Implementation Fidelity of Provider-Initiated HIV Testing and Counselling of Tuberculosis Patients under the National Tuberculosis Control Program in Nepal: A Mixed Method Research

Randeep Kumar, dr. Yanri Wijayanti Subronto Ph.D., Sp.PD.; dr. Ari Natalia Probandari, MPH, Ph.D

2018 | Tesis | S2 Ilmu Kesehatan Masyarakat

Background: National Tuberculosis Program is implementing Provider-Initiated HIV Testing and Counseling (PITC) in response to the high HIV prevalence among Tuberculosis (TB) patients and in an attempt to increase the uptake of HIV testing and Anti Retroviral Therapy (ART). However, there was only seven and seventeen percent utilization status by TB patients in 2015 and 2016 respectively. This study aimed to assess the implementation fidelity of PITC program among Tuberculosis Patients under Tuberculosis Control Program in Kathmandu district of Nepal. Methods: This study used sequential explanatory mixed method design to accomplish the study�s objectives. Retrospective cross-sectional study was conducted using TB registers in 5 DOTS centres for patients diagnosed with TB from July 2016 to June 2017. A qualitative study was conducted to explore the barriers and enablers of PITC services implementation. Results: A total 643 TB patients were registered out of which 591 (92%) patients were offered HIV test counselling. Amongst the offered ones, 571 (96.62%) accepted and then 523 (91.59%) undertook the test. HIV positive result was found to be 3.4 percent (22/643) in the study population and ART uptake was 100 (22/22) percent. Service provider�s knowledge regarding HIV was assessed as good but only 2 out of 5 had participated in TB/HIV related training. The key barriers experienced by service provider were: patients feeling offended, stigmatization and lack of human resource in DOTS centre. The main enablers for PITC were national TB program commitment, good commodities supply, a collaboration between NTP & NCASC, and support of external development partners. Conclusion: PITC services are apparently well integrated into some DOTS centres through TB control programme. The key challenges are; lack of TB/HIV related training opportunity for service providers, proper recording & reporting and monitoring of PITC program activities from a higher level.

Background: National Tuberculosis Program is implementing Provider-Initiated HIV Testing and Counseling (PITC) in response to the high HIV prevalence among Tuberculosis (TB) patients and in an attempt to increase the uptake of HIV testing and Anti Retroviral Therapy (ART). However, there was only seven and seventeen percent utilization status by TB patients in 2015 and 2016 respectively. This study aimed to assess the implementation fidelity of PITC program among Tuberculosis Patients under Tuberculosis Control Program in Kathmandu district of Nepal. Methods: This study used sequential explanatory mixed method design to accomplish the study�s objectives. Retrospective cross-sectional study was conducted using TB registers in 5 DOTS centres for patients diagnosed with TB from July 2016 to June 2017. A qualitative study was conducted to explore the barriers and enablers of PITC services implementation. Results: A total 643 TB patients were registered out of which 591 (92%) patients were offered HIV test counselling. Amongst the offered ones, 571 (96.62%) accepted and then 523 (91.59%) undertook the test. HIV positive result was found to be 3.4 percent (22/643) in the study population and ART uptake was 100 (22/22) percent. Service provider�s knowledge regarding HIV was assessed as good but only 2 out of 5 had participated in TB/HIV related training. The key barriers experienced by service provider were: patients feeling offended, stigmatization and lack of human resource in DOTS centre. The main enablers for PITC were national TB program commitment, good commodities supply, a collaboration between NTP & NCASC, and support of external development partners. Conclusion: PITC services are apparently well integrated into some DOTS centres through TB control programme. The key challenges are; lack of TB/HIV related training opportunity for service providers, proper recording & reporting and monitoring of PITC program activities from a higher level.

Kata Kunci : TB, HIV, PITC, DOTS, Fidelity, Implementation Research, Nepal