Access barriers to comprehensive care for people affected by tuberculosis and human immunodeficiency virus coinfection in 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/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

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 framented into different levels of care, which has an impact on comprehensive patien 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 as barreiras programaticas que dificultam o acesso a atencao integral de pacientes com coinfeccao por tuberculose e virus da imunodeficiencia humana (TB/HIV). Metodos. Estudo de metodos mistos. A pesquisa qualitativa foi realizada mediante entrevistas aprofundadas com atores-chave, e o componente quantitativo baseou-se na analise descritiva transversal de dados programaticos dos programas de tubercu lose e HIV de estabelecimentos de saude das cidades de Lima e Iquitos no periodo de 2010 a 2015. Resultados. Foram entrevistados 22 atores-chave em sete estabelecimentos. As bar reiras identificadas foram: pouca ou nenhuma coordenacao entre as equipes de tuberculose e HIV, manejo separado dos casos de tuberculose e HIV em diferentes niveis de atencao, financiamento insuficiente, recursos humanos escassos ou pouco capacitados e ausencia de um sistema de informacao integrado. Constatou-se que o rastreamento de HIV em pacientes com tuberculose aumentou (de 18,8% em 20