Perceptions of Private Medical Practitioners on Tuberculosis Notification: A Study from Chennai, South India

Abstract

BackgroundThe Government of India declared TB as a notifiable disease in 2012. There is a paucity of information on the government's mandatory TB notification order from the perspective of private medical practitioners (PPs).ObjectiveTo understand the awareness, perception and barriers on TB notification among PPs in Chennai, India.MethodsTotal of 190 PPs were approached in their clinics by trained field staff who collected data using a semi-structured and pre-coded questionnaire after getting informed consent. The data collected included PPs' specialization, TB management practices, awareness about the TB notification order, barriers in its implementation and their suggestions to improve notification.ResultsOf 190 PPs from varied specializations, 138 (73%) had diagnosed TB cases in the prior three months, of whom 78% referred these patients to government facilities. Of 138 PPs, 73% were aware of the order on mandatory TB notification, of whom 46 (33%) had ever notified a TB case. Of 120 PPs, 63% reported reasons for not notifying TB cases. The main reasons reported for not notifying were lack of time (50%), concerns regarding patients' confidentiality (24%) and fear of offending patients (11%). Of 145 PPs, 76% provided feedback about information they felt uncomfortable reporting during notification. PPs felt most uncomfortable reporting patient's government-issued Aadhar number (77%), followed by patient's phone number (37%) and residential address (26%). The preferred means of notification was through mobile phone communication (24%), SMS (18%) and e-mail (17%).ConclusionThis study highlights that one-fourth of PPs were not aware of the TB notification order and not all those who were aware were notifying. While it is important to sensitize PPs on the importance of TB notification it is also important to understand the barriers faced by PPs and to make the process user-friendly in order to increase TB notification.

Perception of private practitioners towards diagnosis and treatment of tuberculosis in Hubballi city, India

“…11 This leads to delay diagnosis and spread on infection in community .Knowledge regarding RNTCP guidelines for case detection is likely to help in early diagnosis and cost reduction in TB management. 13 Similar reason was stated for referral by Hurtig et al in study conducted in Nepal. 10 Lack of affordability can lead discontinuation of treatment and lack of system for supervision of follow up among PPs can lead increased treatment default rate and emergence of drug resistance.…”

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

“…Private sector participation in E-NIKSHAY is low but slowly gaining momentum [26,27]; our study therefore reflects a time period before a substantial increase in private sector notifications, when they had been historically very low. Only 38,596 TB patients were notified to the government by the private sector in 2013 [16], and, since treatment outcome data for these patients are not available, we exclude them from the cascade.…”

Involving private practitioners in the Indian tuberculosis programme: a randomised trial

“…Raising awareness, collection of notification forms right at PP clinics and constant dialogue between RNTCP staff and PPs had no effect on notification in our study. Studies trying to understand the barriers to notification in India reported that not all PPs have fully understood the notification's rationale and that, although aware, many do not notify, the main reasons being lack of time, concerns regarding patients’ confidentiality and lack of trust in the government health system . Ensuring notification without legal backup seems difficult.…”