Barriers to utilisation of provider initiated HIV counseling and testing services among tuberculosis patients;a case of rhodes chest clinic Nairobi, Kenya

Abstract

Tuberculosis (TB) is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis. TB continues to be one of the most important global public health threats and in countries with epidemics particularly those in Sub-Saharan Africa, the majority of TB patients are also infected with HIV. Some patients are aware of the strong correlation between TB and HIV, and once the diagnosis of TB is made, many live with the anxiety of believing that they might be infected with HIV. Such strong associations plus the need to provide comprehensive care and prevent new transmission offer compelling reason for testing TB patients for HIV. Provider initiated HIV counseling and testing is a key component of both HIV care and prevention but uptake is currently low. Few studies have identified barriers to HIV counseling and testing uptake among TB patients.

The objective of the study was to determine the barriers to utilization of provider initiated HIV counseling and testing services among TB patients. To achieve this, a cross sectional survey ofTB suspects visiting chest clinic was conducted. Consenting patients who visited the clinics during that period were the study subjects. Data was collected through structured interviews with TB patients visiting the facility using a standard questionnaire and direct observation. The quantitative data was analyzed using descriptive statistics. These include tables, frequencies, percentages, ranks, mean scores and standard deviation.

A chi square test (2x2 contingency table) was used to interpret results for each possible barrier in terms of utilized versus declined to utilize HIV counseling and testing services. The test was considered to be statistically significant if the P-value was < O.OS. Despite the WHO 2007 recommendations for Provider Initiated HIV counseling and testing, it was found that 83 % of TB patients tested for HIV infection. The main reasons for not being tested were that they don't trust confidentiality (fl Lv'zs), fear of positive test results (11.9%), fear of discrimination (10.4%), fear of being stigmatized (9.0%), self perception oflow risk (7.S%), don't see the importance of the test (6.0%) and fear to cope with dual diagnosis (4.S%) (i=29.473, 9 df, p=0.030).

Factors that were significantly associated with utilization of PITC services were age (i=I1.319,2df,p=0.003), gender (i=S.919,ldf,p=0.0IS), level of education (i=116.04S,2df,p=0.0001), HIV stigma (i=36.947,3df,p=0.0001), awareness ofHIV-TB link (i=22.767,2df,p=0.0001), delay in offering counseling services (i=7S.48,ldf,p=0.0001) and discussion ofHIV/ TB link by nurse (i=S9.232,2df,p=0.0001). The NLTP, NACC and TBIHIV Partners should scale up community awareness about HIV - TB co infection and train all providers on collaborative HIV - TB services. Advocacy for HIV screening for all TB patients should also be increased.