Barriers to HIV testing among TB patients: a case of Machakos district, Kenya
MetadataShow full item record
Human Immunodeficiency Virus infection (HIV) is fuelling tuberculosis (TB) infection tremendously and changing the pattern of this bacterial disease drastically that even good control programs are not sufficient in containing TB where HIV prevalence is high. The Centres for Diseases Control (CDC) recommended universal HIV testing among all patients presenting with AIDS-defining illness including TB for access to comprehensive care and thus, standard care. Four (4) major health facilities offering TB services in Machakos, a rural district in Kenya, East of Nairobi city were used to study the pattern of offer of HIV counseling and testing, the decline to receive the test and the awareness levels of TB/HIV association among TB patients. This was a cross-sectional study using a researcher-administered questionnaire to collect data. The main objective of the study was to determine the reasons for low uptake of HIV testing among TB patients. A questionnaire was administered to each of the sampled 312 TB patients consecutively on exit after service delivery. Machakos District was purposively chosen for this study because it has a high TB burden in Kenya and was one of the only 2 pilot districts that the CDC was supporting for universal HIV DTC in Kenya. Despite the CDC recommendations, in this study it was found that only 73% of TB patients were offered the HIV testing and that only 65% were eventually tested for HIV infection in Machakos District. It was observed that the main reasons for not being tested were failure by the health care providers to offer the service (59%), stigma (24.3%) and denial (8.4%). Patients from the rural set up were more unlikely to be offered the HIV test (22.6% vs. 8.6% among urban). In this study 65% of TB patients preferred HIV testing within the TB clinic and 79% felt it was their responsibility to take drugs and do not need to be supervised (DOTS). The cost of accessing ARVs in Machakos hospital was a major finding that promoted "opt - out". There was a significant association between facilities that were far from the administrative centre with less experienced staff in TB work and ' low offer for HIV testing among TB patients (25%), x = 76.916, df 3, p <_ 0.0001. Among those not offered, a significant 70 % of the respondents would have preferred DTC at the TB clinic although the health care workers did not promptly offer the opportunity (x2 = 20.736, df 3, p <_ 0.0001). A significant proportion of dually infected did not disclose their HIV status to their partners, only disclosing the TB infection, but overall there was more disclosure for HIV status than TB among the respondents (98% vs. 96%). Analysis of data was done using SPSS and Chi-square was used to test for association among variables. Correlation was used to determine the strength of the association. Level of significance was set at 0.05 and p values less than this were considered significant. From this study we concluded that the health care givers only perceive stigma and all TB patients should have been offered opportunity for HIV testing and given the right to "opt-out" if they were not ready. The findings from this study shall assist the health care providers and the NLTP to improve the standard of care to the dually infected by addressing the weaknesses. Key Words: "Opt-out", offer, decline, stigma, universal testing, comprehensive care, standard care.