Assessment of the implementation of TB/HIV collaborative activities of the south east zone in Uganda.
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Introduction and Background: Uganda like other sub Saharan African countries is battling with a dual epidemic of TB and HIV. About 60% of TB patients are co-infected with HIV, while about 20% of HIV patients have TB disease. The ministry of health launched the TB/HIV collaboration policy in may 2006 to scale up the implementation of TB/HIV activities. However, the status of implementation is not fully known but is thought to be low. The 2006 annual report of the national TB and leprosy programme (NTLP) of south east (SE) zone shows that only 25% of the TB patients were offered HCT against the national target of 100%. Objective: To assess the status of implementation of TB/HIV collaborative implementation activities in the SE zone of the NTLP in Uganda, so as to recommend ways to improve TB/HIV care services. Methodology: A cross sectional study was carried out in four districts of the NTLP SE zone. A total of 60 health facilities (all hospitals, HCIVs and HCIIIs) that were expected to offer TB/HIV collaborative services were included in the study. Data were collected using pre-coded interview questionnaires from the 60 facilities and 19 key informants were interviewed. Findings: Policy guidelines were available in 35 of 60 health facilities while 24 out of the 60 health facilities had at least one trained HIV counsellor. Only 10 of the 60 health facilities had professional laboratory staff. Less than half of the 60 facilities had stocked co-trimoxazole, antiretrivirals, condoms, HIV test kits, RHZE and ZN test reagents. The index of availability of drugs indicated the mean number of key drugs of 0.38 while that of supplies was 0.3, both is low. Based on Z scores most (40 out of 60) of the health facilities were categorised as either above average (21) or average (19) while 20 (HCIIIs) were categorised as below average. The poorly implemented TB/HIV collaborative activities which are implemented in less than 50% in all health facilities include IPT (5%), ARVs (18%), HCT (36%), HIV/AIDS support (36%), PMTCT (38%), TB/HIV planning (43%) and TB register (49%). Conclusion: Although the implementation of TB/HIV collaborative activities at most health facilities in the SE zone are either above average or average, there are still health facilities categorised as below average especially the HCIIIs. Recommendations: The ministry of health and stake holders should support the implementation of TB/HIV collaborative activities especially at HCIIIs, activities to support include dissemination of TB/HIV policy guidelines, logistics management system, training, supervision and delegation of laboratory work to microscopists through task shifting.