Factors Influencing Utilisation of Diagnostic Counselling and Testing for HIV among Tuberculosis Patients at Monze Mission Hospital, Zambia

Abstract

Background: Tuberculosis (TB) and human immunodeficiency virus (HIV) constitute the main burden of infectious disease in resource-limited Countries6. Persons infected with HIV are particularly susceptible to tuberculosis, both from the reactivation of latent infection and from new infection with rapid progression to active disease8. An individual who is HIV-positive has 10 times increased risk of developing TB compared to an HIV-negative person the lifetime risk is 50% for an HIV-positive person and 5–10 percent for an HIV-negative9. Estimates by the World Health Organization (WHO) indicate that there are more than 9 million new active cases of TB and close to 2 million deaths per year and that 2.6 million new cases of HIV infection and 1.8 million AIDS-related deaths occur per year6. TB programmes have focused on TB case finding and treatment, with little attention to HIV/AIDS interventions. According to David, (2004) untreated HIV infection leads to increased susceptibility to infections including TB. Currently, global estimates show that about 42 million people are HIV infected and almost one third are also infected with TB (WHO, 2005). The dual epidemics of TB and HIV are particularly pervasive in Africa, where HIV has been the single most common factor contributing to the incidence of TB over the last 10 years. TB and HIV are also a growing concern in Asia, where TB accounts for 40 percent of AIDS deaths (WHO, 2005).Therefore, HIV testing is particularly important in TB because mortality among HIV-infected TB patients is reduced if ART are provided (WHO, 2007). Main objective: To explore factors influencing utilization of Diagnostic Counselling and Testing for HIV among TB patients. Design:.A hospital-based cross-sectional study was carried out to assess the utilization of Diagnostic Testing and Counselling for Human Immune Virus/Acquired Immune Deficiency among tuberculosis patients. Zambia. Research design: A non-experimental which is exploratory study design was used in this study. The study employed a quantitative approach because little is known about DCT utilization. Research setting: The study was undertaken at Monze Mission Hospital chest clinic as it was selected purposively because of the convenience and ease accessibility to the facilities. It was also chosen on the basis that it conducts TB programmes on a daily basis and records showed low utilization of DCT services for HIV among TB patients. Study population: Men and women aged between 18 and 49 years will be included in the study as the above age group may give consent to DCT (MOH/NAC, 2006). The study will require 226 patients to participate. Sample: The sample size was calculated using the Epi- info version 6.0 statistical. The sampling frame will comprise all TB patients visiting chest clinic at the time of the study and who meet the set criteria. The participants were selected using simple random sampling method. The sample size was calculated basing on Krejcie and Morgan's18 formula for calculating sample size of a finite population. The calculated sample size comprised 226 participants. Inclusion criteria: TB patients within Monze Hospital aged between 18 and 49 years. This group was appropriate because it is sexually active and at risk of contracting TB and HIV infection. Patients will include those who are not critically ill to avoid withdraw before the end of the study. In addition, patients who will consent to participate in the study will be enrolled in the study. Exclusion criteria: TB patients outside Monze catchment referred to the chest clinic will not be included in the study because they may withdraw from the study due to distance. Patients aged less than 18 or more than 49 years who are referred to the ART sites for DCT will also not participate in the study. They may not consent to participate as they may think they are young or old to be at risk of contracting TB and HIV infection. Patients who will not consent or volunteer to participate in the study will be freely left out. Data collection tools and technique: Data was collected using a questionnaire. A structured interview schedule was used to collect socio-demographic data, measured variables and entering results of all the participants under study. Pretest: The tool was pre-tested on TB patients at Chikuni Mission Hospital. This hospital was selected because it has similar characteristics as the actual research site. Validity and reliability: A semi-structured interview schedule was used to capture data on demographic characteristics and factors results. The interview schedule was developed based on the World Health Organization (WHO) stepwise survey (STEPS) instrument 22. The same instruments were used on all the patients to ensure reliability and validity. Statistical analyses were carried out using IBM® SPSS® Statistics for Windows Version 20.0 (IBM Corp. Armonk, NY, and USA). The frequencies and descriptive statistics of the variables were calculated. Ethical considerations: Ethical approval and permission was sought from ERESConverge Ethics Committee. Main outcome measures: Diagnostic Counselling and Testing utilization among tuberculosis was assessed to determine the level of uptake. An interview schedule was used to assess utilization and determine the relationships among the factors. Results: The level of knowledge and confidentiality were statistically associated with DCT.Overall (n=226), majority 150(66.3%) of the patients did not utilize diagnostic counselling and testing services while 76 (33.6%) utilized diagnostic counselling and testing. The odds ratio of confidentiality was OR 0.52-1.637 and P-value 0.050 while level of knowledge; OR was 0.719-45.785 and P-value was 0.048 and the variables were statistically significantly associated with Diagnostic Counselling and Testing. The study showed that the patients who did not utilize DCT had 47% decrease in the odds of achieving high level of knowledge and confidentiality were less than 0.05 and therefore failed to reject the null hypothesis. Multivariate binary logistic regression model predicted that confidentiality and knowledge were associated with DCT at p-value of 0.05. Conclusion: Diagnostic Counselling and Testing utilization were low in the study population. Level of knowledge and confidentiality were the factors found to be associated with diagnostic testing and counselling. The findings suggest the need for information, education and communication as patients lack information on the importance of tuberculosis patients taking up the test.