Abstract
SettingPrivate practitioners are frequently the first point of healthcare contact for patients with tuberculosis (TB) in India. Inappropriate TB management practices among private practitioners may contribute to delayed TB diagnosis and generate drug resistance. However, these practices are not well understood. We evaluated diagnostic and treatment practices for active TB and benchmarked practices against International Standards for TB Care (ISTC) among private medical practitioners in Chennai.DesignA cross-sectional survey of 228 practitioners practicing in the private sector from January 2014 to February 2015 in Chennai city who saw at least one TB patient in the previous year. Practitioners were randomly selected from both the general community and a list of practitioners who referred patients to a public-private mix program for TB treatment in Chennai. Practitioners were interviewed using standardized questionnaires.ResultsAmong 228 private practitioners, a median of 12 (IQR 4–28) patients with TB were seen per year. Of 10 ISTC standards evaluated, the median of standards adhered to was 4.0 (IQR 3.0–6.0). Chest physicians reported greater median ISTC adherence than other MD and MS practitioners (score 7.0 vs. 4.0, P<0.001), or MBBS practitioners (score 7.0 vs. 4.0, P<0.001). Only 52% of all practitioners sent >5% of patients with cough for TB testing, 83% used smear microscopy for diagnosis, 33% monitored treatment response, and 22% notified TB cases to authorities. Of 228 practitioners, 68 reported referring all patients with new pulmonary TB for treatment, while 160 listed 27 different regimens; 78% (125/160) prescribed a regimen classified as consistent with ISTC. Appropriate treatment practices differed significantly between chest physicians and other MD and MS practitioners (54% vs. 87%, P<0.001).ConclusionTB management practices in India’s urban private sector are heterogeneous and often suboptimal. Private providers must be better engaged to improve diagnostic capacity and decrease TB transmission in the community.
Highlights
India accounts for approximately one-quarter of the world’s 9 million incident tuberculosis (TB) cases every year [1]
Usage of inappropriate TB diagnostic and treatment practices, and lack of adherence to the International Standards for TB Care (ISTC) continues to be documented among private practitioners in India [5,6,9,10,11], potentially contributing to delays in TB diagnosis, development of drug resistance, and ongoing TB transmission [6,10,12]
Diagnostic and treatment practices were variable in this study of qualified private practitioners who diagnosed at least one patient with TB in the past year in the urban Indian private sector
Summary
India accounts for approximately one-quarter of the world’s 9 million incident tuberculosis (TB) cases every year [1]. There are several ongoing efforts to engage and improve the quality of TB care in the private sector These include NGO-led models [13] and Private Provider Interface Agency projects in select cities [14] to engage private practitioners in TB care and the Initiative for Promoting Affordable Quality TB Tests (IPAQT) to increase availability of appropriate diagnostic tests in private laboratories [12,15]. In this context, it is helpful to assess urban private practitioners’ practices for diagnosing and treating patients with active pulmonary TB
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