Proportion of all registered TB patients who are tested for HIV
To assess the uptake of HIV testing by TB patients
Total number of TB patients, registered over a given time period, who are tested for HIV (after giving consent) during their TB treatment
Total number of TB patients, registered over the same given time period
Ideally all TB patients should be offered an HIV test. It is preferable that this occurs within the context of the TB service provider, in which case the HIV test can be recorded in the patient record and a modified TB register and reported quarterly with the outcome data. In some settings, however, HIV counselling and testing will be carried out in a different part of the same facility or even at a distant site. Then, a referral system will need to be established such that the TB programme records when a TB patient is referred for an HIV test, and is notified when a TB patient attends for counselling and whether or not they are tested for HIV. Such information should be collected at the TB facility level and recorded in the facility or district TB register. Patient confidentiality must be maintained. It is preferable that TB patients are tested at the start of TB treatment so that they can benefit from appropriate care throughout their TB treatment. However, some patients are reluctant to undertake an HIV test until later in their TB treatment, once they feel stronger. A recording and reporting system should be able to capture these late tests – otherwise the total number of TB patients knowing their HIV status will be underreported.
Global Fund adds: Although this indicator is similar to TB/HIV 1, Intensified TB case finding among PLWHA, which measures HIV prevalence through surveillance, this indicator measures the services’ ability to encourage HIV testing in TB patients under program conditions. If a high proportion of TB patients are tested (>80 percent) then this provides a sufficiently robust estimate of the true HIV prevalence among TB patients which can be used for surveillance purposes.
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The risk of having HIV infection is higher among TB patients than in the general population. Knowledge of HIV status can help to reduce stigma, promote safe behaviour to reduce HIV transmission and improve access to appropriate care for TB patients whether HIV-positive or HIV-negative. Health care workers caring for TB patients need to know the HIV status of their patients to ensure that they are able to provide the most appropriate treatment, care and support during the TB treatment. Every TB patient should be encouraged to give consent for an HIV test. Uptake of testing will reflect the degree to which patients understand and accept the benefits of HIV testing, how effectively staff are able persuade patients to accept testing, and the availability, accessibility and quality of HIV testing and counselling resources. This indicator gives an overall measure of the acceptability and accessibility of HIV testing to TB patients. However, there are many factors that will influence whether a TB patient has an HIV test, including patient understanding of HIV, patient socioeconomic status, accessibility of testing centre, cost of the test, counselling skills and enthusiasm of health staff, societal attitudes to HIV testing and HIV in general, and reliability of HIV test supplies. If the indicator value is high this suggests that the system as a whole is likely to be working well; however, a low indicator value provides no indication of where the problem lies. If the indicator value is very high it is possible that TB patients are somehow coerced into having HIV tests or that adequate consent is not sought for the test. The indicator gives no information on whether a patient receives his or her test result or appropriate post-test counselling, both of which are crucial if any behaviour change is to be achieved to reduce HIV transmission.