Utilization of HIV and Tuberculosis Services by Health Care Workers in Uganda: Implications for Occupational Health Policies and Implementation

Esther Buregyeya,Suzanne Verver,Bart Criel,Rhoda K Wanyenze,Simon Kasasa,Robert Colebunders,Ellen M H Mitchell,Fred Nuwaha,D William Cameron

doi:10.1371/journal.pone.0046069

Esther Buregyeya, Suzanne Verver + Show 7 more

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https://doi.org/10.1371/journal.pone.0046069

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Abstract

BackgroundAccess to HIV testing and subsequent care among health care workers (HCWs) form a critical component of TB infection control measures for HCWs. Challenges to and gaps in access to HIV services among HCWs may thus compromise TB infection control. This study assessed HCWs HIV and TB screening uptake and explored their preferences for provision of HIV and TB care.MethodsA cross-sectional mixed-methods study involving 499 HCWs and 8 focus group discussions was conducted in Mukono and Wakiso districts in Uganda between October 2010 and February 2011.ResultsOverall, 5% of the HCWs reported a history of TB in the past five years. None reported routine screening for TB disease or infection, although 89% were willing to participate in a TB screening program, 77% at the workplace. By contrast, 95% had previously tested for HIV; 34% outside their workplace, and 27% self-tested. Nearly half (45%) would prefer to receive HIV care outside their workplace. Hypothetical willingness to disclose HIV positive status to supervisors was moderate (63%) compared to willingness to disclose to sexual partners (94%). Older workers were more willing to disclose to a supervisor (adjusted prevalence ratio [APR] = 1.51, CI = 1.16–1.95). Being female (APR = 0.78, CI = 0.68–0.91), and working in the private sector (APR = 0.81, CI = 0.65–1.00) were independent predictors of unwillingness to disclose a positive HIV status to a supervisor. HCWs preferred having integrated occupational services, versus stand-alone HIV care.ConclusionsDiscomfort with disclosure of HIV status to supervisors suggests that universal TB infection control measures that benefit all HCWs are more feasible than distinctions by HIVstatus, particularly for women, private sector, and younger HCWs. However, interventions to reduce stigma and ensuring confidentiality are also essential to ensure uptake of comprehensive HIV care including Isoniazid Preventive Therapy among HCWs.

Highlights

High rates of tuberculosis (TB) disease among health care workers (HCWs) have been reported in African countries, with HIV-infected HCWs at extremely high risk [1,2,3]
If diagnosed with HIV, HCWs should be offered a package of TB prevention and care that includes regular screening, access to antiretroviral therapy (ART) and Isoniazid Preventive Therapy (IPT)
HIV positive HCWs should be given a choice to opt out of working in areas where they are exposed to infectious TB especially multidrug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), and offered a position from where exposure to untreated TB is low

Summary

Introduction

High rates of tuberculosis (TB) disease among health care workers (HCWs) have been reported in African countries, with HIV-infected HCWs at extremely high risk [1,2,3]. Previous studies have reported challenges HCWs face to access general or workplace HIV services [9,10]. Such challenges include: stigma, a feeling of professional failure, shame, and fear to be known as HIV infected by colleagues and patients [9,10]Uganda is ranked 18th among the 22 TB high burden countries in the world [11]. About 54% of TB cases in Uganda are co-infected with HIV and about 30% of the HIV-related deaths are attributed to TB [12] Despite this high TB burden, not many studies have been conducted on TB among HCWs in Uganda. This study assessed HCWs HIV and TB screening uptake and explored their preferences for provision of HIV and TB care

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