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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

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...

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Autores principales: Kumar, Randeep, Probandari, Ari, Ojha, Biwesh, Bhattarai, Ashmin Hari, Subronto, Yanri Wijayanti
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679426/
https://www.ncbi.nlm.nih.gov/pubmed/31375112
http://dx.doi.org/10.1186/s12913-019-4343-3
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author Kumar, Randeep
Probandari, Ari
Ojha, Biwesh
Bhattarai, Ashmin Hari
Subronto, Yanri Wijayanti
author_facet Kumar, Randeep
Probandari, Ari
Ojha, Biwesh
Bhattarai, Ashmin Hari
Subronto, Yanri Wijayanti
author_sort Kumar, Randeep
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4343-3) contains supplementary material, which is available to authorized users.
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spelling pubmed-66794262019-08-06 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 Kumar, Randeep Probandari, Ari Ojha, Biwesh Bhattarai, Ashmin Hari Subronto, Yanri Wijayanti BMC Health Serv Res Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4343-3) contains supplementary material, which is available to authorized users. BioMed Central 2019-08-02 /pmc/articles/PMC6679426/ /pubmed/31375112 http://dx.doi.org/10.1186/s12913-019-4343-3 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kumar, Randeep
Probandari, Ari
Ojha, Biwesh
Bhattarai, Ashmin Hari
Subronto, Yanri Wijayanti
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
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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679426/
https://www.ncbi.nlm.nih.gov/pubmed/31375112
http://dx.doi.org/10.1186/s12913-019-4343-3
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