Journal Article

Utilization of HIV and Tuberculosis Services by Health Care Workers in Uganda: Implications for Occupational Health Policies and Implementation

Nuwaha, Fred, Verver, Suzanne, Kasasa, Simon, Buregyeya, Esther, Colebunders, Robert, Criel, Bart, Wanyenze, Rhoda K., Mitchell, Ellen M. H.

2012

Overview

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. 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. 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. 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Access control / Acquired immune deficiency syndrome / AIDS / AIDS Serodiagnosis / Antiretroviral agents / Care and treatment / Cross-Sectional Studies / Focus Groups / Health aspects / Health care / Health facilities / Health Personnel / Health Policy / Health screening / Health Services Accessibility / HIV / HIV Infections - diagnosis / HIV Infections - therapy / Human immunodeficiency virus / Humans / Infections / Isoniazid / Medical personnel / Medicine / Occupational health / Occupational Health Services - organization & administration / Practice / Prevention / Private sector / Screening / Sexual partners / Sexually transmitted diseases / Social and Behavioral Sciences / STD / Studies / Supervisors / Tuberculosis / Tuberculosis - diagnosis / Tuberculosis - therapy / Uganda