Counseling and testing TB patients for HIV: Evaluation of three implementation models in Kinshasa, Congo
Kinshasa, Democratic Republic of Congo.
To evaluate the implementation of three models of provider-initiated HIV counseling and testing (CT) for tuberculosis (TB) patients.
HIV CT was offered to all TB patients aged > or =18 months registered for treatment at three project clinics between August 2004 and June 2005. HIV CT was performed at the TB clinic, the health center or the freestanding voluntary counseling and testing (VCT) center. HIV-infected patients received cotrimoxazole prophylaxis.
Uptake of HIV CT was high (95-98%) when performed at the TB clinic or primary health care center, but significantly lower (68.5%) among patients referred to a free-standing VCT center. The overall HIV prevalence among the 1088 patients tested for HIV was 18.8%. HIV was associated with female sex (aOR 1.91), recurrent TB (aOR 2.74), extra-pulmonary TB (aOR 1.97) and age.
Implementation of provider-initiated routine HIV CT by the TB nurse or health care worker at the primary health care center results in a higher uptake compared to referral of patients with TB to freestanding VCT clinics. Provider-initiated HIV CT is only a first step and needs to be linked to access to HIV care, support and treatment.
Available from: Wakjira Kebede
- "In this study there is a high acceptance of PITC (92.5%) among TB patients. The study results that were not comparable with the previous studies conducted in Addis Ababa (capital city of Ethiopia) and Arba Minch (south nation, nationality people) among TB patients showed 66.6% and 73%, respectively [13, 14]. This difference may relate to the recent introduction of free life-saving antiretroviral therapy at selected health centers throughout Ethiopia. "
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ABSTRACT: Human immunodeficiency virus (HIV) is a powerful risk factor for the development of tuberculosis. This study assessed the acceptance and associated factors that can affect provider initiated HIV testing and counseling (PITC) among tuberculosis patients at the East Wollega administrative zone, Oromia regional state, western Ethiopia, from January to August, 2010. A single population proportion formula is used to calculate the total sample size of 406 and the cluster sampling technique was used to select 13 health centers that provide PITC services. The sample size was proportionally allocated to each health center. The study participants were selected using a simple random sampling technique using the lottery method. Structured questionnaire was used for collection of sociodemographic data. From the total of study subjects, 399 (98.2%) TB patients were initiated for HIV test and 369 (92.5%) patients accepted the initiation. Of those, 353 (95.5%) patients had taken HIV test and received their results. According to the reviewed documents, the prevalence of HIV among tuberculosis (TB) patients in the study area was 137 (33.7%). The logistic regression result showed the PITC was significantly associated with their knowledge about HIV (AOR = 3.22, 95% CI: 1.3-7.97), self-perceived risk (AOR = 2.93, 95% CI: 1.12-7.66), educational status (AOR = 3.51, 95% CI: 1.13-10.91), and knowledge on transmission of HIV/AIDS (AOR = 7.56, 95% CI: 1.14-40.35) which were significantly associated with the acceptance of PITC among TB patients. Therefore, this study's results showed, the prevalence of HIV among TB patient was high; to enhance the acceptance of PITC among TB patients, health extension workers must provide health education during home-to-home visiting. TB treatment supervisors also provide counseling intensively for all forms of TB patients during their first clinical encounter.
Available from: Helena Legido-Quigley
- "For example, in Malawi, introduction of a daily TB/HIV clinic where all TB patients were tested for HIV and referred for HIV care in the same physical area increased ART uptake from 10% to 30% (Chan et al. 2009). Two studies compared the outcomes or impacts of different models of care (Miti et al. 2003; Van Rie et al. 2008). For example, a cross-sectional study in rural DRC compared three models of HIV testing for TB patients (TB clinic vs. primary health centre where the TB clinic was based vs. referral to a free-standing HIV testing centre ) and found that testing uptake was higher in test onsite models (97.7% in TB clinic, 94.8% in primary health centre) than the referral model (68.5%; "
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Given the imperative to scale up integrated tuberculosis (TB) and HIV services in settings where both are of major public health importance, we aimed to synthesise knowledge concerning implementation of TB/HIV service integration.
Systematic review of studies describing a strategy to facilitate TB and HIV service integration, searching 15 bibliographic databases including Medline, Embase and the Cochrane library; and relevant conference abstracts.
Sixty-three of 1936 peer-reviewed articles and 70 of 170 abstracts met our inclusion criteria. We identified five models: entry via TB service, with referral for HIV testing and care; entry via TB service, on-site HIV testing, and referral for HIV care; entry via HIV service with referral for TB screening and treatment; entry via HIV service, on-site TB screening, and referral for TB diagnosis and treatment; and TB and HIV services provided at a single facility. Referral-based models are most easily implemented, but referral failure is a key risk. Closer integration requires more staff training and additional infrastructure (e.g. private space for HIV counselling; integrated records). Infection control is a major concern. More integrated models hold potential efficiencies from both provider and user perspective. Most papers report 'outcomes' (e.g. proportion of TB patients tested for HIV); few report downstream 'impacts' such as outcomes of TB treatment or antiretroviral therapy. Very few studies address the perspectives of service users or staff, or costs or cost-effectiveness.
While scaling up integrated services, robust comparisons of the impacts of different models are needed using standardised outcome measures.
Available from: Owen Mugurungi
- "Patients have embraced PITC which is perceived to have resulted in healthier people living with HIV through timely access to appropriate treatment. The acceptability of PITC among patients has been reported in other countries in Sub-Saharan Africa [6,8,10,29]. The negative aspects that patients reported about the programme (eg incomplete information giving during counselling) can be solved by resolving challenges with human resources. "
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ABSTRACT: Provider-initiated HIV testing and counselling (PITC) is widely recommended to ensure timely treatment of HIV. The Zimbabwe Ministry of Health introduced PITC in 2007. We aimed to evaluate institutional capacity to implement PITC and investigate patient and health care worker (HCW) perceptions of the PITC programme.
Purposive selection of health care institutions was conducted among those providing PITC. Study procedures included 1) assessment of implementation procedures and institutional capacity using a semi-structured questionnaire; 2) in-depth interviews with patients who had been offered HIV testing to explore perceptions of PITC, 3) Focus group discussions with HCW to explore views on PITC. Qualitative data was analysed according to Framework Analysis.
Sixteen health care institutions were selected (two central, two provincial, six district hospitals; and six primary care clinics). All institutions at least offered PITC in part. The main challenges which prevented optimum implementation were shortages of staff trained in PITC, HIV rapid testing and counselling; shortages of appropriate counselling space, and, at the time of assessment, shortages of HIV test kits. Both health care workers and patients embraced PITC because they had noticed that it had saved lives through early detection and treatment of HIV. Although health care workers reported an increase in workload as a result of PITC, they felt this was offset by the reduced number of HIV-related admissions and satisfaction of working with healthier clients.
PITC has been embraced by patients and health care workers as a life-saving intervention. There is need to address shortages in material, human and structural resources to ensure optimum implementation.
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