Factors associated with non-enrolment of tuberculosis HIV co-infected patients on an Anti-Retroviral Therapy program at Mulago Hospital Tuberculosis Clinic

Abstract

Introduction: The high TB/HIV co-infection rate presents one of the most significant challenges to the overburdened healthcare systems in many low-income countries. However, collaborative TB/HIV treatment has not achieved much in developing countries despite the higher expectations. Objectives: The objective of the study was to ascertain the level of non enrolment and factors associated with non enrolment of TB/HIV co infected patients on the ART program in order to provide TB/HIV control programs with information for scaling up enrolment of TB/HIV co infected patients on the ART program in Mulago TB clinic. Methods: A facility based independent case control study with a sample size of 246. Cases were defined as subjects with PTB eligible for anti retroviral therapy but not enrolled on the anti retroviral therapy program within four weeks of TB diagnosis while controls were defined as subjects with PTB eligible for anti retroviral therapy and enrolled on the anti retroviral therapy program within four weeks of TB diagnosis. Outcome measures of interest for quantitative data included odds ratios and 95% confidence intervals. Results: The proportion of TB/HIV patients attending Mulago hospital TB clinic that were eligible for ART but not enrolling on the ART program was 39.8%. Of the 220 respondents enrolled in this study, 60.0% of the cases had disclosed their status to other people compared to 96.4% among the controls (p-value < 0.001). Sixty nine percent of the cases had convenient clinic appointment schedules compared to 48% of the controls while 60.9% of the cases had been offered counseling compared to 79.1% of the controls (p-value=0.003). Conclusion/Recommendation: The low enrollment of TB/HIV ART eligible patients on ART program was found to be associated with non disclosure, clinic appointment convenience and inaccessibility of HIV counseling service at the TB clinic. The findings suggest that there is need to have a fully functional ART clinic within the TB clinic.