Quality of intensified tuberculosis case finding in public and private HIV-AIDS care and treatment clinics in Ilala municipality Dar es Salaam, Tanzania

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.