Integrating tb-hiv services in community health centers in Kulon Progo District

Titi Supriati(1*), Yodi Mahendradhata(2), Ari Probandari(3)

(*) Corresponding Author


Background: Indonesia is a country with a high burden of tuberculosis and the human immunodeficiency virus. In response, countries adopted WHO recommendations on integrated services, including diagnostic screening and care for TB-HIV patients. Kulon Progo seeks to improve services under existing health system resources, and it is very important to understand its capacity to provide integrated TB-HIV services.

Objective: This study aims to assess the readiness of TB-HIV integrated services in Puskesmas for the health system in the Kulon Progo Regency.

Method: The research method uses mixed methods explanatory sequential design. The unit of analysis is the Puskesmas. Observation of the availability and readiness of TB services and cross-sectional HIV services using SARA modified questionnaires, followed by in-depth interviews exploring barriers and opportunities for integration of TB-HIV services at the Puskesmas.

Results: Puskesmas service readiness, 93.3% (95% CI; 92.7% -93.9). Puskesmas had the readiness to provide basic health services, 63.8% (95% CI, 60.7-66.8). Puskesmas TB service readiness, 80.9% (95% CI: 73.6–88.2) HIV test counseling service readiness, only 1 Puskesmas (4.7%) has readiness for both services. Based on the domain assessment, 40.4% of the Puskesmas had trained TB diagnosis and treatment officers, 61.9% had trained officers and HIV testing counseling guidelines. The dominant themes include non-supportive staffing, not optimal human resource capacity, the lack of coordination and teamwork, and lack of monitoring and supervision system. With the support of leaders and good policies to mobilize funding, the availability of facilities becomes an opportunity for integrated TB-HIV services to run.

Conclusion: Towards readiness to integrate TB-HIV services under the TB-HIV collaboration recommendation, efforts to address the needs of the number of health workers and equip staff with knowledge and skills as capacity building to manage integrated care. The involvement and support of the leadership of the determinants of readiness to ensure the availability of facilities, diagnostic supplies, and medicines as a continuous implementation.


Readiness; Integration; TB; HIV; community health centers


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