Abstract
In India, the private sector diagnoses and treats more patients with TB than the public sector. Gaps in the TB care cascade were observed more among the patients diagnosed in the private sector. The System for TB Elimination in Private Sector (STEPS) model evolved as a solution to address gaps in the quality of care for patients in the private sector by ensuring standards of TB care. STEPS has 3 components: a consortium of private hospitals, a coalition of all professional medical associations, and a STEPS center in each private hospital. STEPS centers act as a single window for notification, linkage for social welfare measures, contact investigation, chemoprophylaxis, direct benefit transfers, and treatment adherence support. STEPS was piloted in 14 districts in the state of Kerala. All 14 districts formed consortiums of private hospital management for policy support and a coalition of professional medical associations for advocacy with doctors. STEPS centers were established in 318 private hospitals. Notification to National TB Elimination Program from the private sector improved by 26% when compared to the previous year. Among the patients notified from the private sector, microbiologically confirmed cases increased by 81%, rifampicin resistance testing at baseline increased by 56%, and the percentage of those informed of their HIV status increased by 95%. The percentage of patients notified from the private sector with their treatment outcome reported improved from 39% (2018) to 99% (2019). The STEPS model demonstrated that a low-cost locally customized private sector engagement model is feasible and is beneficial to society. STEPS could be one of the major solutions for supporting patients reaching the private sector.
Highlights
India contributes to 26% of the global TB burden
Gaps in the TB care cascade include people with active TB not having access to correct and complete diagnosis, including diagnosis of drug resistance; people diagnosed with TB not being started on treatments; and people started on treatment not completing treatment, were observed more among patients who were diagnosed in the private sector compared to the public sector.[3,4]
Since the System for TB Elimination in Private Sector (STEPS) model was piloted, TB patient notification to National TB Elimination Program (NTEP) from the private sector in Kerala has increased by 26% in 2019 compared to 2018 from 3,981 cases to 5,003; 78% of these notifications were contributed by the STEPS centers
Summary
India contributes to 26% of the global TB burden. With 27% of the drug-resistant TB burden, India has the largest number of drug-resistant TB patients in the world.[1]. The absence of which was the major reason the Several models private sector cited not participating—there was that have not much improvement in the private sector par- successfully ticipation.[17] Operations research identified several increased private important barriers to engagement of the private case notifications sector in NTEP: absence of mutual trust between are difficult to the public and private sector, concerns over pa- expand due to tient confidentiality and patient choices, appre- lesser emphasis hension of losing patients, lack of consideration on creating lasting for hospital management, lack of time for doctors public-private to document, inability of the program to keep partnerships and commitments and timely payments, poor recognition of the private sector, and bureaucratic huge short-term hurdles.[17] financial. The STEPS strategy has 3 components (Figure 1): (1) establish STEPS Centers, (2) form a district consortium of private hospitals, and (3) form a district coalition of professional medication associations
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