Abstract
BackgroundThere exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculosis (TB) patients through Provider-Initiated HIV Testing and Counseling (PITC) under the national TB control program in Nepal. The degree and quality of program delivery were explored through determining whether the PITC program is currently implemented as intended. This study aimed to assess three major components of the program’s implementation fidelity: adherence to PITC service, exposure, and quality of program delivery in order to optimize and standardize PITC implementation by exploring its barriers and enablers.MethodsThis research used a sequential explanatory mixed method design. Retrospective cross-sectional study of TB patients enrolled in five TB treatment centers of the Kathmandu district from July 1, 2016, to June 30, 2017 was done to assess PITC adherence to Direct Observed Treatment-Short Course (DOTS) protocols. The centers’ TB-DOTS readiness was assessed using the WHO Service Availability and Readiness Assessment checklist. A qualitative study was conducted to explore the barriers and enablers of PITC service implementation.ResultsFrom a total of 643 TB patients registered, 591 (92.1%) patients were offered HIV test counseling. Amongst those, 571 (96.6%) accepted and 523 (91.5%) were tested. Service providers’ HIV knowledge was found to be good although only 2/5 (40%) had participated in PITC training. The key barriers experienced by service providers were: patients feeling offended, stigmatization and lack of human resources in DOTS centers. The main enablers for PITC were national TB program commitment, health workers’ motivation, collaboration between stakeholders and external development partners’ promotion of program implementation.ConclusionIn the selected study sites, PITC services are well integrated into the routine TB control program with a high uptake of HIV testing among registered TB patients. This achievement should be sustained by addressing the identified barriers mainly in the quality of the PITC program delivery.
Highlights
There exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculosis (TB) patients through Provider-Initiated HIV Testing and Counseling (PITC) under the national TB control program in Nepal
All of the HIV infected TB patients were referred for Antiretroviral Therapy (ART) (22, 100%) (Table 2)
From the total of 643 TB patients registered in the care cascade, 591 (92%) patients were offered HIV testing and counseling (HTC)
Summary
There exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculosis (TB) patients through Provider-Initiated HIV Testing and Counseling (PITC) under the national TB control program in Nepal. A TB/HIV situation analysis in Nepal was initiated in 2006 to facilitate the development of common policies and strategies for the effective implementation of TB/HIV collaborative activities. To take advantage of this situation analysis on the strengths and to address the weaknesses of both programs, the strategic policy guidelines on collaborative TB/HIV activities in Nepal was developed in 2008. To convert policy into action, the Implementation Guidelines on TB and HIV/AIDS collaboration in Nepal was introduced in the year 2009. As per the national PITC guidelines, HIV tests are offered routinely to all TB patients registered in the Directly Observed Treatment, Short-course (DOTS) and those who are found seropositive are referred to the Antiretroviral Therapy (ART) center for assessment and initiation of ART course [4]
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