Adherence to international standards of tuberculosis care guidelines among private practitioners, Chennai, Tamilnadu, India, 2016–2017

Abstract

Background: Tuberculosis (TB) prevalence in Indian city of Chennai, located in Tamil Nadu, is higher than national average. Around 80% of TB patients in Chennai, approach private practitioners for first consultation. International standards for TB care (ISTC) recommends sputum examination as gold standard for diagnostics, contact tracing, screening for HIV, diabetes comorbidities, case notification and Isoniazid prophylaxis treatment (IPT). We did a study to describe the adherence to ISTC recommended treatment practices among private doctors and factors associated with adherence. Methods and materials: We did a cross-sectional analytical study between August 2016 and August 2017. We did multistage cluster sampling in the 15 zones of Chennai. We needed a sample of 225 doctors, assuming prevalence of adherence to ISTC diagnostic practices as 63%, with 10% as margin of error and 95% confidence level. We used semi-structured questionnaire for interview. We calculated proportions for adherence to ISTC guidelines. We did a multivariate analysis to calculate adjusted odd ratio (AOR) with 95% confidence interval (95% CI) to identify factors associated with adherence to ISTC guidelines. Results: Among 225 doctors interviewed, 140 were males (62%) and majority were in 30–39 years (44%) age group. Sputum examination as gold standard for diagnosis was practised by 58% (n = 130) of doctors and was associated with exposure to RNTCP training (AOR = 1.9, 95% CI = 1.1–3.5). Contact tracing was practiced by 38% (n = 85) and adherence was associated with age of doctors above 40 years (AOR = 3.1, 95% CI = 1.2–7.9). While screening for HIV and Diabetes was practiced by 63% (n = 142) and 65% (n = 146) respectively, being in government service (AOR = 2, 95% CI = 1.04–3.9) and exposure to RNTCP training (AOR = 2, 95% CI = 1.03–3.9) were associated with screening. Case notification was practiced by 65% (n = 146) and adherence was associated with RNTCP training (AOR = 3, 95% CI = 1.5–6.1) and awareness about mandatory notification (AOR = 8, 95% CI = 2.4–26.6). Awareness about IPT prophylaxis was 32% (n = 73) and was associated with exposure to RNTCP training (AOR = 2.2, 95% CI = 1.1–4.3). Conclusion: Adherence to ISTC guidelines among private practitioners was low. Training in RNTCP was associated with adherence. We recommend RNTCP training for all private practitioners.