Utilization of HIV and Tuberculosis Services by Health Care Workers in Uganda: Implications for Occupational Health Policies and Implementation
Utilization of HIV and Tuberculosis Services by Health Care Workers in Uganda: Implications for Occupational Health Policies and Implementation
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DOI：
10.1371/journal.pone.0046069
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发表时间：
2012-10-11
期刊：
影响因子：
3.7
通讯作者：
Colebunders, Robert
中科院分区：
文献类型：
--
作者：
Buregyeya, Esther;Nuwaha, Fred;Colebunders, Robert
背景资料：卫生保健工作者获得艾滋病毒检测和后续护理是卫生保健工作者结核病感染控制措施的一个关键组成部分。因此，医务工作者在获得艾滋病毒服务方面的挑战和差距可能会损害结核病感染控制。本研究评估了HCWs的艾滋病毒和结核病筛查摄入量，并探讨了他们的喜好，提供艾滋病毒和结核病careers.Methods：一个横断面的混合方法的研究，涉及499 HCWs和8个焦点小组讨论进行了穆科诺和Wakiso区在乌干达之间2010年10月和2011年2月。没有人报告结核病或感染的常规筛查，尽管89%的人愿意参加结核病筛查计划，77%的人愿意在工作场所参加。相比之下，95%的人以前曾接受过艾滋病毒检测; 34%的人在工作场所外接受过检测，27%的人进行过自我检测。近一半（45%）的人更愿意在工作场所以外接受艾滋病毒护理。假设愿意透露艾滋病毒阳性状态的主管是中等（63%）相比，愿意透露性伴侣（94%）。年龄较大的工人更愿意向主管透露（调整后的患病率[APR] = 1.51，CI = 1.16-1.95）。女性（APR = 0.78，CI = 0.68-0.91）和在私营部门工作（APR = 0.81，CI = 0.65-1.00）是不愿意向主管透露HIV阳性状态的独立预测因素。HCWs更喜欢有综合的职业服务，而不是独立的HIV Care.Conclusions：不适与披露的艾滋病毒状态的监督员表明，普遍的结核病感染控制措施，有利于所有HCWs是更可行的区别比艾滋病毒状态，特别是对妇女，私营部门，和年轻的HCWs。然而，减少耻辱感和确保保密的干预措施对于确保医务人员接受全面的艾滋病毒护理，包括异烟肼预防治疗也至关重要。
Background: Access to HIV testing and subsequent care among health care workers (HCWs) form a critical component of TB infection control measures for HCWs. Challenges to and gaps in access to HIV services among HCWs may thus compromise TB infection control. This study assessed HCWs HIV and TB screening uptake and explored their preferences for provision of HIV and TB care.Methods: A cross-sectional mixed-methods study involving 499 HCWs and 8 focus group discussions was conducted in Mukono and Wakiso districts in Uganda between October 2010 and February 2011.Results: Overall, 5% of the HCWs reported a history of TB in the past five years. None reported routine screening for TB disease or infection, although 89% were willing to participate in a TB screening program, 77% at the workplace. By contrast, 95% had previously tested for HIV; 34% outside their workplace, and 27% self-tested. Nearly half (45%) would prefer to receive HIV care outside their workplace. Hypothetical willingness to disclose HIV positive status to supervisors was moderate (63%) compared to willingness to disclose to sexual partners (94%). Older workers were more willing to disclose to a supervisor (adjusted prevalence ratio [APR] = 1.51, CI = 1.16-1.95). Being female (APR = 0.78, CI = 0.68-0.91), and working in the private sector (APR = 0.81, CI = 0.65-1.00) were independent predictors of unwillingness to disclose a positive HIV status to a supervisor. HCWs preferred having integrated occupational services, versus stand-alone HIV care.Conclusions: Discomfort with disclosure of HIV status to supervisors suggests that universal TB infection control measures that benefit all HCWs are more feasible than distinctions by HIVstatus, particularly for women, private sector, and younger HCWs. However, interventions to reduce stigma and ensuring confidentiality are also essential to ensure uptake of comprehensive HIV care including Isoniazid Preventive Therapy among HCWs.