Nurses’ perceptions of obstacles to treatment adherence counselling for individuals with coinfections of HIV and TB in Cape Town metropolitan community health centres

Abstract

One out of every three HIV-related deaths occurs in people who are coinfected with TB. To improve health outcomes, people coinfected with HIV and TB should continue to practice two crucial behaviours: staying in care and taking their medications as prescribed. Barriers to TB and HIV treatment adherence counselling as a tool to strengthen holistic care. However, the literature lacks an in-depth exploration of nurses’ perspectives on the perceived obstacles to treatment adherence counselling for individuals with HIV and TB coinfection in Cape Town metropolitan community health centres. The Social Cognitive Theory underpinned this study. The study investigated the perceived obstacles that nurses in community health centres in the Cape Town metropolitan region faced when providing treatment adherence counselling to patients coinfected with HIV and TB. Using a qualitative exploratory study design, nurses caring for people living with HIV and with TB were purposively selected. Semistructured interviews were used to collect data. All interviews were audio-recordedusing a digital voice recorder with participants’ permission, and verbatim transcripts were produced. We used ATLAS.ti 8 electronic software to manage the qualitative data, which were analysed thematically. Findings: Health system barriers, which included human resource constraints, increased workload, time and space limitations, unsupportive attitudes from nursing staff, inadequate capacity building, and absence of regular updates on HIV and TB adherence counselling. Patient-related barriers: Patients experienced pill burden and adverse medication side effects, and the negative impact of social grants on treatment adherence. Community-related barriers: Stigma and discrimination from the community towards people living with HIV coinfected with TB, limited knowledge among some patients, sharing of medication and substance use, and lack of community-level interaction with healthcare workers, including nurses, are the contributing factors to poor adherence counselling.