Patients? A Mixed-Methods Study from Ayeyawady Region, Myanmar

Abstract

Antiretroviral therapy (ART) coverage among HIV-infected tuberculosis (HIV-TB) patients has been suboptimal in Myanmar and the reasons are unknown. We aimed to assess the ART uptake among HIV-TB patients in public health facilities of Ayeyawady Region from July 2017–June 2018 and explore the barriers for non-initiation of ART. We conducted an explanatory mixed-methods study with a quantitative component (cohort analysis of secondary programme data) followed by a descriptive qualitative component (thematic analysis of in-depth interviews of 22 providers and five patients). Among 12,447 TB patients, 11,057 (89%) were HIV-tested and 627 (5.7%) were HIV-positive. Of 627 HIV-TB patients, 446 (71%) received ART during TB treatment (86 started on ART prior to TB treatment and rest started after TB treatment). Among the 181 patients not started on ART, 60 (33%) died and 41 (23%) were lost-to-follow-up. Patient-related barriers included geographic and economic constraints, poor awareness, denial of HIV status, and fear of adverse drug effects. The health system barriers included limited human resource, provision of ART on ‘fixed’ days only, weaknesses in counselling, referral and feedback mechanism, and clinicians’ reluctance to start ART early due to concerns about immune reconstitution inflammatory syndrome. We urge the national TB and HIV programs to take immediate actions to improve the ART uptake.

Tuberculous Meningitis in HIV-Positive Patients in North-Eastern Romania

“…We must find and eliminate obstacles affecting patients and the healthcare system. In order to increase ART uptake among HIV-infected TB patients and to put an end to the TB and HIV epidemics, these hurdles must be removed [27].…”

Barriers to Accessing Antiretroviral Treatment Among Key Populations in Southwest Nigeria

“…Health system-related barriers include poor treatment literacy, long waiting times, inadequate health infrastructure, limited availability of ART medications, and the facility not implementing person-centred or integrated approach [ 8 , 9 ]. Patient-related barriers encompass factors such as denial of HIV status, socioeconomic status, transportation, poor awareness, fear of adverse drug effects, and the stigma associated with HIV/AIDS [ 7 ]. Community-related obstacles include the criminalization of same-sex relationships by the Nigerian government, societal stigma, and discrimination against KPs, which can deter them from seeking treatment [ 14 , 15 ].…”