- Title
- Integration of HIV/ AIDS, Tuberculosis and Patients’ Services into the General Health Care Systems: Implementation Challenges and Impact on TB Control Programme in O.R. Tambo District, Eastern Cape, South Africa.
- Creator
- Dlatu, Ntandazo
- Description
- Tuberculosis (TB), a disease of poverty and inequality, is a leading cause of severe illness and death among people with human immunodeficiency virus (HIV). In South Africa, both TB and HIV epidemics have been closely related and persistent, posing a significant burden for healthcare provision. 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. Studies have observed that TB and HIV integration reduces mortality. However, the operational implementation of integrated services is still challenging. Gaps exist between the challenges of combining TB and HIV control with evidence-based knowledge, affecting the implementation process of this highly recommended strategy. Despite the policy, frameworks for integration exist; integration of TB and HIV services is far from ideal in many resource-limited countries, including South Africa. Few studies have examined the advantages and disadvantages of integrated TB and HIV care in public health facilities, and even fewer have proposed conceptual models for proven integration. Objectives: The goals of this study consisted of: (i) investigating the associations between socio-economic deprivation and tuberculosis (TB) treatment outcomes, alongside well-known TB risk factors. The effects of healthcare expenditures and their growth on trends in TB incidence from 2009 to 2013 were also assessed. (ii) Exploring patients’ and healthcare workers’ perceptions of TB and HIV integration as well as a strategy for integrating these programs. (iii) Describing patients’ perceptions on barriers to scaling up of TB-HIV integration services at selected health facilities; and (iv) Developing a paradigm for integrating TB, HIV, and patient services in a single facility and highlighting the importance of TB-HIV services for greater accessibility under one roof. Methods: In Phase 1 of the study, secondary data analysis was performed on data obtained from various sources including governmental, non-governmental, and research institutions. Indicators for TB treatment outcomes included TB death rate, TB rate among the household contacts of the Index TB cases, TB treatment failure, HIV-associated TB death rate, TB defaulter rate, and new TB smear-positive cases. Analysis of variance (ANOVA) and Turkey’s tests for post-hoc analysis were used to P a g e xvii | compare means of variables of interest considering a type I error rate of 0.05.
- Description
- Thesis (PhD) -- Faculty of Medicine and Health Sciences, 2024
- Date
- 2024-08
- Type
- Doctoral theses, text
- Identifier
- http://hdl.handle.net/11260/12987
- Identifier
- vital:76186
- Format
- computer, online resource, application/pdf, 1 online resource (184 leaves), pdf
- Publisher
- Walter Sisulu University, Faculty of Medicine and Health Sciences
- Language
- English
- Rights
- Faculty of Medicine and Health Sciences, All Rights Reserved, Open Access
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details | SOURCE1 | Dlatu PhD thesis v01.08.2024 corrected.pdf | 2 MB | Adobe Acrobat PDF | View Details |