Building a sociomedical framework for coordinated HIV-tuberculosis care

The combination of HIV and tuberculosis (TB) has resulted in greater illness and death compared to that caused by either infection alone. The effect is greater still in the case of drug-resistant TB, including multi and extensively drug-resistant TB (M/XDR-TB). The impact of dual infection is most severe in South Africa where about 75% of patients with TB, and over 90% with M/XDR-TB, are also infected with HIV. Coinfection gives rise to numerous clinical complications related to diagnosis and treatment. Based on the candidate's PhD research, it is also laden with social complications affecting the delivery and usage of related healthcare. These social issues are exacerbated in the case of M/XDR-TB, which requires 2-3 years of complicated treatment, long-term hospitalization and separation from families, increases providers' burden of work, and is associated with higher rates of treatment discontinuation and death. In the proposed research, qualitative methods will be used to build a framework for the delivery of coordinated HIV/TB healthcare, drawing on lessons learned from the candidate's PhD research, and further examination of patient- and provider-related challenges with dual healthcare for HIV and drug-resistant TB. Research will be set at a specialist TB hospital in KwaZulu-Natal, South Africa. An in-depth analysis of interviews conducted with 12 men and women coinfected with HIV and M/XDR-TB will be collectively used to initiate interactive discussions with practicing healthcare workers. Four focus groups of 5-8 persons each will be held with doctors, nurses, allied health professionals including pharmacists, dietitians, social workers and counsellors, to examine their encounters with patients, and to engage their responses with issues arising from patient interviews. The proposed research will promote context-sensitive health practice and policy development in South Africa, and globally, where TB is a burgeoning public health threat in the context of HIV/AID