Effect of public-private interface agency in Patna and Mumbai, India: Does it alter durations and delays in care seeking for drug-sensitive pulmonary tuberculosis?

Abstract

Background: Public–private interface agency (PPIA) intervention models in Patna (E. India) and Mumbai (W. India) for pulmonary drug-sensitive (DS) tuberculosis (TB) patients were evaluated over 2 years after maturity to examine effect on reduction of patient pathways and retention. The models engaged private providers, diagnostic facilities and pharmacies into an effective network providing free diagnostic tests and treatment. Methods: A population-based retrospective study was undertaken to assess effectiveness of the PPIA model in care pathways of 64 (Patna) and 86 (Mumbai) patients through in-depth interviews conducted within 6 months of initiation treatments to identify types and facilities accessed, duration to diagnosis and treatment. Median durations based on facilities accessed were statistically analysed. Comparisons were made with baseline values and endline pathways of patients accessing PPIA engaged/non-engaged facilities in private and public sectors. Results: Compared to non-engaged facilities, persons accessing engaged facilities at first point-of-care had shorter pathways (Mumbai: 32 vs 43 days), (Patna: 15 vs 40 days). Duration for first care-seeking was considerably shorter for patients accessing PPIA in Patna and for both engaged and non-engaged private facilities in Mumbai (4 days). Whilst PPIA engaged facilities diagnosed more cases than others, the RNTCP in Mumbai provided diagnosis early. There was good retention of patients by PPIA-engaged (1st) facilities (90% post-diagnosis in Patna) but this was affected by the hub-spoke referral system in Mumbai (13%). Second diagnosis is a common feature in Mumbai. The spoke-hub model in Mumbai contributed considerably to treatment delay; PPIA-engaged providers were better at retaining patients post treatment initiation 11/25 (44%). Conclusion: PPIA-engaged facilities, accessed at onset, result in marked reduction in pathway durations. Such initiatives should engage a critical mass of competent providers, proximal investigation facilities with enhanced disease awareness and literacy efforts amongst communities. Patient movement should be minimized for early treatment and retention.

Understanding dynamics of private tuberculosis pharmacy market: a qualitative inquiry from a South Indian district

“…States of Gujarat and Maharashtra have experimented with the setting up of a private provider interface agency to facilitate engagement of RPPs in the NTEP. 52 Investing in public provider support agency 19 that responds to pharmacists’ profit making is needed, while promoting the optimal delivery of healthcare services needs to be prioritised.…”

“…It is imperative that the symbiotic relations existing between PPs, medical representatives and RPPs should be closely scrutinised for any kind of engagement to meet public health goals. States of Gujarat and Maharashtra have experimented with the setting up of a private provider interface agency to facilitate engagement of RPPs in the NTEP 52. Investing in public provider support agency19 that responds to pharmacists’ profit making is needed, while promoting the optimal delivery of healthcare services needs to be prioritised.…”

Tuberculosis research: Quo vadis

“…In operations research, the engagement of the private sector has become a key theme in recent times taken up on a global basis through the formation of public-private learning networks led by McGill University in Toronto. The Public Private Interface Agency (PPIA) introduced by the Gates Foundation in India around 2015 showed some early gains for patients accessing a PPIA-engaged physician at the first point of call ( 22 ). Whether this has translated to its successor, the Private Provider Support Agency (PPSA) overseen by the Government of India, remains to be evaluated.…”

Case fatality and recurrent tuberculosis among patients managed in the private sector: A cohort study in Patna, India

“…One solution for improved quality of care in the private sector lies in Private Provider Interface Agencies (PPIAs) which have been successfully implemented in multiple regions in India [ 6 ]. Early evidence suggests that PPIAs have been effective in increasing TB case notifications, increasing rates of TB testing, and improving treatment completion rates [ 7 , 8 ].…”