Division of Public Health, Department of Community Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa.
Division of Medical Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University and National Health Laboratory Services, Mthatha, South Africa.
BMC Health Serv Res. 2023 Jul 27;23(1):804. doi: 10.1186/s12913-023-09748-2.
Tuberculosis is the leading infectious cause of death among people living with HIV. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with fully integrated, people-centered models of care.
This is a qualitative study design using principles of ethnography and the application of aggregate complexity theory. A total of 54 individual interviews with healthcare workers and patients took place in five primary healthcare facilities in the O.R. Tambo district. The participants were purposively selected until the data reached saturation point, and all interviews were tape-recorded. Quantitative analysis of qualitative data was used after coding ethnographic data, looking for emerging patterns, and counting the number of times a qualitative code occurred. A Likert scale was used to assess the perceived quality of TB/HIV integration. Regression models and canonical discriminant analyses were used to explore the associations between the perceived quality of TB and HIV integrated service delivery and independent predictors of interest using SPSS® version 23.0 (Chicago, IL) considering a type I error of 0.05.
Of the 54 participants, 39 (72.2%) reported that TB and HIV services were partially integrated while 15 (27.8%) participants reported that TB/HIV services were fully integrated. Using the Likert scale gradient, 23 (42.6%) participants perceived the quality of integrated TB/HIV services as poor while 13 (24.1%) and 18 (33.3%) perceived the quality of TB/HIV integrated services as moderate and excellent, respectively. Multiple linear regression analysis showed that access to healthcare services was significantly and independently associated with the perceived quality of integrated TB/HIV services following the equation: Y = 3.72-0.06X (adjusted R2 = 23%, p-value = 0.001). Canonical discriminant analysis (CDA) showed that in all 5 municipal facilities, long distances to healthcare facilities leading to reduced access to services were significantly more likely to be the most impeding factor, which is negatively influencing the perceived quality of integrated TB/HIV services, with functions' coefficients ranging from 9.175 in Mhlontlo to 16.514 in KSD (Wilk's Lambda = 0.750, p = 0.043).
HIV and TB integration is inadequate with limited access to healthcare services. Full integration (one-stop-shop services) is recommended.
结核病是导致艾滋病毒感染者死亡的主要传染病。减少艾滋病毒相关结核病的发病率和死亡率需要各级结核病和艾滋病毒服务之间进行强有力的合作，采用完全整合、以患者为中心的护理模式。
这是一项使用民族志原则和综合复杂性理论应用的定性研究设计。在奥勒松地区的五个初级保健机构中，共进行了 54 次与医护人员和患者的个别访谈。参与者是根据目的选择的，直到数据达到饱和点，并对所有访谈进行录音。使用定量分析方法对民族志数据进行分析，寻找新出现的模式，并计算定性代码出现的次数。使用李克特量表评估结核病/艾滋病毒综合服务提供的质量。使用 SPSS® 版本 23.0（芝加哥，IL）进行回归模型和典型判别分析，考虑到 0.05 的Ⅰ型错误，探讨参与者对结核病和 HIV 综合服务提供质量的感知与感兴趣的独立预测因素之间的关系。
在 54 名参与者中，39 名（72.2%）报告结核病和艾滋病毒服务部分整合，15 名（27.8%）参与者报告结核病/HIV 服务完全整合。使用李克特量表梯度，23 名（42.6%）参与者认为综合结核病/艾滋病毒服务的质量较差，13 名（24.1%）和 18 名（33.3%）分别认为结核病/艾滋病毒综合服务的质量为中等和优秀。多元线性回归分析表明，获得医疗保健服务与对综合结核病/艾滋病毒服务质量的感知显著且独立相关，其方程为：Y=3.72-0.06X（调整后的 R2=23%，p 值=0.001）。典型判别分析（CDA）显示，在所有 5 个市级机构中，距离医疗设施较远导致获得服务的机会减少，这是影响综合结核病/艾滋病毒服务质量的主要阻碍因素，功能系数范围从 Mhlontlo 的 9.175 到 KSD 的 16.514（Wilk's Lambda=0.750，p=0.043）。
艾滋病毒和结核病的整合程度不足，获得医疗服务的机会有限。建议实现全面整合（一站式服务）。
