000			02952nam a22003017a 4500
003			OSt
005			20240305193746.0
008			221206b |||||||| |||| 00| 0 eng d
028			_b Phone: +255 28 298 3384
028			_b Fax: +255 28 298 3386
028			_b Email: vc@bugando.ac.tz
028			_b Website: www.bugando.ac.tz
040			_bEnglish _cDLC
041			_aEnglish
100			_aBahati MK Wajanga _945957
245			_aHealthcare worker perceived barriers to early initiation of antiretroviral and tuberculosis therapy among Tanzanian inpatients
260			_aMwanza, Tanzania: _bPublic Library of Science & _bCatholic University of Health and Allied Sciences [CUHAS – Bugando] _cFebruary 14, 2014
300			_aPages e87584
490			_a Wajanga BMK, Peck RN, Kalluvya S, Fitzgerald DW, Smart LR, Downs JA (2014) Healthcare Worker Perceived Barriers to Early Initiation of Antiretroviral and Tuberculosis Therapy among Tanzanian Inpatients. PLoS ONE 9(2): e87584. https://doi.org/10.1371/journal.pone.0087584
520			_aAbstract: Setting: Clinical trials have shown that early initiation of antiretroviral therapy in HIV-infected patients with tuberculosis saves lives, but models for implementation of this new strategy have been under-studied in real-world settings. Objective:To identify the barriers and possible solutions for implementing concurrent early treatment with antiretroviral and anti-tuberculosis therapy in a large East African referral hospital where the prevalence of both infections is high. Design: In-depth interviews among hospital administrators, laboratory technicians, nurses, pharmacists, and physicians. Results: Twenty-six hospital staff identified six key barriers and corresponding solutions to promote rapid initiation of antiretroviral therapy in HIV-infected inpatients with tuberculosis. These include revising systems of medication delivery, integrating care between inpatient and outpatient systems, training hospital nurses to counsel and initiate medications in inpatients, and cultivating a team approach to consistent guideline implementation. Conclusion: Most barriers identified by hospital staff were easily surmountable with reorganization, training, and policy changes at minimal cost. Efforts to reduce mortality for HIV and tuberculosis co-infected patients in accordance with new World Health Organization guidelines are currently hampered by implementation barriers in real-world settings. Our findings suggest that these can be overcome with strategic enactment of simple, realistic interventions to promote early dual treatment for HIV/tuberculosis co-infected patients.
700			_aJennifer A Downs _923034
700			_a Robert N Peck _922982
700			_a Samuel Kalluvya _922760
700			_aDaniel W Fitzgerald _923036
700			_aLuke R Smart _923177
856			_u https://doi.org/10.1371/journal.pone.0087584
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999			_c19937 _d19937