title: What are the reasons for poor uptake of HIV testing among patients with TB in an Eastern India District?
abstract: BACKGROUND
  National policy in India recommends HIV testing of all patients with TB. In West Bengal state, only 28% of patients with TB were tested for HIV between April-June, 2010. We conducted a cross-sectional survey to understand patient, provider and health system related factors associated with low uptake of HIV testing among patients with TB.
  
  
  METHODS
  We reviewed TB and HIV program records to assess the HIV testing status of patients registered for anti-TB treatment from July-September 2010 in South-24-Parganas district, West Bengal, assessed availability of HIV testing kits and interviewed a random sample of patients with TB and providers.
  
  
  RESULTS
  Among 1633 patients with TB with unknown HIV status at the time of diagnosis, 435 (26%) were tested for HIV within the intensive phase of TB treatment. Patients diagnosed with and treated for TB at facilities with co-located HIV testing services were more likely to get tested for HIV than at facilities without [RR = 1.27, (95% CI 1.20-3.35)]. Among 169 patients interviewed, 67 reported they were referred for HIV testing, among whom 47 were tested. During interviews, providers attributed the low proportion of patients with TB being referred and tested for HIV to inadequate knowledge among providers about the national policy, belief that patients will not test for HIV even if they are referred, shortage of HIV testing kits, and inadequate supervision by both programs.
  
  
  CONCLUSIONS
  In West Bengal, poor uptake of HIV testing among patients with TB was associated with absence of HIV testing services at sites providing TB care services and to poor referral practices among providers. Comprehensive strategies to change providers' beliefs and practices, decentralization of HIV testing to all TB care centers, and improved HIV test kit supply chain management may increase the proportion of patients with TB who are tested for HIV.
authors.affiliation: Office of the World Health Organization (WHO) Representative in India, WHO Country Office, New Delhi, India.
authors.forename: Bipra
authors.initials: B
authors.lastname: Bishnu
authors.forename: Sudipto
authors.initials: S
authors.lastname: Bhaduri
authors.forename: Ajay M V
authors.initials: AM
authors.lastname: Kumar
authors.forename: Eleanor S
authors.initials: ES
authors.lastname: Click
authors.forename: Vineet Kumar
authors.initials: VK
authors.lastname: Chadha
authors.forename: Srinath
authors.initials: S
authors.lastname: Satyanarayana
authors.forename: Sreenivas Achutan
authors.initials: SA
authors.lastname: Nair
authors.forename: Devesh
authors.initials: D
authors.lastname: Gupta
authors.forename: Quazi T
authors.initials: QT
authors.lastname: Ahmed
authors.forename: Silajit
authors.initials: S
authors.lastname: Sarkar
authors.forename: Durba
authors.initials: D
authors.lastname: Paul
authors.forename: Puneet
authors.initials: P
authors.lastname: Dewan
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000458:organization & administration / Q000706:statistics & numerical data*; D008875:Middle Aged; D011933:Reagent Kits, Diagnostic / Q000706:statistics & numerical data / Q000600:supply & distribution; D012017:Referral and Consultation; D012424:Rural Population; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*
chemical_list: D011933:Reagent Kits, Diagnostic