Factors affecting antiretroviral therapy initiation among tuberculosis and human immunodeficiency virus co-infected patients at health facilities in Masaka district.

Abstract

Background: Evidence shows that infection with Human Immunodeficiency Virus (HIV) increases the risk of tuberculosis (TB) infection following exposure to TB germs and HIV also promotes progression of TB infection to active TB disease in people with both recently acquired and latent TB. People living with HIV account for 1.2 million (11%) of all new TB cases globally. HIV infection in patients with TB is associated with significant morbidity and mortality. Initiation of anti-retroviral therapy (ART) among TB/HIV co-infected patients reduces morbidity and mortality. Since 2006, Uganda has been implementing TB/HIV collaborative activities so as to leverage on the above observed benefits. However, the level of ART initiation and timeliness of ART initiation among TB/HIV co-infected patients is not known. Objective: To determine the uptake/level of ART initiation and factors that affect ART initiation among TB/HIV co-infected patients in Masaka district, central Uganda. Methods: A cross-sectional study was conducted at selected health facilities in Masaka District in 2017. The study utilized both quantitative and qualitative data collection methods. Quantitative methods comprised questionnaires while qualitative utilized key informant interviews. Quantitative data were analyzed using Stata version 13. Quantitative data were analysed using a modified Poisson regression model to obtain Prevalence Ratios (PR) as a measure of association at 95% confidence intervals while qualitative data were analysed using MAXQDA version 12. Results: Out of 490 patients interviewed, majority 65.9% (323/490) were females; aged 31 50 years 52.9% (259/490) and had attended primary education 46.1% (226/490). Seventy three per cent (358/490) of TB/HIV co-infected patients initiated ART; of these, 46.9% (168/358) initiated TB treatment first. Of the 168 that started with TB treatment, 48.2% (81/168) initiated ART on time. Low monthly income (adjusted prevalence ratio (APR) 2

=1.77, 95% CI: 1.37-2.28; p<0.001) and residing in an urban area (APR=1.29, 95%CI: 1.16 1.42, p<0.001) increased the odds of ART initiation while old age (APR=1.05, 95% CI 0.95 1.16) and male gender (APR= 0.47, 95% CI: 0.39-0.58) reduced the odds of ART initiation. Qualitative findings revealed that regular support supervision and patient’s knowledge of TB/HIV improved ART initiation while pill burden, stigma, untrained health workers and lack of space for confidentiality were found to hamper ART initiation.

Conclusion and Recommendation: The study showed that ART initiation among TB/ HIV co-infected patients in Masaka District was fairly high but below the national recommended level of 100%. Timeliness of ART initiation was low. Interventions to reduce stigma and ensure quality counselling by trained health workers are essential to improve ART initiation among TB/HIV co-infected patients especially among males and rural settings.