Abstract

In Sub Saharan Africa, human immunodeficiency virus (HIV) and tuberculosis (TB) co-infections are common, and patients often find out about their HIV positive status during consultation for pulmonary tuberculosis. Reports from the HIV and TB hospital unit in Swaziland indicate that many deaths are related to low uptake of antiretroviral therapy among patients co-infected with TB, and anecdotal evidence suggests reluctance and refusal by some TB/HIV co-infected patients to initiate antiretroviral therapy (ART) before completing TB treatment, and this phenomenon is not well understood. The aim of this study was to explore the reasons for refusing antiretroviral therapy among HIV co-infected tuberculosis patients, prior to the completion of tuberculosis treatment, at a regional hospital in Swaziland. A qualitative descriptive study was conducted to understand patients’ views and concerns, which results in their refusing to initiate ART before completing tuberculosis treatment. A sample of convenience, consisting of nineteen HIV/TB co-infected patients was selected to answer the research question. Reasons given were the clients’ un-readiness for ART, the perception that one was still in good health, the fear of adverse outcomes being precipitated by combining ART with TB medicines, preference for traditional medicines, and health systems-related problems. Key words: Antiretroviral therapy, human immunodeficiency virus (HIV)/tuberculosis (TB) co-infections, tuberculosis, HIV.

Highlights

  • The scourge of human immunodeficiency virus (HIV) continues to significantly contribute to morbidity and mortality in Sub-Saharan Africa, and it is estimated that 70% of the worldwide acquired immune deficiency syndrome (AIDS) mortality occurs in Sub-Saharan Africa (UNAIDS, 2009)

  • The purpose of this study was to explore reasons why HIV and TB co-infected patients who are on tuberculosis treatment refuse antiretroviral therapy before they complete tuberculosis treatment

  • The remaining themes are categorized as minority voices, because each of these were coded from scripts of at least 4 participants

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Summary

Introduction

The scourge of human immunodeficiency virus (HIV) continues to significantly contribute to morbidity and mortality in Sub-Saharan Africa, and it is estimated that 70% of the worldwide acquired immune deficiency syndrome (AIDS) mortality occurs in Sub-Saharan Africa (UNAIDS, 2009). Mycobacterium tuberculosis, which is one of the opportunistic infections for HIV infected people, has been identified as a major factor in these deaths. The HIV/TB co-infections remain a major public health challenge in Sub-Saharan Africa (Hesseling, 2009). Tuberculosis is the most frequent opportunistic infection among HIV infected individuals, and accounts for the majority of deaths in these patients in developing countries. Despite effective tuberculosis chemotherapy in HIV/TB co-infection, tuberculosis is associated with substantially increased case fatality rates. HIV is the strongest risk factor for TB infection in countries that have a high prevalence of HIV (Karim et al, 2010).

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