Tuberculosis diagnostic and treatment practices in private sector: Implementation study in an Indian city

Chadha, V. K.; Bhalla, Bhoomika Bajaj; Ramesh, Sowmya; Gupta, J.; Nagendra, N.; Padmesh, R.; Ahmed, Javed; Srivastava, R. K.; Kumar, Ravi; Praseeja, P.

doi:10.1016/j.ijtb.2018.06.010

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…This is consistent with examples from PPP in the Asia Pacific focussed on adult health where private providers had access to free essential medicines and diagnostics, access to training and supervision, and branding to align the provider with the national program and generate demand. [25][26][27][28][29][30][31][32][33][34][35][36][37][38] This is also consistent with approaches more globally. [39] By contrast, incentives for the public sector were often less well articulated and/ or more altruistic (improved services for adolescents), but identifying these benefits were nonetheless important to ensuring enhanced partnership.…”

Section: Discussionsupporting

confidence: 81%

Key recommendations to strengthen public-private partnership for adolescent health in resource constrained settings: Formative qualitative inquiry in Mongolia, Myanmar and the Philippines

Azzopardi

Hennegan

Prabhu³

et al. 2021

The Lancet Regional Health - Western Pacific

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Background Public health services can be inaccessible for adolescents. The private sector provides many services, but often in parallel to the public sector. This study aimed to understand current private sector engagement in adolescent health service delivery and develop recommendations to strengthen partnerships. Methods The study focussed on Mongolia, Myanmar and the Philippines. An initial participatory workshop in each country was followed by semi-structured key-informant interviews (32 in total) with public and private sector actors and adolescents to explore: perceptions of the public and private sectors, strengths and challenges, existing models of partnership, and insights for successful public-private partnership (PPP). Interview transcripts were analysed thematically, with findings and recommendations verified through a second workshop in Mongolia and the Philippines. Findings The private sector already plays a significant role in adolescent health care, and stakeholders reported a genuine willingness for partnership. Strengthened PPP was identified as necessary to improve service accessibility and quality for adolescents, unburden the public sector and introduce new technologies, with advantages for the private sector including improved access to training and resources, and an enhanced public image. Recommendations for strengthened PPP included the need to establish the foundations for partnership, clearly define roles and co-ordinate stakeholders, ensure capacity and sustainability, and monitor and evaluate efforts. Interpretation This is the first comprehensive study of public-private partnership for adolescent health in the Asia Pacific region. It identifies stakeholders are willing for stronger partnerships and the benefits this partnership will bring. We define eight key recommendations to enable this partnership across sectors.

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Section: Discussionsupporting

confidence: 81%

Key recommendations to strengthen public-private partnership for adolescent health in resource constrained settings: Formative qualitative inquiry in Mongolia, Myanmar and the Philippines

Azzopardi

Hennegan

Prabhu³

et al. 2021

The Lancet Regional Health - Western Pacific

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“…The present study found almost half of practitioners prescribing drug‐susceptible PTB regimen as per guidelines, whereas it was reported as 35%, 52%, 61% and 78% in Andhra Pradesh, Mangalore, Mumbai and Chennai, respectively 6,18,21,22 . A study in Bangalore city found only 20% of private practitioners prescribing standard guidelines for both PTB and EPTB regimen 23 . A study among private practitioners (including nonallopathic) in Pune found that 26% of them prescribing fluoroquinolones for newly diagnosed TB patients 17 .…”

Section: Discussioncontrasting

confidence: 55%

‘We are not aware of notification of tuberculosis’: A mixed‐methods study among private practitioners from western India

Rupani

Shah

Dave

et al. 2021

Health Planning & Management

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Background Implementing the Standards for tuberculosis care in India (STCI) guidelines in the private sector is vital. This study attempted to estimate the knowledge and practices regarding STCI guidelines among private practitioners and to explore the reasons and solutions for low tuberculosis (TB) notification rates. Methods We conducted a cross‐sectional study for assessing the knowledge and practices of the STCI guidelines among 100 full‐time allopathic private practitioners in Bhavnagar (in western part of India) from September 2018 to January 2019. Knowledge and practice were categorised as good or poor by assigning scores to the responses to a questionnaire based on the STCI guidelines. It was followed by two focus group discussions to explore the reasons and solutions for low notification rates of TB as perceived by private practitioners. Results Among the 100 private practitioners, 55% had good knowledge, and 41% had good practice regarding the STCI guidelines; 69% knew about the gazette notification of mandatory notification of TB, and 58% were notifying TB cases to the government. Lack of awareness about the process as well as incentives for notification, time constraints and infrequent visits by health workers were the main reasons perceived by private practitioners for not notifying TB cases to the government. The critical solutions suggested by them were creating awareness regarding the notification process as well as incentives, increasing health worker visits and use of social media for notification. Conclusion Only about half of private practitioners follow the STCI guidelines for TB care, and the notification rates are low in our setting. Regular sensitisation programs need to be arranged for private practitioners to create awareness on TB notification.

