Tuberculosis and HIV integration in sub-Saharan Africa

Abstract

Sub-Saharan Africa (SSA) has borne the greatest burden of the tuberculosis (TB) and HIV pandemics. In attempt to halt and reverse the situation, World Health Organization-inspired policies have been adopted by many countries. However, implementing these policies have seen limited success. And few studies have been conducted to ascertain the factors influencing interventions and their implementation. This review therefore sought to use comparative analysis to determine the activities implemented, service delivery models as well as the barriers and facilitators of TB/HIV integration in SSA. Many literatures were identified and selected based on a criteria. Narrative approach was then used to review the literature. Eight articles were identified based on different TB/HIV integration programmes across SSA. TB/HIV implemented interventions were HIV screening for TB patients, co-trimoxazole preventive therapy and antiretroviral therapy for eligible HIV positive patients. Three main service delivery models with varying levels of integration were identified: referral, partial integration and full integration model. Staff shortages, poor documentation, lack of resources, irregular supply of drugs, inadequate infrastructure were barriers whereas direct supervision, standardization and mutual adjustment were identified as facilitators of integration. TB/HIV integration in SSA is feasible but the uptake of interventions has been low due to barriers arising from the local policies and other contexts. Identified facilitators can therefore be used to promote TB/HIV integration.