title: Cross-referral between HIV counselling and testing centres and smear microscopy centres in Tamil Nadu.
abstract: BACKGROUND
  The combined tuberculosis and human immunodeficiency virus (TB-HIV) epidemic demands effective and urgent action.
  
  
  OBJECTIVE
  To assess the effectiveness of the system of referral of TB suspects from the integrated HIV counselling and testing centres (ICTCs) to the designated microscopy centres (DMCs) in Tamil Nadu, and to identify reasons for dropping out.
  
  
  METHODS
  ICTC counsellors identified TB suspects among clients (excluding pregnant women and children) in six districts of Tamil Nadu in 2007 and referred them to DMCs, irrespective of their HIV status. From the records at ICTCs and DMCs, we collected information on the number of referrals to the DMCs, TB suspects attending DMCs and smear-positive TB cases with or without HIV. Clients who did not attend the DMCs were interviewed to elicit reasons for dropping out.
  
  
  RESULTS
  Of 18329 clients counselled, 1065 (6%) were identified as TB suspects and referred to DMCs. Of these, 888 (83%) attended and 177 (17%) dropped out; 81% of the drop-outs were interviewed. Reasons for dropping out were multiple: 51% were due to the health system, 62% due to the disease and 62% due to personal reasons. Twelve per cent of DMC attendees were smear-positive.
  
  
  CONCLUSIONS
  The ICTC-to-DMC referral system makes a significant contribution to the detection of TB cases. Reasons for dropping out were multiple, but are correctable. This study also probes into current policies on programme coordination and recommends strategies for strengthening the collaboration between the TB and HIV programmes.
authors.affiliation: Tuberculosis Research Centre, Indian Council of Medical Research, Chennai, India. rajerama@yahoo.com
authors.forename: R
authors.initials: R
authors.lastname: Ramachandran
authors.forename: V
authors.initials: V
authors.lastname: Chandrasekaran
authors.forename: M
authors.initials: M
authors.lastname: Muniyandi
authors.forename: K
authors.initials: K
authors.lastname: Jaggarajamma
authors.forename: A
authors.initials: A
authors.lastname: Bagchi
authors.forename: S
authors.initials: S
authors.lastname: Sahu
mesh_terms: D003140:Communicable Disease Control / Q000379:methods / Q000458:organization & administration*; D003153:Community Health Services / Q000379:methods / Q000458:organization & administration*; D015897:Comorbidity; D003376:Counseling / Q000458:organization & administration; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007194:India; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*