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“…Of the 29 studies reporting treatment success (27, 29, 31, 33, 35–37, 41, 43–45, 51–54, 56, 57, 60, 62, 65, 66, 68, 73, 75, 77, 78, 81, 83, 89), 17 (60.7%) reported rates >=85%. Figure 2 plots the estimates from 21/28 studies (for which 95% CIs were reported or could be estimated), according to PPM model type.…”

Section: Resultsmentioning

confidence: 99%

“…The interface models achieved a treatment success rate close to 90% more consistently than the direct models, although given the heterogeneity of the studies, it was not possible to draw conclusions. Ten studies compared favourable and/ or unfavourable treatment outcomes (treatment success, default, failure, mortality) for PPM Directly Observed Treatment Short course (DOTS) provision with public DOTS/private non-DOTS during the study period (27, 29, 31, 37, 44, 62, 65, 68, 78, 81). The majority (8/10) reported comparable or better outcomes with the implementation of PPM models (Table 1 and Appendix 7).…”

Section: Resultsmentioning

confidence: 99%

Public–Private Mix (PPM) for Tuberculosis (TB) in Urban Health Systems in Least Developed, Low Income and Lower-Middle-Income Countries and Territories – A Systematic Review

Vidyasagaran,

Siqueira,

Kakchapati

et al. 2024

Preprint

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Objective To assess the impact of Public-Private Mix (PPM) models for Tuberculosis (TB) diagnosis and treatment on health, process, and system outcomes within urban contexts of least developed, low Income, and lower-middle-income countries and territories (LMICs). Design Systematic review. Study selection Ten electronic databases and research repositories, covering published and grey literature were searched on 15 August 2022. All primary studies on PPM models delivering TB services in urban health sectors of eligible countries were included. There were no restrictions applied by type of outcome measurement, publication date, or language. Data extraction and synthesis Data were extracted on COVIDENCE and quality appraisals were carried out using the Mixed Methods Appraisal Tool (MMAT). Narrative synthesis was carried out by tabulating studies according to PPM model types (direct or interface), and assessing their performance on TB health, process (including cost-effectiveness) and system outcomes. Results Of the 55 included studies, covering quantitative (n=41), qualitative (n=5), and mixed-method (n=9) designs, the majority were from South-East Asia (n=36). PPM models had overall positive results on TB treatment outcomes, access and coverage, and value for money. They also promoted and improved TB health workers' skills and service delivery. Most outcomes tended to favour interface models, albeit with considerable heterogeneity. Inconsistent implementation of NTP guidelines, uncoordinated referrals, and lack of trust among partners were identified as areas of improvement. Evidence was lacking on involvement of informal providers within PPM models. Conclusions PPM models can be effective and cost-effective for TB care in urban LMIC contexts, particularly when levels of mistrust between public and private sectors are addressed through principles of equal partnership. The evidence indicates that this may be more achievable when an interface organisation manages the partnership. Study registration PROSPERO CRD42021289509.

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Tuberculosis diagnostic and treatment practices in private sector: Implementation study in an Indian city

Cited by 5 publications

References 10 publications

Key recommendations to strengthen public-private partnership for adolescent health in resource constrained settings: Formative qualitative inquiry in Mongolia, Myanmar and the Philippines

Key recommendations to strengthen public-private partnership for adolescent health in resource constrained settings: Formative qualitative inquiry in Mongolia, Myanmar and the Philippines

‘We are not aware of notification of tuberculosis’: A mixed‐methods study among private practitioners from western India

Public–Private Mix (PPM) for Tuberculosis (TB) in Urban Health Systems in Least Developed, Low Income and Lower-Middle-Income Countries and Territories – A Systematic Review

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