Assessing implementation fidelity of provider-initiated HIV testing and counselling among TB patients in Sylhet sadar, Sylhet district, Bangladesh: An Implementation Research

Tahmina Akter, Dr. Dra. Retna Siwi Padmawati, dr. Firdaus Hafidz MPH., Ph.D.

2024 | Tesis | S2 Ilmu Kesehatan Masyarakat

Background: Bangladesh is one of the 30 high TB-burden nations and 27 for MDR-TB, and accounts for 3.6% of the worldwide add up to. As per the National Guidelines on TB Management Program Collaboration & Implementation Manual there is a strategy to provide TB testing and counselling to patients with TB and HIV, this policy is already endorsed; o?er of HIV test to all TB patients in 23 high priority districts and o?er HIV test among population (KPs) in rest of the 41 districts. In order to evaluate the implementation fidelity of provider-initiated HIV testing and counseling (PITC) among TB patients in Sylhet Sadar, Bangladesh, the study assessed participant responsiveness, identifies facilitators and barriers, looks at healthcare providers' adherence to guidelines, and investigates ways to improve PITC implementation. Method: A qualitative observational study was conducted in the Sylhet District to assess the implementation fidelity of the PITC program and participants were patients with TB, PLHIV, doctors, NGO officials, community health workers, nurse, and other health workers. In total 26 participants were enrolled through purposive sampling and 14 in-depth interviews (IDI) were taken. Two FGDs were done. For the qualitative study, thematic analysis was done. Result: The results showed that healthcare practitioners adhered to PITC principles to a moderate degree, but implementation was hampered by a number of issues, such as patient reluctance because of stigma, financial limitations, and logistical obstacles. It also showed that in order to successfully implement PITC for TB patients in Sylhet Sadar, coordinated interventions aimed at both patients and clinicians are important. Conclusion: This study revealed critical gaps in awareness, significant barriers, and key facilitators affecting the implementation fidelity of PITC among TB patients in Sylhet Sadar. While NGOs played a vital role in bridging the gap between healthcare services and patients, financial constraints, logistical challenges, and social stigma impede the effective implementation of PITC.

Background: Bangladesh is one of the 30 high TB-burden nations and 27 for MDR-TB, and accounts for 3.6% of the worldwide add up to. As per the National Guidelines on TB Management Program Collaboration & Implementation Manual there is a strategy to provide TB testing and counselling to patients with TB and HIV, this policy is already endorsed; o?er of HIV test to all TB patients in 23 high priority districts and o?er HIV test among population (KPs) in rest of the 41 districts. In order to evaluate the implementation fidelity of provider-initiated HIV testing and counseling (PITC) among TB patients in Sylhet Sadar, Bangladesh, the study assessed participant responsiveness, identifies facilitators and barriers, looks at healthcare providers' adherence to guidelines, and investigates ways to improve PITC implementation. Method: A qualitative observational study was conducted in the Sylhet District to assess the implementation fidelity of the PITC program and participants were patients with TB, PLHIV, doctors, NGO officials, community health workers, nurse, and other health workers. In total 26 participants were enrolled through purposive sampling and 14 in-depth interviews (IDI) were taken. Two FGDs were done. For the qualitative study, thematic analysis was done. Result: The results showed that healthcare practitioners adhered to PITC principles to a moderate degree, but implementation was hampered by a number of issues, such as patient reluctance because of stigma, financial limitations, and logistical obstacles. It also showed that in order to successfully implement PITC for TB patients in Sylhet Sadar, coordinated interventions aimed at both patients and clinicians are important. Conclusion: This study revealed critical gaps in awareness, significant barriers, and key facilitators affecting the implementation fidelity of PITC among TB patients in Sylhet Sadar. While NGOs played a vital role in bridging the gap between healthcare services and patients, financial constraints, logistical challenges, and social stigma impede the effective implementation of PITC.

Kata Kunci : tuberculosis, HIV, fidelity, barriers, coverage.