Tuberculosis Management by Private Practitioners in Mumbai, India: Has Anything Changed in Two Decades?

Abstract

SettingMumbai, India. A study conducted in Mumbai two decades ago revealed the extent of inappropriate tuberculosis (TB) management practices of private practitioners. Over the years, India's national TB programme has made significant progress in TB control. Efforts to engage private practitioners have also been made with several successful documented public-private mix initiatives in place.ObjectiveTo study prescribing practices of private practitioners in the treatment of tuberculosis, two decades after a similar study conducted in the same geographical area revealed dismal results.MethodsSurvey questionnaire administered to practicing general practitioners attending a continuing medical education programme.ResultsThe participating practitioners had never been approached or oriented by the local TB programme. Only 6 of the 106 respondents wrote a prescription with a correct drug regimen. 106 doctors prescribed 63 different drug regimens. There was tendency to over treat with more drugs for longer durations. Only 3 of the 106 respondents could write an appropriate prescription for treatment of multidrug-resistant TB.ConclusionsWith a vast majority of private practitioners unable to provide a correct prescription for treating TB and not approached by the national TB programme, little seems to have changed over the years. Strategies to control TB through public sector health services will have little impact if inappropriate management of TB patients in private clinics continues unabated. Large scale implementation of public-private mix approaches should be a top priority for the programme. Ignoring the private sector could worsen the epidemic of multidrug-resistant and extensively drug-resistant forms of TB.

Did diabetes mellitus affect treatment outcome in drug-resistant tuberculosis patients in Pakistan from 2010 to 2014?

“…22 It is therefore very important for the NTP to engage the private sector in TB control. 23 The costs of quality-assured SLDs and monthly culture are usually unaffordable for patients, resulting in treatment interruption and loss to follow-up. Regulating the private sector will be challenging but vital for TB control in the country.…”

“…24 Private practitioners should be engaged, trained in NTP guidelines and encouraged to refer DR-TB patients to PMDT sites for treatment. 23 The study had several strengths. It is the first study from Pakistan to examine treatment outcomes among DR-TB patients, and as the study had a large sample size and used routinely collected data, the findings reflect programme realities.…”

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“…5 Studies from Mumbai and elsewhere have shown poor diagnosis and treatment practices among practitioners in the private health sector that contribute to acquired drug resistance. [6][7][8][9][10] To reduce TB transmission and prevent the emergence of virtually incurable forms of drug-resistant TB, TB management in the private sector must be aligned with the international standards of TB care. [6][7][8][9][10] The involvement of the private sector in India's Revised National TB Control Programme (RNTCP) is therefore crucial.…”

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“…Numerous challenges exist to effectively contain TB drug resistance [3,4,6,13,26]. The WHO policy package to combat antimicrobial drug resistance addresses AMR in a broad sense, but all principles apply fully to TB drug resistance [2,3].…”

“…The challenge is to ensure that, in all healthcare facilities where TB care is delivered, health workers rigorously follow in routine practice the quality standards that national programmes promote on paper [28]. Importantly, in many countries today, TB drugs are prescribed by private practitioners and inadequate or irregular prescription due to the inability of the patients to buy the drugs and maintain continuity of treatment are leading to development of drug resistance [26]. Therefore, engagement of all health providers is essential, as promoted within the Stop TB Strategy [29].…”