February 24, 2010
South Africa's Eastern Cape Province has some of the world's highest rates of TB and HIV infection. The current study assessed factors playing a role in the "limited but effective" implementation of provider-initiated HIV counseling in TB clinics there as part of a clinical trial. The parent study was a pragmatic, cluster-randomized trial engineered to measure the effect of provider-initiated opt-out counseling on the acceptance of HIV counseling and testing in newly registered TB patients.
The investigators interviewed key informants, and clinic nurses who took part in the study were asked to participate in focus group discussions (FGDs). Thematic transcript analysis was conducted on data collected during the interviews and the FGDs.
This analysis pointed to three major themes regarding nurses' experiences, indicating that numerous structural and personal factors influence the success of provider-initiated HIV counseling of TB patients in primary care settings. These were: chronic frustration with recognizing the TB tasks that need to be accomplished but not having the resources, including staff, to do so; conflict between the nurses' appreciation of the importance of HIV counseling and testing and the health system's recognition of their difficulties in implementing it; and ambivalence in their roles as caregivers and educators in the context of HIV counseling and testing.
"Innovative and coordinated strategies are needed in this environment to facilitate greater number of patients receiving HIV counseling and testing services," the authors concluded.