Abstract
BackgroundThe acceptability and feasibility of provider-initiated HIV testing and counseling (PITC) in many settings across Asia with concentrated HIV epidemics is not known. A pilot study of the PITC policy undertaken within the public health care systems in two districts in India offered the opportunity to understand patient's perspectives on the process of referral for HIV testing and linking to HIV treatment and care.MethodsWe conducted a cross-sectional study of randomly selected TB patients registered by the TB control program between July and November 2007 in two districts in south India. Trained interviewers met patients shortly after TB diagnosis and administered a structured questionnaire. Patients were assessed regarding their experience with HIV status assessment, referral for counseling and testing, and for HIV-infected patients the counseling itself and subsequent referral for HIV treatment and care.ResultsOf the 568 interviewed TB patients, 455 (80%) reported being referred for HIV testing after they presented to the health facility for investigations or treatment for TB. Over half the respondents reported having to travel long distances and incurred financial difficulties in reaching the Integrated Counselling and Testing Centre (ICTC) and two-thirds had to make more than two visits. Only 48% reported having been counseled before the test. Of the 110 HIV-infected patients interviewed, (including 43 with previously-known positive HIV status and 67 detected by PITC), 89 (81%) reported being referred for anti-retroviral treatment (ART); 82 patients reached the ART centre but only 44 had been initiated on ART.ConclusionsThis study provides the first evidence from India that routine, provider-initiated voluntary HIV testing of TB patients is acceptable, feasible and can be achieved with very high efficiency under programmatic conditions. While PITC is useful in identifying new HIV-infected patients so that they can be successfully linked to ART, the convenience and proximity of testing centres, quality of HIV counseling, and efficiency of ART services need attention.
Highlights
The human immunodeficiency virus (HIV) epidemic has the potential to worsen the tuberculosis (TB) epidemic, as has occurred in certain African countries [1]
This paper describes the findings from this survey of TB patients, focusing on understanding patient’s perspectives on the whole process of referral for HIV testing, linkage to HIV treatment and care and the challenges they encountered
At Integrated Counselling and Testing Centre (ICTC), pre- and post-test counseling is provided for all clients; free HIV testing is conducted by rapid test kits using a 3-test algorithm [13]
Summary
The human immunodeficiency virus (HIV) epidemic has the potential to worsen the tuberculosis (TB) epidemic, as has occurred in certain African countries [1]. HIV diagnosis among TB patients could serve as an entry point for HIV care and treatment, thereby preventing significant morbidity and mortality. This would be expected to improve TB treatment outcomes as well [2,3]. The World Health Organization [7], the Joint United Nations Programme on HIV/AIDS and the International Standards for Tuberculosis Care (2005) recommend providing counseling services and HIV testing for every TB patient in a country with high HIV seroprevalence in the general population [7,8,9,10]. A pilot study of the PITC policy undertaken within the public health care systems in two districts in India offered the opportunity to understand patient’s perspectives on the process of referral for HIV testing and linking to HIV treatment and care
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