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. 2017 May 25:41:e23.
doi: 10.26633/RPSP.2017.23.

[Access barriers to comprehensive care for people affected by tuberculosis and human immunodeficiency virus coinfection in Peru, 2010-2015]

[Article in Spanish]
Lisset García-Fernández  1 , Carlos Benites  1 , Byelca Huamán  1
Affiliations

[Access barriers to comprehensive care for people affected by tuberculosis and human immunodeficiency virus coinfection in Peru, 2010-2015]

[Article in Spanish]
Lisset García-Fernández et al. Rev Panam Salud Publica. .

Abstract
in English, Spanish

Objective: Identify the programmatic barriers that hinder access to comprehensive care of patients with tuberculosis and human immunodeficiency virus (TB/HIV) coinfection.

Methods: This is a mixed-method study. Qualitative research was conducted via in-depth interviews with key actors and the quantitative component involved cross-sectional descriptive analysis of programmatic data from 2010-2015 on tuberculosis and HIV programs at health facilities in the cities of Lima and Iquitos.

Results: Twenty-two key actors in seven establishments were interviewed. The identified barriers were: little or no coordination between tuberculosis and HIV teams, separate management of tuberculosis and HIV cases at different levels of care, insufficient financing, limited or poorly trained human resources, and lack of an integrated information system. It was found that HIV screening in TB patients increased (from 18.8% in 2011 to 95.2% in 2015), isoniazid coverage of HIV patients declined (from 62% to 9%), and the proportion of deaths among TB/HIV coinfection cases averaged 20%.

Conclusions: There is poor coordination between HIV and TB health strategies. Management of TB/HIV coinfection is fragmented into different levels of care, which has an impact on comprehensive patient care. As a result of this research, a technical document was prepared to establish joint procedures that should be implemented to improve comprehensive care of TB/HIV coinfection.

Objetivo.: Identificar las barreras programáticas que dificultan el acceso a la atención integral de pacientes con coinfección por tuberculosis y virus de la inmunodeficiencia humana (TB/VIH).

Métodos.: Se trata de un estudio de métodos mixtos. La investigación cualitativa se realizó mediante entrevistas en profundidad a actores clave y el componente cuantitativo a través del análisis descriptivo de corte transversal de datos programáticos del período 2010–2015 sobre los programas de tuberculosis y VIH de establecimientos de salud de las ciudades de Lima e Iquitos.

Resultados.: Se entrevistaron a 22 actores clave en siete establecimientos. Las barreras identificadas fueron: poca o ninguna coordinación entre los equipos de tuberculosis y VIH, manejo por separado de los casos de tuberculosis y de VIH en diferentes niveles de atención, financiamiento insuficiente, recursos humanos escasos o poco capacitados y ausencia de un sistema de información integrado. Se evidenció que el tamizaje para VIH en pacientes con tuberculosis se incrementó (de 18,8% en 2011 a 95,2% en 2015), la cobertura de isoniazida en pacientes con VIH disminuyó (de 62% a 9%) y la proporción de fallecidos entre los casos de coinfección por TB/VIH fue de 20% en promedio.

Conclusiones.: Existe una débil coordinación entre las estrategias sanitarias sobre VIH y sobre tuberculosis. El manejo de la coinfección por TB/VIH es fragmentado en diferentes niveles de atención, lo que repercute en la atención integral del paciente. Como producto de esta investigación, se elaboró un documento técnico para establecer los procedimientos conjuntos, el cual deberá ser implementado para una mejora en la atención integral de la coinfección por TB/VIH.

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Figures

FIGURA 1.
FIGURA 1.. Diagrama de flujo del desarrollo de la investigación
FIGURA 2.
FIGURA 2.. Ubicación de los establecimientos de salud incluidos en el estudio
FIGURA 3.
FIGURA 3.. Cobertura de tamizaje para VIH en pacientes con TB en todos los establecimientos de salud del estudio, 2010–2015
FIGURA 4.
FIGURA 4.. Porcentaje de pacientes con VIH que iniciaron TPI por año, Iquitos, 2010–2015
See this image and copyright information in PMC

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