Factors influencing uptake of antiretroviral therapy among TB/HIV co-infected patients attending TB and HIV clinics in Temeke municipality Dar es salaam, Tanzania.

Abstract

Background: HIV/AIDS and Tuberculosis diseases are disturbing each other, while TB is the most common opportunistic infection among PLHIV meanwhile HIV/AIDS is the most risk factor for the progression from latent TB into active or recurrent TB. The two diseases have accounted for the increased morbidity and mortality in the community. The ARVs uptake among TB/HIV patients in the country is 35% as compared to WHO target of above 80%. The MOHSW in collaboration with stakeholders since 2007 have launched several strategies to mitigate this problem in the country however no substantial outcome has been achieved so far in terms of ARVs uptake among co-infected patients. Objective: The study was aimed at describing individual factors that influence the ARVs uptake among patients with Tuberculosis and HIV/AIDS co –infections, particularly on characteristics such as socio- economic, Accessibility and availability of ARVs services and Patient’s awareness and perceptions on ARVs for TB/HIV clinics in Temeke Municipality. Material and methods: This cross sectional study was done in high burden TB and HIV area in Temeke, Three health facilities in Mbagala, Kigamboni and Temeke were purposely selected based on patients load and accessibility of ARVs Services. A sample size of 183 TB/HIV co-infected patients were enrolled in this study, data were collected through semi-structured questionnaires, while SPSS version 17 were deployed for data entry, cleaning and analysis. Results: A total of 183 TB/HIV co-infected patients in which 50% were from Mbagala hospital were interviewed with the mean age of 40.5 years (ranging from 13 to 67 years). Out of these 165(90.2%) had reported to take ARV and TB medications concomitantly. There was no significant relationship between level of education and ARVs uptake [OR=0.4]. Majority 163 (98.8%) out of 165 patients were satisfied with health care services provided particularly flexibility at clinic (89.3%), availability of health care providers (91%). The study also found among 165 patients who took ARVs, 81.2% had good awareness on the importance of ARVs and by regression analysis patients who had knowledge on ARVs were 4 times likely to adhere to ARVs than those who had no knowledge (OR=3.9, P=0.02), further study found 171(93.3%) out of 183 patients held a perceptions that integrating of TB and HIV services under one unit is of major importance, particular reducing waiting time(43%) and improve privacy(26%) . On the general patient view on ARVs medications 106 (61%) out of 169 respondents understand that ARVs prolong life and reduce possibilities of acquiring opportunistic infections Conclusion: Anti-retro viral uptake among TB/HIV co-infected patients is high and is extensively associated with high awareness and perceptions on ARV medication indeed also the provision of health care provided at the clinic. There is need for further search to explore more on how institution or management factors influence utilization of ARV services among TB/HIV co-infected.