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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Tuberculosis | Research article

Implementation fidelity of provider-initiated HIV testing and counseling of tuberculosis patients under the National Tuberculosis Control Program in Kathmandu District of Nepal: an implementation research

Authors: Randeep Kumar, Ari Probandari, Biwesh Ojha, Ashmin Hari Bhattarai, Yanri Wijayanti Subronto

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

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. 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.

Methods

This 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.

Results

From 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.

Conclusion

In 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.
Appendix
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Literature
1.
World Health Organization: Global Tuberculosis Report. WHO/HTM/TB/2017 WHO Report Geneva, Switzerland 2017:23.
2.
World Health Organization: Global HIV-Associated Tuberculosis Fact Sheet. WHO/HTM/TB/2017 WHO Report Geneva, Switzerland 2017.
3.
Aung MN, Moolphate S, Paudel D, PH MJ. Regional review global evidence directing regional preventive strategies in Southeast Asia for fighting TB/HIV. J Infect Dev Ctries. 2013;7(3):191–202.CrossRef
4.
National Tuberculosis Program. Implementation guidelines for TB and HIVAIDS collaboration in Nepal. National Tuberculosis Center 2013.
5.
World Health Organization: Interim policy on collaborative TB/HIV activities. WHO/HTM/TB/2004.330 Geneva, Switzerland: WHO 2004.
6.
Njozing NB, Miguel SS, Tih PM, Hurtig AK, et al. Assessing the accessibility of HIV care packages among tuberculosis patients in the northwest region, Cameroon. BMC Public Health. 2010;10:129.CrossRef
7.
Achanta S, Kumar AMV, Nagaraja SB, Jaju J, et al. Feasibility and effectiveness of provider initiated HIV testing and counseling of TB suspects in Vizianagaram district, South India. PLoS One. 2012;7:1–6.
8.
Vijay S, Swaminathan S, Vaidyanathan P, Thomas A, et al. Feasibility of provider-initiated HIV testing and counselling of tuberculosis patients under the TB control programme in two districts of South India. PLoS One. 2009;4:1–7.CrossRef
9.
National Tuberculosis Program. Annual report. National Tuberculosis Center, Nepal 2015.
10.
National Tuberculosis Program. Annual report. National TB Programme, Nepal 2016.
11.
12.
13.
Proctor E, Silmere H, Raghavan R, Hovmand P, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Pol Ment Health. 2011;38:65–76.CrossRef
14.
Pinnock H, Barwick M, Carpenter CR, Eldridge S, et al. Standards for reporting implementation studies (StaRI): explanation and elaboration document. BMJ. 2017;356:i6795.CrossRef
15.
World Health Organization. Service availability and readiness assessment (SARA): an annual monitoring system for service delivery. WHO 2014.
16.
Howard AA, El-Sadr WM. Integration of tuberculosis and HIV services in sub-Saharan Africa: lessons learned. Clin Infect Dis. 2010;50:S238–44.CrossRef
17.
Kebede W, Keno F, Ewunetu T, Mamo G. Acceptance of provider initiated HIV testing and counseling among tuberculosis patients in east Wollega administrative zone, Oromia regional state, Western Ethiopia. Tuberc Res Treat. 2014;2014:5–9.
18.
Ogbo FA, Mogaji A, Ogeleka P, Agho KE, et al. Assessment of provider-initiated HIV screening in Nigeria with sub-Saharan African comparison. BMC Health Serv Res. 2017;17:188.CrossRef
19.
20.
21.
Nansera D, Bajunirwe F, Kabakyenga J, Asiimwe PKJ, Kizza HM. Opportunities and barriers for implementation of integrated TB and HIV care in lower level health units: experiences from a rural western Ugandan district. Afr Health Sci. 2010;10:312–9.PubMedPubMedCentral
22.
Mahendradhata Y, Ahmad RA, Lefèvre P, Boelaert M, Van der Stuyft P. Barriers for introducing HIV testing among tuberculosis patients in Jogjakarta, Indonesia: a qualitative study. BMC Public Health. 2008;8:385.CrossRef
23.
Ayenew A, Leykun A, Colebunders R, Deribew A. Predictors of HIV testing among patients with tuberculosis in north West Ethiopia: a case-control study. PLoS One. 2010;5:1–5.CrossRef
Metadata
Title
Implementation fidelity of provider-initiated HIV testing and counseling of tuberculosis patients under the National Tuberculosis Control Program in Kathmandu District of Nepal: an implementation research
Authors
Randeep Kumar
Ari Probandari
Biwesh Ojha
Ashmin Hari Bhattarai
Yanri Wijayanti Subronto
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4343-3

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