Abstract:
Introduction. Concurrent use of public sector and other healthcare facilities by adult
persons seeking treatment for human immunodeficiency virus (HIV) and/ or
tuberculosis (TB) has been shown to lead to poorer health outcomes for such
patients. Apart from structural factors (e.g. service standards), demographic and
personal factors may also influence patients to use private health services
concurrently with public sector services for these two diseases.
Aim. The Aim of this analysis was to explore demographic and personal factors
associated with concurrent use of public and private health services by TB and/or
HIV patients, attending public sector primary health care clinics.
Methods. This was a secondary analysis of data collected during a cluster
randomised controlled trial. In that trial, structured interviews were conducted with
486 patients with HIV and or TB aged between 18 and 71 years in 18 primary health
care clinics in Ekurhuleni North, Gauteng South Africa. Descriptive analyses were
followed by multiple logistic regression using Stata Version 12 to analyse
associations between independent variables and concurrent use of public and private
health services. The analyses were repeated with adjustment for the complex survey
sampling design and also with regular logistic regression but using the cluster
option available in Stata, for comparison.
Results. It was found that two factors associated with concurrent use of public and
private health services were shown to be statistically significant: having access to
medical scheme funding and being accompanied by at least one other adult when
attending the public sector clinic.
Conclusions and recommendations. As the factors associated with co-consultation
may be beyond the control of policy makers it is recommended that emphasis be
placed on improving standards of care in both the public and private sectors; and
encouraging private providers to comply with national diagnostic, treatment and
reporting guidelines for these two conditions.
