Challenges in HIV Screening Among Pulmonary Tuberculosis Patients as Perceived by Healthcare Workers: Mixed-Methods Study and Qualitative Synthesis of Data in Indonesia

Objective: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) remain major global health challenges, with only half of TB patients in Indonesia aware of their HIV status. Despite the World Health Organization (WHO)’s recommendations for HIV testing among TB patients, stigma and other barriers hinder implementation. This study, conducted in Sragen, Indonesia, aimed to explore the barriers to HIV screening education and testing among TB patients, drawing from qualitative studies conducted in Indonesia.Material and Methods: The study employed a mixed-methods approach, combining quantitative and qualitative data, along with a systematic literature review. A quantitative study assessed TB-HIV service readiness by surveying healthcare workers, providing insights into facility backgrounds and staff knowledge preparedness. Qualitative interviews explore healthcare providers’ goals, strategies, and challenges in educating TB patients about HIV screening, complemented by a synthesis of Indonesian journals on challenges in HIV case detection among primary pulmonary TB patients.Results: Eight participants were involved in providing TB-HIV services at their respective hospitals. Of these, only five had received TB-HIV training in the past two years, and only three had undergone training on HIV screening education. Six themes emerged from the qualitative study, including the significance of HIV screening, TB-HIV program management during the pandemic, provision of HIV testing to TB patients, challenges in HIV screening, proposed solutions, and aspirations. Data synthesis identified individual, interpersonal, and environmental factors influencing the implementation of HIV screening programs.Conclusion: Healthcare workers face challenges in providing HIV screening education to TB patients in Indonesia, including communication barriers, stigma, and limited medical support.