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Advisory Committee Chair

Eric Chamot

Advisory Committee Members

Joan M Mangan

Sibylle Kristensen

Charles Cowan

Michael E Kimerling

Document Type

Dissertation

Date of Award

2010

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

HIV-positive persons bear an elevated risk of developing, relapsing, and dying from tuberculosis (TB), and have greater risk of TB treatment default. Yet little is known about the factors that influence TB care-seeking among this population. This study evaluated sociodemographic, cognitive, and psychosocial characteristics of PLHA without a history of TB receiving care in specialized HIV/AIDS clinics in Honduras, and the influence of several variables on self-efficacy to seek care, including: (1) seeking care for prolonged cough despite external constraints and potential HIV stigmatization, and (2) completing TB treatment once diagnosed. The majority of participants were women (55%). Seventy-two percent were 33 years of age or older. Nearly 70% believed that they knew little or nothing about TB, but only 38% scored low on items of actual knowledge. One third of respondents perceived their risk of having TB as high, and 67% believed TB to be a fairly/ highly severe illness. A majority (72%) of participants had positive attitudes toward public health center staff. Only 49% displayed high self-efficacy to seek care despite external constraints, and 53% had strong care-seeking self-efficacy despite potential HIV stigmatization. Factors associated with increased self-efficacy to seek care despite external constraints included: (1) no health center visit within the previous year (OR 2.0; 95% CI 1.15-3.78; p=.01); (2) positive attitude toward care provided by health center staff (OR 3.94; 95% CI 2.07-7.52; p<.0001); and (3) perceived benefit of TB treatment (OR 2.6; 95% CI 1.46-4.67; p=.001). The first two factors also predicted increased self-efficacy to seek TB care despite HIV stigmatization (OR 1.89; 95% CI 1.11-3.22; p=0.02 and OR 3.93; 95% CI 2.22-6.99; p<.0001, respectively). PLHA believing TB to be a fairly to highly severe illness were twice as likely to have high self-efficacy to complete TB treatment if diagnosed, compared with those viewing TB as less severe (OR 2.0; 95% CI 1.09-3.39; p=0.02). National TB and HIV programs, and non-governmental health care organizations, can use these findings to develop, implement, and evaluate tailored behavior change communication (BCC) targeted at patients and health providers, and create environments in which patients feel confident and self-assured.

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