The health service network in Parsa district faces challenges in addressing TB-HIV co-infection due to limited collaboration between government and NGO-run facilities. While 14 sites provide DOTS services and 4 offer VCT services, only Narayani Sub-Regional Hospital integrates both, along with ART and PMTCT. Most sites lack trained staff, resources, and comprehensive TB-HIV services under one roof. Poor referral systems, inadequate coordination, and low community awareness further hinder efforts. Despite these gaps, confidentiality is well-maintained, and there is strong recognition of the need for collaborative interventions to improve TB-HIV care in the region.