Access barriers to comprehensive care for people affected by tuberculosis and human immunodeficiency virus coinfection in Peru, 2010-2015/Barreras para el acceso a la atencion integral de las personas afectadas por la coinfeccion por tuberculosis y virus de inmunodeficiencia humana en Peru, 2010-2015/Barreiras no acesso a atencao integral de pessoas afetadas pela coinfeccao por tuberculose e virus da imunodeficiencia humana no Peru, 2010 a 2015

Objective. Identify the programmatic barriers that hinder access to comprehensive care of patients with tuberculosis and human immunodeficiency virus (TB/HIV) coinfection. Methods. This is a mixed-method study. Qualitative research was conducted via in-depth interviews with key actors and the quantitative component involved cross-sectional descriptive analysis of programmatic data from 2010-2015 on tuberculosis and HIV programs at health facilities in the cities of Lima and Iquitos. Results. Twenty-two key actors in seven establishments were interviewed. The identified barriers were: little or no coordination between tuberculosis and HIV teams, separate management of tuberculosis and HIV cases at different levels of care, insufficient financing, limited or poorly trained human resources, and lack of an integrated information system. It was found that HIV screening in TB patients increased (from 18.8% in 2011 to 95.2% in 2015), isoniazid coverage of HIV patients declined (from 62% to 9%), and the proportion of deaths among TB/HIV coinfection cases averaged 20%. Conclusions. There is poor coordination between HIV and TB health strategies. Management of TB/HIV coinfection is fragmented into different levels of care, which has an impact on comprehensive patient care. As a result of this research, a technical document was prepared to establish joint procedures that should be implemented to improve comprehensive care of TB/HIV coinfection. Keywords Coinfection; tuberculosis; HIV; Peru. Objetivo. Identificar las barreras programaticas que dificultan el acceso a la atencion integral de pacientes con coinfeccion por tuberculosis y virus de la inmunodeficiencia humana (TB/VIH). Metodos. Se trata de un estudio de metodos mixtos. La investigacion cualitativa se realizo mediante entrevistas en profundidad a actores clave y el componente cuantitativo a traves del analisis descriptivo de corte transversal de datos programaticos del periodo 2010-2015 sobre los programas de tuberculosis y VIH de establecimientos de salud de las ciudades de Lima e Iquitos. Resultados. Se entrevistaron a 22 actores clave en siete establecimientos. Las barreras identificadas fueron: poca o ninguna coordinacion entre los equipos de tuberculosis y VIH, manejo por separado de los casos de tuberculosis y de VIH en diferentes niveles de atencion, financiamiento insuficiente, recursos humanos escasos o poco capacitados y ausencia de un sistema de informacion integrado. Se evidencio que el tamizaje