Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, and School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2013 Jan 7;103(4):237-40. doi: 10.7196/samj.6423.
Patients with tuberculosis (TB) face several challenges in accessing care, and an integrated service that includes HIV testing could be preferable for them and ensure timely HIV treatment initiation and optimal TB care.
To investigate factors, including uptake of the offer of HIV testing, associated with availability and utilisation of healthcare by TB patients in a rural programme devolved to primary care in Hlabisa sub-district, KwaZulu-Natal.
Three hundred TB patients were randomly selected in a two-stage-sampling scheme with five primary healthcare clinic (PHC) sampling units selected with probability proportional to size. Data were collected using a structured questionnaire. We describe key availability and utilisation factors and analyse factors associated with being offered an HIV test in multiple regressions controlling for sex, age, education, employment and marital status.
Most patients (75.2%) received care for a first episode of TB, mainly pulmonary. Nearly all (94.3%) were offered an HIV test during their current TB treatment episode, patients using their closest clinic being substantially more likely to have been offered HIV testing than those not using their closest clinic (adjusted odds ratio 12.79, p=0.05). About one-fifth (20.3%) of patients did not take medication under observation, and 3.4% reported missing taking their tablets at some stage. Average travelling time to the clinic and back was 2 hours, most patients (56.8%) using minibus taxis.
We demonstrate high HIV testing rates among TB patients in a rural public programme, suggesting appropriate management of HIV-TB co-infected patients. We describe healthcare availability and utilisation factors that can inform the proposed district management teams for PHC re-engineering on areas needing improvement.
结核病（TB）患者在获得医疗服务方面面临诸多挑战，为他们提供包括 HIV 检测在内的综合服务可能更为理想，这有助于及时启动 HIV 治疗和优化 TB 护理。
在夸祖鲁-纳塔尔省赫拉布萨分区下放到基层医疗的农村项目中，调查与 TB 患者获得和利用医疗保健相关的因素，包括对 HIV 检测的接受程度。
采用两阶段抽样方案，随机选择了 300 名 TB 患者，其中 5 个初级保健诊所（PHC）抽样单位按大小比例概率选择。使用结构化问卷收集数据。我们描述了关键的可及性和利用因素，并通过多元回归分析控制性别、年龄、教育、就业和婚姻状况，分析与提供 HIV 检测相关的因素。
大多数患者（75.2%）接受了首次 TB 发作的治疗，主要是肺部的。在当前 TB 治疗期间，几乎所有患者（94.3%）都被提供了 HIV 检测，与未使用最近诊所的患者相比，使用最近诊所的患者接受 HIV 检测的可能性要大得多（调整后的优势比 12.79，p=0.05）。大约五分之一（20.3%）的患者未在观察下服药，3.4%的患者报告在某个阶段漏服了药片。往返诊所的平均旅行时间为 2 小时，大多数患者（56.8%）乘坐小型巴士出租车。
我们在农村公共项目中展示了 TB 患者的高 HIV 检测率，这表明对 HIV-TB 合并感染患者的管理得当。我们描述了医疗保健可及性和利用因素，这可以为拟议的 PHC 重新设计提供信息，以确定需要改进的领域。
