Barriers for introducing HIV testing among tuberculosis patients in Jogjakarta, Indonesia: a qualitative study

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.Indonesia is critical to the global tuberculosis (TB) control efforts and increasingly important in the global HIV control efforts. The country ranks third in the world for TB burden [1]. The number of reported AIDS cases has increased by 15 fold in the past ten years [2]. The rapid increase of new HIV infections in Indonesia makes the epidemic one of the fastest growing in Asia, even though the aggregate national prevalence is as low as 0.16% [3]. By the end of 2007, there were 296 Voluntary Counselling and Testing (VCT) clinics throughout Indonesia, in addition to 153 hospitals which provide free antiretroviral treatment [3]. Patients with HIV-TB co-infection are appearing in hospitals and jails across several provinces and TB is a leading opportunistic infection among AIDS patients [4]. These trends suggest a potential of a dual HIV-TB epidemic, which many other developing countries, particularly in Sub-Saharan Africa are already facing.WHO Interim Policy on HIV-TB recommends HIV testing among TB patients as an entry point for integrated