Mahendradhata Yodi, Ahmad Riris Andono, Lefèvre Pierre, Boelaert Marleen, Van der Stuyft Patrick
Department of Public Health, Faculty of Medicine, Gadjah Mada University, Sekip Utara 55281, Jogjakarta, Indonesia.
BMC Public Health. 2008 Nov 12;8:385. doi: 10.1186/1471-2458-8-385.
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.
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.
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.
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.
在印度尼西亚，艾滋病毒（HIV）与HIV-结核病合并感染情况正缓慢增加。世界卫生组织建议对结核病患者进行HIV检测，作为应对HIV-结核病双重流行的关键措施。对结核病控制潜在负面影响的担忧以及操作上的不明确阻碍了进展。我们调查了印度尼西亚日惹市结核病患者和医疗服务提供者对引入HIV检测的障碍和机遇。
在进行HIV患病率调查的同时，我们为结核病患者提供了自愿咨询检测（VCT）服务。我们对33名结核病患者、3名专科医生和3名疾病控制管理人员进行了深入访谈。我们还与护士进行了4次焦点小组讨论（FGD）。所有访谈和FGD均进行了录音，数据分析得到QSR N6软件的支持。
患者和医疗服务提供者对HIV的了解较差。患者认为的主要障碍包括：获得VCT的负担以及对知晓检测结果的恐惧。耻辱感引起了医疗服务提供者的担忧，但在患者对VCT的态度方面作用不大。医疗服务提供者认为的主要障碍包括沟通、患者感到被冒犯、耻辱感以及额外负担。
在印度尼西亚的结核病患者中引入HIV检测时，应同时开展患者和医疗服务提供者教育，并提供有效沟通的条件。
