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Objective : The objective of the study was to determine factors contributing to acceptability of Highly Active Anti-Retro Therapy (HAART) by HIV-positive clients co-infected with tuberculosis accessing care at health facilities in Livingstone district, Zambia. Design : An explorative descriptive design study was conducted at three major chest clinics in Livingstone; namely Livingstone General Hospital, Mahatma Gandhi and Sepo health centers. The study population was all the TB/HIV co-infected patients aged between 18 and 49 years who were referred for HAART in the previous one month or more prior to the study and were not critically ill. The respondents were selected using systematic sampling method. A total number of 131 TB/HIV coinfected patients who were being attended to at the selected chest clinics in Livingstone were enrolled into the study. Data were collected using a structured interview schedule and focus group discussion guide to enable the investigator collect both quantitative and qualitative data. Epi-info version 6 and SPSS 12.0 for windows software computer packages were used to analyze the quantitative data. Chi-square was used to measure association between the dependent variable (acceptability of HAART by TB patients) and the independent variables. With the confidence interval set at 95%, the p value was used to ascertain the degree of significance by using the decision rule which rejects the null hypothesis if p value is equal or less than 0.05. Results : This study revealed that the most significant factors associated with acceptability of HAART by TB patients and accessibility of HAART were knowledge of TB and HIV relationship including HAART, HIV-related stigma and discrimination and support from health care providers regarding HAART. A significant association was found between knowledge of TB and HIV relationship and safety of taking HAART while on TB treatment, 77.9% of the respondents who did not know the relationship between TB and HIV indicated that it was not safe to take HAART concurrently with TB treatment (p value 0.000). There was also significant association knowledge of commencement of HAART in TB patients and discussion of HAART and its benefits with the counselor. Of the 52 respondents who did not know that HAART could be commenced in TB patients, majority (71.2%) did not discuss HAART and its benefits with the counselor (p value 0.001). In addition, there was a significant association between HIV-related stigma and discrimination and acceptability of HAART. Majority (78.7%) of the respondents who were treated differently because of HIV reported that they would not go back to the ART clinic for medication (p value 0.002). Furthermore, respondents whose HAART concerns were not addressed (74.1%) would not go back to the ART clinic for HAART (p value 0.008). The results further showed that factors such as TB-related stigma and discrimination, sex, age, marital status and level of education were not significantly associated with acceptability of HAART. Probably, TB-related stigma and discrimination is not associated to acceptability of HAART because TB is curable. The demographic characteristics were also not associated with acceptability of HAART probably because of personality attributes of an individual. Conclusion : From this study, it is evident that there are certain factors that are significantly associated with low acceptability of HAART by TB patients. These factors include TB patients' level of knowledge on TB/HIV coinfection and HAART, TB- and HIV-associated stigma and discrimination, amount and depth of information provided to the TB patient during the pre- and post-test counseling and provision of support to TB patients by health care providers. The other factors identified to be associated with acceptability of HAART by TB patients were integration of the TB and HIV services and number of health facilities offering the TB and HIV services. Most of the clients indicated that integration of TB and HIV services will be beneficial to them as it limits the number of time spent in these facilities, minimizes the cost of travelling to the sites and allows them more time to rest. The study further revealed that certain factors were not associated with acceptability of HAART in this study. These factors were sex, age, marital status and educational level of respondents. However, in similar studies, these factors were found to be statistically significant to acceptability of HAART by patients coinfected with TB/HIV. As revealed from this study, the burden of being diagnosed with concurrent TB and HIV infections on individuals can be lessened by uptake of HAART. This in turn will have a positive impact on the development of the nation.

A case study of government innovative programmes for increasing access to qualified health personnel in selected rural districts of Zambia