{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:53:33Z","timestamp":1792601613615,"version":"4.5.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Integrated service models aim to improve HIV\u2013tuberculosis (TB) comorbidity management, yet little is known about how frontline providers perceive adherence challenges under China\u2019s Integrated Prevention and Control of Four Diseases (IPC4D) policy. This mixed-methods study explored healthcare workers\u2019 assessments of adherence, perceived barriers, and policy effects in Liangshan Prefecture\u2014a high-burden, resource-limited, multi-ethnic region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between May and June 2025, an online survey of 492 healthcare workers and 30 in-depth interviews were conducted. Quantitative data were analyzed using descriptive statistics and ordinal logistic regression [odds ratios (ORs), 95% confidence intervals (CIs)]; qualitative data underwent thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 64.0% of respondents rated patient adherence as \u201cgood\u201d or \u201cvery good,\u201d yet intermittent medication use (50.4%), unsupervised discontinuation (43.7%), and missed follow-ups (37.8%) remained common. Key perceived barriers included low health literacy (86.8%), regimen complexity (62.8%), side effects (61.2%), financial burden (59.8%), and limited family support (52.2%). Female respondents were less likely to report high adherence (OR\u202f=\u202f0.57, 95% CI: 0.36\u20130.91), while clinicians (OR\u202f=\u202f2.67, 95% CI: 1.35\u20135.31) and those in infectious disease departments (OR\u202f=\u202f2.38, 95% CI: 1.23\u20134.64) reported more favorable assessments. Standardized adherence assessment correlated with lower reported adherence (OR\u202f=\u202f0.16, 95% CI: 0.09\u20130.28), whereas institutional efforts to reduce financial burden were linked to higher adherence (OR\u202f=\u202f1.78, 95% CI: 1.02\u20133.11). Qualitative findings highlighted persistent stigma, socioeconomic barriers, and mixed experiences with IPC4D implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Healthcare workers recognize IPC4D\u2019s value in improving coordination and access but report enduring multilevel barriers. Strengthening policy impact requires standardized adherence monitoring, socioeconomic support, workforce development, and culturally sensitive patient education.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1704215","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T06:39:14Z","timestamp":1764743954000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["A mixed-methods study on healthcare workers\u2019 perceptions of treatment adherence among HIV-TB co-infected patients in a multi-disease prevention policy context"],"prefix":"10.3389","volume":"13","author":[{"given":"Ruili","family":"Bi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingwei","family":"Dou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Pei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunnong","family":"Jike","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifei","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"ref1","volume-title":"Global tuberculosis report 2024","year":"2024"},{"key":"ref2","volume-title":"Tuberculosis","year":"2025"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e32811","DOI":"10.1097\/md.0000000000032811","article-title":"Predictors of death among TB\/HIV co-infected patients on tuberculosis treatment in Sichuan, China: a retrospective cohort study","volume":"102","author":"Yang","year":"2023","journal-title":"Medicine"},{"key":"ref4","volume-title":"China health statistics yearbook","year":"2025"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1136\/bmjresp-2024-002801","article-title":"6-month regimen of isoniazid prevention therapy for tuberculosis among people living with human immunodeficiency virus in minority areas of China: a 3-year prospective cohort study","volume":"11","author":"Li","year":"2024","journal-title":"BMJ Open Respir Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1186\/s12879-024-09328-7","article-title":"Association between TB delay and TB treatment outcomes in HIV-TB co-infected patients: a study based on the multilevel propensity score method","volume":"24","author":"Liao","year":"2024","journal-title":"BMC Infect Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1186\/s12879-024-09683-5","article-title":"Mortality and associated factors among patients with TB-HIV co-infection in Ethiopia: a systematic review and meta-analysis","volume":"24","author":"Moges","year":"2024","journal-title":"BMC Infect Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1186\/s12913-023-09748-2","article-title":"Models of integration of TB and HIV services and factors associated with perceived quality of TB-HIV integrated service delivery in O. 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