Factors associated with concurrent consultation of primary health care clinics and other providers by TB patients and HIV patients

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.