a Department of Population and Health , University of Cape Coast , Cape Coast , Ghana.
b African Population and Health Research Centre , Nairobi , Kenya.
Glob Public Health. 2018 Sep;13(9):1192-1203. doi: 10.1080/17441692.2017.1385823. Epub 2017 Oct 6.
Scaling up of integrated tuberculosis (TB)-human immunodeficiency virus (HIV) services remains sub-optimal in many resource-limited countries, including Ghana, where the two conditions take a heavy toll on the financial resources of health systems as well as infected persons. Previous studies have documented several implementation challenges towards TB-HIV service integration, but views of patients on integrated service delivery have not received commensurate research attention. This paper explored the experiences of 40 TB-HIV co-infected patients at different stages of treatment in Ghana. Using Normalisation Process Theory as a framework, data were coded using inter-rater coding technique and analysed inductively and deductively with the help of QSR NVivo 10. For several participants, either of the diseases was diagnosed 'accidentally', leading to inconsistencies in co-therapy administration, constraints regarding separate clinic appointment dates for TB and HIV and prolonged TB treatment due to treatment failure. Put differently, there were widespread negative experiences among TB-HIV co-infected patients with regard to treatment and care, especially among patients who were accessing care in separate facilities or separate units in the same facility. Co-infected patients unanimously support full-service integration. However, they felt powerless to request for reforms on a mode of service delivery.
在许多资源有限的国家，包括加纳，结核病（TB）-人类免疫缺陷病毒（HIV）综合服务的扩大仍然不理想，这两种疾病给卫生系统以及感染者的财政资源带来了沉重的负担。以前的研究已经记录了结核病-艾滋病综合服务整合的几个实施挑战，但患者对综合服务提供的看法并没有得到相应的研究关注。本文探讨了加纳不同治疗阶段的 40 名结核病-艾滋病合并感染患者的经验。本文使用正常化进程理论作为框架，使用相互评分编码技术对数据进行编码，并在 QSR NVivo 10 的帮助下进行归纳和演绎分析。对一些参与者来说，要么是偶然诊断出其中一种疾病，要么是两种疾病同时被诊断出来，这导致了联合治疗管理的不一致，限制了结核病和艾滋病分别预约门诊的日期，以及由于治疗失败而延长了结核病的治疗时间。换句话说，结核病-艾滋病合并感染患者在治疗和护理方面存在广泛的负面体验，尤其是那些在不同机构或同一机构的不同科室接受治疗的患者。合并感染的患者一致支持全面的综合服务。然而，他们感到无力要求对服务提供模式进行改革。
