Factors that shape the integration of HIV and TB services in Zomba District, Malawi
Abstract Background The co-occurrence of HIV and tuberculosis (TB) presents significant challenges for effective healthcare delivery and patient outcomes. Integrating HIV and TB services has been recognised as a key strategy to optimise care and improve health outcomes. However, the factors that sha...
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| Format: | Article |
| Language: | English |
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BMC
2025-02-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-12367-8 |
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| author | Alex F. Maseko Adam Silumbwe Patricia Maritim Margarate N. Munakampe Griphin Baxter Chirambo Choolwe Jacobs Joseph M. Zulu |
| author_facet | Alex F. Maseko Adam Silumbwe Patricia Maritim Margarate N. Munakampe Griphin Baxter Chirambo Choolwe Jacobs Joseph M. Zulu |
| author_sort | Alex F. Maseko |
| collection | DOAJ |
| description | Abstract Background The co-occurrence of HIV and tuberculosis (TB) presents significant challenges for effective healthcare delivery and patient outcomes. Integrating HIV and TB services has been recognised as a key strategy to optimise care and improve health outcomes. However, the factors that shape the optimal integration of these services remain unclear in many settings. This study aimed to explore the factors that influence the integration of HIV and TB services. Methods A purposive sampling technique was used to select study participants from 3 selected health facilities in Zomba, Malawi. This study used an exploratory qualitative case study and was performed from February to March 2024. A total (n = 31) of semistructured interviews were conducted. Healthcare providers (n = 12), program coordinators (n = 4), and recipients of care (n = 15) involved in the delivery of HIV and TB services were purposefully included. Thematic analysis using the Atun framework, which groups factors shaping integration around the problem, intervention, adoption system, health system characteristics and broad context, was employed. Results Increased workload among health workers and side effects among patients were reported barriers given the nature of the problem. The benefits of integrating HIV/TB services and compatibility with one’s job shaped HIV/TB integration. The adoption system-related factors included the role of volunteers and nongovernmental organisations. Health system characteristics facilitating HIV/TB integration included strong positive relationships among stakeholders, the provision of incentives and the availability of demand-generating activities. Structural challenges, a lack of financial support and shortages of commodities and supplies were health system-related barriers. Broad contextual factors facilitating HIV/TB integration included strong political will, whereas barriers included the impact of religious, sociocultural and economic factors, including the impact of natural disasters and the COVID-19 pandemic. Conclusion The effective integration of HIV and TB services is contingent upon addressing systemic and contextual barriers while leveraging facilitating factors. Enhancing health worker capacity, ensuring consistent supply chains, and fostering strong stakeholder relationships are vital steps. Additionally, comprehensive strategies that address these multifaceted issues are key to achieving successful integration and better health outcomes. |
| format | Article |
| id | doaj-art-78cabfa669514a5d9abf2a799a596044 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-78cabfa669514a5d9abf2a799a5960442025-02-09T12:26:55ZengBMCBMC Health Services Research1472-69632025-02-0125111410.1186/s12913-025-12367-8Factors that shape the integration of HIV and TB services in Zomba District, MalawiAlex F. Maseko0Adam Silumbwe1Patricia Maritim2Margarate N. Munakampe3Griphin Baxter Chirambo4Choolwe Jacobs5Joseph M. Zulu6Kamuzu Central HospitalDepartment of Health Policy and Management, School of Public Health, University of ZambiaDepartment of Health Policy and Management, School of Public Health, University of ZambiaDepartment of Health Policy and Management, School of Public Health, University of ZambiaDepartment of Nursing and Midwifery, Mzuzu UniversityDepartment of Epidemiology and Biostatistics, School of Public Health, University of ZambiaDepartment of Health Policy and Management, School of Public Health, University of ZambiaAbstract Background The co-occurrence of HIV and tuberculosis (TB) presents significant challenges for effective healthcare delivery and patient outcomes. Integrating HIV and TB services has been recognised as a key strategy to optimise care and improve health outcomes. However, the factors that shape the optimal integration of these services remain unclear in many settings. This study aimed to explore the factors that influence the integration of HIV and TB services. Methods A purposive sampling technique was used to select study participants from 3 selected health facilities in Zomba, Malawi. This study used an exploratory qualitative case study and was performed from February to March 2024. A total (n = 31) of semistructured interviews were conducted. Healthcare providers (n = 12), program coordinators (n = 4), and recipients of care (n = 15) involved in the delivery of HIV and TB services were purposefully included. Thematic analysis using the Atun framework, which groups factors shaping integration around the problem, intervention, adoption system, health system characteristics and broad context, was employed. Results Increased workload among health workers and side effects among patients were reported barriers given the nature of the problem. The benefits of integrating HIV/TB services and compatibility with one’s job shaped HIV/TB integration. The adoption system-related factors included the role of volunteers and nongovernmental organisations. Health system characteristics facilitating HIV/TB integration included strong positive relationships among stakeholders, the provision of incentives and the availability of demand-generating activities. Structural challenges, a lack of financial support and shortages of commodities and supplies were health system-related barriers. Broad contextual factors facilitating HIV/TB integration included strong political will, whereas barriers included the impact of religious, sociocultural and economic factors, including the impact of natural disasters and the COVID-19 pandemic. Conclusion The effective integration of HIV and TB services is contingent upon addressing systemic and contextual barriers while leveraging facilitating factors. Enhancing health worker capacity, ensuring consistent supply chains, and fostering strong stakeholder relationships are vital steps. Additionally, comprehensive strategies that address these multifaceted issues are key to achieving successful integration and better health outcomes.https://doi.org/10.1186/s12913-025-12367-8IntegrationBarriersFacilitatorsRecipients of careHIVTB |
| spellingShingle | Alex F. Maseko Adam Silumbwe Patricia Maritim Margarate N. Munakampe Griphin Baxter Chirambo Choolwe Jacobs Joseph M. Zulu Factors that shape the integration of HIV and TB services in Zomba District, Malawi BMC Health Services Research Integration Barriers Facilitators Recipients of care HIV TB |
| title | Factors that shape the integration of HIV and TB services in Zomba District, Malawi |
| title_full | Factors that shape the integration of HIV and TB services in Zomba District, Malawi |
| title_fullStr | Factors that shape the integration of HIV and TB services in Zomba District, Malawi |
| title_full_unstemmed | Factors that shape the integration of HIV and TB services in Zomba District, Malawi |
| title_short | Factors that shape the integration of HIV and TB services in Zomba District, Malawi |
| title_sort | factors that shape the integration of hiv and tb services in zomba district malawi |
| topic | Integration Barriers Facilitators Recipients of care HIV TB |
| url | https://doi.org/10.1186/s12913-025-12367-8 |
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