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

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 counselling (HTC) and TB services. 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 guidelines, focusing on key domains such as trained staff, guidelines, equipment, diagnostics, and commodities to calculate facility readiness scores. We reported the percentage for readiness scores for HTC and TB services overall and across different types of facilities. The overall readiness score for both HTC and TB services was 51%. Stand-alone HTC facilities 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. Rural location and residence 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. This study highlights critical gaps and regional 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.