Evaluación de la implementación del protocolo de manejo de coinfección de tuberculosis y VIH en los servicios de asistencia especializada del estado de Ceará, Brasil

OBJECTIVES. Identify barriers and strategies for implementation of the protocol for managing tuberculosis/human immunodeficiency virus (TB/HIV) coinfection in specialized care services in Ceará state, through evaluation research. METHODS. The study followed iPIER methodology, a new initiative to help improve the implementation of health programs through the use of research that is conducted as a part of the implementation process. Data were collected on the structure and processes of 22 services and barriers were explored in four focus groups with 28 participants, from the standpoint of the health team, administrators, and users. The discussions were transcribed and interpreted with regard to the objectives of the study. RESULTS. The information on structure and process revealed that six services manage TB/HIV coinfection and 16 do not. The barriers were: team members were unaware of the protocol; lack of clinical practice guidelines in the services; specialized care services working at all three levels of the health system; inadequate spaces for treatment of airborne diseases; and lack of communication with primary health care sectors for patient transfers. The results were discussed with teams and administrators in seminars held in the services and with program managers for sexually transmitted infections, human immunodeficiency virus, AIDS, hepatitis, and tuberculosis. CONCLUSIONS. Direct dialogue between administrators, implementers, users, and researchers generated knowledge about the services and led to joint preparation of modifications in workflow aimed at acceptance and use of the protocol; however, users continue to resist adherence to treatment.