Healthcare Workers' Experiences with Integrated HIV and TB Prevention in Liangshan, China: A Qualitative Exploration of Barriers and Enablers

Ruili Bi^1*Rong Pei²Chunnong Jike³Gang Yu³Ju Wang³Zhonghong Wang³Yubin Wang³Xujia Zhang²

• ¹School of Public Administration, China University of Geosciences Wuhan, Wuhan, China
• ²School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
• ³Liangshan Prefecture Center for Disease Control and Prevention, Xichang, Sichuan, China

Background: Evidence on frontline implementation of integrated HIV/TB prevention in resource-limited, ethnic minority regions remains limited. Liangshan Yi Autonomous Prefecture in Southwest China carries a dual HIV/TB burden. This study explored healthcare workers ' experiences with China's Integrated Prevention and Control of Four Diseases (IPC4D) policy to identify barriers and enablers of service integration. Methods: A qualitative phenomenological study was conducted from July to December 2024. 37 semi-structured interviews were held with purposively sampled healthcare workers across prefectural CDCs, infectious disease hospitals, county hospitals, and township health centers. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed following Braun and Clarke's six-phase framework. Reflexive memos and triangulation across facility levels, professional roles, and ethnic groups enhanced study rigor. Results: Four themes emerged. First, policy-driven progress: participants reported greater governmental support, increased resource inputs, and modest improvements in public awareness. Second, structural barriers: chronic underfunding of TB services, workforce shortages, and burnout weakened integration. Third, the multi-sectoral "1+M+N+P" model—local government leadership ("1"), township centers ("M"), village doctors and maternal – child health staff ("N"), and public security departments ("P") — expanded service reach but also generated task overload, cultural – linguistic challenges, and inter-sectoral friction. Fourth, urban–rural divergence: township providers faced more severe infrastructure gaps and patient non-adherence, often driven by stigma and financial constraints. This is a provisional file, not the final typeset article Conclusion: The IPC4D policy demonstrates potential to reduce HIV/TB disparities in Liangshan, yet sustained progress requires dedicated TB financing, culturally competent workforce training, rational task redistribution, and stigma-reduction strategies that leverage Yi community networks. These findings provide practical insights for adapting integrated disease-control policies in other high-burden, resource-constrained settings.