Research article

Barriers for introducing HIV testing among tuberculosis patients in Jogjakarta, Indonesia: a qualitative study

Yodi Mahendradhata^1,2 , Riris Andono Ahmad¹ , Pierre Lefèvre² , Marleen Boelaert² and Patrick Van der Stuyft²

¹  Department of Public Health, Faculty of Medicine, Gadjah Mada University, Sekip Utara 55281, Jogjakarta, Indonesia

²  Epidemiology and Disease Control Unit, Public Health Department, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium

author email corresponding author email

BMC Public Health 2008, 8:385doi:10.1186/1471-2458-8-385

Published:	12 November 2008

Abstract

Background

HIV and HIV-TB co-infection are slowly increasing in Indonesia. WHO recommends HIV testing among TB patients as a key response to the dual HIV-TB epidemic. Concerns over potential negative impacts to TB control and lack of operational clarity have hindered progress. We investigated the barriers and opportunities for introducing HIV testing perceived by TB patients and providers in Jogjakarta, Indonesia.

Methods

We offered Voluntary Counselling and Testing (VCT) to TB patients in parallel to a HIV prevalence survey. We conducted in-depth interviews with 33 TB patients, 3 specialist physicians and 3 disease control managers. We also conducted 4 Focus Group Discussions (FGDs) with nurses. All interviews and FGDs were recorded and data analysis was supported by the QSR N6^® software.

Results

Patients' and providers' knowledge regarding HIV was poor. The main barriers perceived by patients were: burden for accessing VCT and fear of knowing the test results. Stigma caused concerns among providers, but did not play much role in patients' attitude towards VCT. The main barriers perceived by providers were communication, patients feeling offended, stigmatization and additional burden.

Conclusion

Introduction of HIV testing among TB patients in Indonesia should be accompanied by patient and provider education as well as providing conditions for effective communication.