Bottlenecks in integrating TB and HIV services in the Philippines: a qualitative implementation research

Abstract

Background The Philippines is subdivided into 17 regions, with a devolved health system. It has a high burden of tuberculosis (TB) (554 per 100,000 population), and more than 25% increase in human immunodeficiency virus (HIV) incidence. However, years after the World Health Organization’s (WHO) recommendations on TB/HIV collaborative activities, only 24% of Filipinos with TB know their HIV status. The present study aims to describe implementation bottlenecks that hamper integration of TB and HIV services in the Philippines. Methods Ten focus group discussions with program managers, non-government organizations (NGO), patient organizations, and primary healthcare centers from different levels of the Philippine health system were conducted. Thematic analysis was used to analyze qualitative data. Results Implementation bottlenecks can be categorized into four areas: policy, operational, human resources, and patient-related factors. Mechanisms to cascade TB/HIV knowledge and policies from the national to the municipality level have been identified as barriers to integrated TB/HIV services. Double stigmatization among TB patients was also linked to poor uptake of HIV testing. Conclusion National policies and health promotion efforts need to be revisited to operationalize how information about TB/HIV policies is cascaded to the grassroots. Interventions to address double stigmatization should also be explored.