KESIAPAN INTEGRASI LAYANAN TB-HIV PUSKESMAS DI KABUPATEN KULON PROGO

READINESS FOR INTEGRATION OF TB-HIV SERVICES IN KULON PROGO DISTRICT

Abstract

Background: Indonesia is one of the countries with a high burden of TB and HIV. In response, countries adopted collaborative TB-HIV
guidelines which recommending integrated services including diagnostic screening and care for TB-HIV patients. In Kulon Progo, only
half of the target achieved for HIV testing on TB patients and efforts to improve services under the existing health system resources.
Therefore, it is very important to understand its capacity to provide integrated TB-HIV services.
Objective: This study aimed to assess the readiness for integration of TB-HIV services at the Puskesmas for the health system in Kulon Progo District.
Methods: The research used mixed methods explanatory sequential design. The unit of analysis was the Puskesmas. Crosssectional observations using a modified SARA questionnaire followed by in-depth interviews explored the barriers and opportunities
for integration of TB-HIV services at the Puskesmas were conducted.
Results: Overall from 21 Puskesmas, 93.3% (95% CI; 92.7%-93.9) Puskesmas had readiness to provide basic health services, 63.8%
(95% CI, 60.7–66.8) Puskesmas had TB service readiness, 80.9% (95% CI: 73.6–88.2) Puskesmas had readiness for HIV testing counseling services, only 1 Puskesmas (4.7%) had good readiness for
both services. Based on the domain assessment, only 40.4% of Puskesmas have trained staff in TB diagnosis and treatment and
61.9% of Puskesmas have trained personnel and guidance on HIV testing counseling. Leadership involvement had a positive effect
on strengthening integration readiness, while negative responses from access to knowledge and training weaken service integration readiness.
Conclusion: Puskesmas had good readiness for general services and HIV counseling services. However, readiness for TB services
was suboptimal, only one puskesmas had readiness in the good category for both services. Leadership involvement coordinates
the two services and directs management support to strengthen integration readiness. Trained staff and the availability of TB-HIV guidelines must be met to support the integration of TB-HIV services.