Implementation of Tuberculosis and Human Immune-Deficiency Virus Programs Collaborative Services in Public-Private Mix Direct Observed Therapy Short Course Facilities in Addis Ababa, Ethiopia: Cross Sectional Facility Based Mixed Method

摘要

Background: Ethiopia is one of the countries with the highest Human Immune-deficiency Virus (HIV) and Tuberculosis (TB) infection rates in the world. To improve TB/HIV Programs outcomes through Public Private Partnership Mix (PPM) approach was in place since 2006. But the status of its implementation has never been assessed. Methods: In this cross sectional study we employed mixed methods; we interviewed 272 tuberculosis patients, reviewed their records, and facilitated six in-depth interviews and four focus group discussions. The survey was conducted from January through March 2014 in Addis Ababa. Result: Among the interviewees 51.5% were males and the mean age was (32.7 ± SD 12.4) years. PPM facilities were offering HIV counseling for all TB patients; whereas 87.5% of TB patients have received HIV testing services. The TB/HIV co-infection rate was 45.4%. And only 72.2% TB/HIV patients were enrolled into chronic disease care services, 64.8% were put on Cotrimoxazol Preventive Therapy (CPT) and 50% were put on standard highly active anti-retro viral therapy (HAART) services. All PPM facilities don’t have IPT (Isoniazid Prophylaxis Therapy). The TB/HIV collaborative services strongly linked with the public health sector which was documented by developing inclusive work plan which create access to supplies and conducting joint supportive supervisions. However, the majorities of PPM facilities don’t have Multi-Disciplinary Team and lacks some essential supplies. The predictor for uptake of CPT were: being females TB patients was 86% lower than their counter part males (AOR = 0.14; 95% CI = 0.04 - 0.92 P = 0.002), patients who has attended their TB/HIV care at private for the profit facilities were 84% lower than those attend in private not for profit facilities (AOR = 0.16; 95% CI = 0.49 - 0.55, P = 0.003). Conclusions: The TB/HIV collaborative services at program level are stronger but only half of patients didn’t get the comprehensive TB/HIV collaborative services to achieve recommended quality of care. Strengthening the services and ensuring the availability of essential supplies was highly recommended.