Abstract:
Background
Tuberculosis (TB) is the most common opportunistic infection and the number one cause of
death in HIV/AIDS patients in developing counties. In Sub Saharan Africa four fold rise in TB
cases related to HIV epidemic has been reported while in Tanzania a six fold rise of TB cases
has been observed .. The World Health Organization formulated an interim policy in 2004 to
guide member states in implementing collaborative TBIHIV activities that was also adopted
by Tanzanian Government. Intensified TB case finding is among the three strategies to
reduce burden of TB among People Living with HIV (PLHIV), however since its
implementation 2007 in Tanzania there has been no information with regard to its quality and
actual practice in HIV care and treatment clinics thus this study was carried out to fill this gap.
Methods
To assess the quality of intensified TB case finding among PLHIV attending public and
private HIV/AIDS care and treatment clinics a cross sectional descriptive study was
undertaken in 432 randomly selected PLHIV in Ilala Municipality, Dar es Salaam, Tanzania.
The study used three tools, checklist to assess resources and interview health workers, an exit
interview and case review guide to PLHIV and their files respectively to assess structure,
process and outcome components of quality of intensified TB case finding as per Tanzanian
National guideline.
Result
Overall it was found that intensified TB case finding was implemented in 43.5% of both
public and private clinics the majority (64.4%) of PLHIV screened were from public clinics
compared to those registered in private clinics (22.7%) and the difference was statistically
significant (p value < 0.05). The prevalence of TB disease was 11.6%. The number of trained
physicians (47.4%) and structural resources required for TB screening were inadequate in both
clinics with exception of adult TB screening tools. Most Physicians (83%) reported to have
different forms to feel which hinder their performance. Few (27.1 %) PLHIV were aware of
intensified TB case finding with varying experience and satisfaction of PLHIV between public
and private clinics.
Conclusion
The overall quality ofIntensified TB case finding in HIV/AIDS care and treatment clinics was
poor and more pronounced in private clinics. More collaborative effort is recommended
between National TB and Leprosy Programme and National AIDS Control Program to ensure
at least 90% of staff in Care and Treatment clinics (CTC) receive TBIHIV training. Also TB
screening tool needs to be integrated into CTC2 forms in order to alleviate the challenge of
poor documentation.
