Readiness of health facilities to provide HIV testing and counseling and TB services in Nepal: Findings from a 2021 Nepal Health Facility Survey

Abstract

Introduction

HIV and Tuberculosis (TB) are major public health challenges in Nepal, requiring well-prepared health systems to provide effective care. We assessed the readiness of Nepal’s health facilities to provide HIV testing and counseling (HTC) and TB services.

Methods

We conducted a secondary analysis of 359 health facilities providing HTC and TB services using data from the 2021 Nepal Health Facility Survey. We used WHO Service Availability and Readiness Assessment manual, focusing on key domains such as trained staff, guidelines, equipment, diagnostics, and medicines/commodities to calculate readiness scores. We reported the readiness scores for HTC and TB services across different types of facilities. Further, the multivariable linear regression analyses were conducted to assess the relationship between exposures and the HTC and TB service readiness.

Results

The overall readiness score for both HTC and TB services was 51 %. Stand-alone HTC centres demonstrated the highest readiness (80 %–100 %), and public hospitals also showed strong readiness for both HTC (69 %) and TB (63 %) services, particularly when equipped with quality assurance systems, routine management meetings, and external supervision. In contrast, basic health care centers and private hospitals demonstrated substantially lower readiness for HTC (47 %–48 %) and TB services (48 %–55 %). Urban facilities had higher readiness than rural facilities (53 % vs. 47 %), and readiness varied across provinces, with Sudurpashchim showing relatively higher scores. Multivariable analysis indicated that private facilities, primary health care centers, and basic health care centers had significantly lower readiness compared to public hospitals. Health facilities in rural locations and those in Karnali Province were associated with lower HTC readiness, whereas Sudurpashchim Province had higher TB readiness. Facilities performing quality assurance had higher readiness for both services, and for HTC services, those receiving external supervision in the past four months also demonstrated significantly improved readiness.

Conclusions

This study highlights critical gaps and subnational variations in HTC and TB service readiness across health facilities in Nepal. Strengthening quality assurance systems, routine supervision, and management practices is essential to improve readiness, particularly in rural areas, basic health care centers, and private hospitals. Investments in infrastructure and targeted interventions are recommended to enhance equitable access to HTC and TB services in Nepal.