1. Christo Heunis
Gladys Kigozi
Michelle Engelbrecht
Centre for Health Systems Research & Development
University of the Free State

2. Source: WHO 2009: 81-168

4. Source: WHO 2009: 81-168

5. Source: WHO 2009: 28

6. Free State
31.1%-32.9%
Thabo Mofutsanyana
Lejweleputswa
32.2-33.1%
34.8%-33.8%
Source: DoH (2009)

7. Free State
43.1% -45.9%
Thabo Mofutsanyana
Lejweleputswa
37.9%-49.7%
32.4%-44.6%
Source: FSDoH (2009)

8. Free State
60.3%-65.3%
Thabo Mofutsanyana
Lejweleputswa
63.2%-67.3% 63.8%-67.6%
Source: FSDoH (2009)

9. Mechanisms for
collaboration between
TB and HIV programmes
Intensified TB case-
finding among PLWHA
IPT for PLWHA without
active TB
Improved infection
control in health-care
and congregate settings
HIV testing for TB
patients
CPT for TB patients
infected with HIV

10. Identify factors impacting on uptake/non-uptake of HIV
counselling and testing by TB patients from the perspectives
of (1) patients, (2) professional and (3) community health
workers
Propose recommendations to increase uptake of HIV testing
by TB patients

11. Cross-sectional face-to-face interview survey: Feb-Mar
2008
61 PHC facilities offering:
o TB services
o HIV counselling and testing services
Sample
o 600 TB patients
o 81 professional health workers
o 97 lay health workers
Voluntary, informed consent

12. Variable n %
Female 310 51.7
Unemployed 513 85.5
Retreatment 232 38.7
Did (self-reportedly) not receive
information on the link between TB and 214 35.7
HIV/AIDS

13. Thabo
Lejweleputswa Total (%)
Mofutsanyana
Fixed clinics
Manager 4 1 5 (6.2%)
Manager/TB/HIV nurse 6 5 11 (13.6%)
Manager/TB nurse 2 4 6 (7.4%)
Manager/HIV nurse 1 3 4 (4.9%)
TB/HIV nurse 2 1 3 (3.7%)
TB nurse 3 3 6 (7.4%)
HIV nurse 4 4 8 (9.9%)
Mobile clinics
Nurse 5 5 10 (12.3%)
Hospitals
Nursing services
4 4 8 (9.9%)
manager
Doctor 4 4 8 (9.9%)
TB nurse 3 2 5 (6.2%)
HIV nurse 2 2 4 (4.9%)
TB/HIV nurse 1 2 3 (3.7%)
Total 41 40 81 (100%)

14. n %
Lay counsellors 40 41.2
DOT supporters 57 58.8
Total 97 100

15. Qualitative: simple content analysis
Quantitative: uni-, bi-, multi-variate
(logistic regression) analysis

18. Odds ratio (95% CI) Odds ratio (95% CI) (adjusted
Variable
(unadjusted model) for all other factors)
Received TB-HIV
information 3.9 (2.7-5.6)** 4.1 (2.5-6.7)**
Ref: Not received
Know someone
ill with HIV/AIDS 3.0 (2.0-4.3)** 3.5 (2.2-5.7)**
Ref: Not know
Unemployed
2.6 (1.6-4.1)** 2.3 (1.2-4.3)**
Ref: Employed
Female
1.9 (1.3-2.7)** 2.2 (1.4-3.6)**
Ref: Male
Retreatment
1.8 (1.3-2.6)* 2.0 (1.3-3.3)*
Ref: New
* Significant at 5% level ; ** Significant at 1% level

19. Shortage of nurses
Insufficient training on TB/HIV
integration
Inadequate space for counselling
Lack of patient trust in lay counsellors

20. Re-offer HIV counselling and testing at every
opportunity
Supply TB-HIV (“the link”) information
Motivation & support
Availability of antiretroviral treatment

21. TB patients’ fear of HIV, TB/HIV co-infection, death
TB patients’ fear of anticipated
stigmatisation/discrimination should they test HIV-
positive

22. Encouragement and motivation

23. Intensifying education on the link between TB and HIV
Motivating patients in the decision-making process
Targeting especially males, newly diagnosed and employed
patients
Improving DOT supporters and counsellors’ training and skills
Public Health Evaluation (PHE) protocol submission to CDC
pending: quasi-experiment to implement and evaluate training
interventions:
Training of nurses and clinic managers to scale-up PITC of
TB patients
Training of lay counsellors to provide high quality HIV
counselling services to TB patients
Training of DOT supporters to continuously and more
effectively encourage and motivate TB patients to take up
HIV counselling and testing

24. Funders:
Department for International Development (DfID, UK)
National Research Foundation
University of the Free State
Authorisation:
Free State Department of Health
Collaboration:
Department of Sociology, University of Antwerp
American International Health Alliance
SUNY Downtown Medical Center
Ethical clearance:
Committee for Research Ethics, Faculty of the Humanities,
University of the Free State
Colleagues:
A Pienaar, H Hlophe, M Machere
Drs P Chikobvu, E Wouters, H van den Berg

25. FSDoH. 2009. Tuberculosis statistical reports.
http://www.fshealth.gov.za.
NDoH. 2007. Tuberculosis Strategic Plan for South Africa, 2007-
2011. Pretoria: NDoH.
WHO. 2004. Interim policy on collaborative TB/HIV activities.
Geneva: WHO.
WHO. 2009. Global tuberculosis control 2009: epidemiology,
strategy, financing. Geneva: WHO.