Engaging Informal Private Health Care Providers for TB Case Detection: Experiences from RIPEND Project in India.

Santosha Kelamane,Amera Khan,Vishnuvardhan Kamineni,Vikas Panibatla,Srinath Satyanarayana,Sharath Burugina Nagaraja,Rajeesham Rajeesham,Ramesh Dasari,Karl Drlica

doi:10.1155/2021/9579167

Abstract

Background Informal (unqualified) health care providers are an important source of medical care for persons with presumptive TB (PPTB) in India. A project (titled RIPEND) was implemented to engage informal providers for the identification of PPTBs and TB patients in 4 districts of Telangana State, India, during October 2018-December 2019 project period. Engagement involved sensitizing the informal providers about TB, providing them financial incentives to identify PPTBs, and linking these PPTBs to diagnostic and treatment services provided by the Government of India's National TB Elimination Programme. Objectives To describe (a) the characteristics of the informal providers, along with their self-reported practices on TB diagnosis, treatment, and challenges encountered by the RIPEND project staff in engaging them in the project and (b) the outputs and outcomes of this engagement. Methods We used a combination of one-on-one interviews with informal providers, group interviews with RIPEND project staff, and secondary analysis of data available within the project's recording and reporting systems. Results A total of 555 informal providers were actively engaged under the project. The majority (87%) had a nonmedicine-related graduate degree and had been providing medical care for more than 10 years. Most (95%) were aware that a cough for 2 weeks or more is a symptom of pulmonary TB and that such patients should be referred for sputum-smear microscopy at a government health facility. Challenges in engaging the informal providers included motivating them to participate in the study, suboptimal mobile usage for referral services, and delays in providing financial incentives to them for referring PPTBs. During the project period (October 2018-December 2019), 8342 PPTBs were identified of which 1003 TB patients were detected and linked to TB treatment services. Conclusion This project showed that engaging informal providers is feasible and that a large number of PPTB and TB patients can be identified through this effort. The Government of India should consider engaging informal providers for the early diagnosis of TB to reduce the missing TB cases in the country.

Highlights

India accounts for nearly 27% of the global tuberculosis (TB) burden [1]
The study describes the process, challenges, outputs, and outcomes of a project that was aimed towards engaging the informal providers
Through this project, ~555 informal providers were engaged, and through them, 8342 presumptive TB (PPTB) were identified and subjected to diagnostic tests, of which 1003 persons were diagnosed with TB and all the patients were initiated on treatment according to programme guidelines

Summary

Introduction

India accounts for nearly 27% of the global tuberculosis (TB) burden [1]. Despite the efforts of the Government of India’s Revised National TB Control Programme (RNTCP) over the past couple of decades, TB continues to be a major public health problem. It is sometimes thought that the quality of care is compromised by informal care providers and that this often leads to delayed diagnosis and inappropriate treatment [10] It is important for a national health programme to have a greater accessibility and deeper penetrability in the community. Engagement involved sensitizing the informal providers about TB, providing them financial incentives to identify PPTBs, and linking these PPTBs to diagnostic and treatment services provided by the Government of India’s National TB Elimination Programme. Challenges in engaging the informal providers included motivating them to participate in the study, suboptimal mobile usage for referral services, and delays in providing financial incentives to them for referring PPTBs. During the project period (October 2018-December 2019), 8342 PPTBs were identified of which 1003 TB patients were detected and linked to TB treatment services. The Government of India should consider engaging informal providers for the early diagnosis of TB to reduce the missing TB cases in the country

Methods

Results

Conclusion