Referral process in tuberculosis − Human immunodeficiency virus collaborative activities – Need for a relook into policy implementation in Uttarakhand

Abstract

Background: Provider-initiated testing and counselling (PITC), an essential component of tuberculosis (TB) human immunodeficiency virus (HIV) collaborative activities, is intended to translate into the increased rates of HIV testing in TB patients. Aim: The study intends to assess compliance with the referral process and other attributes of HIV testing in TB patients. Methods: The study was conducted at various designated microscopy centres (DMCs) in four randomly selected districts in the Garhwal region of Uttarakhand and included 346 patients. Results: Only 46.8% of patients went for HIV testing. The most common reason cited for not going was the absence of specific advice by the health staff at DMC. In addition, the long waiting time at Integrated Counselling and Testing Centres favoured the spread of infection to susceptibles in the waiting area. Binary logistic regression analysis also found that patient's importance towards HIV testing, advice by the health worker and higher education and age were significant predictors of HIV testing. Conclusions: The referral process at DMC requires closer monitoring and supervision for improvement in qualitative parameters. Training and supportive supervision of health staff at DMC for 'counselling' of patients during referral for testing are also necessary to preserve the essence of PITC.