Abstract
SettingPrivate medical practitioners in Visakhapatnam district, Andhra Pradesh, India.ObjectivesTo evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC), and factors associated with compliance with ISTC.DesignCross- sectional survey using semi-structured interviews.ResultsOf 296 randomly selected private practitioners, 201 (68%) were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6%) followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14%) private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment). Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine.ConclusionFew private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance.
Highlights
As per the World Health Organization (WHO) global TB control report 2011, India continues to bear the highest global burden of TB with an estimated 2.3 million incident cases per annum accounting for more than one-fourth of global TB incidence [1]
The Revised National TB Control Programme (RNTCP) is being implemented in the country since 1997 with complete country coverage by March 2006, with TB diagnostic and treatment services integrated throughout the public health infrastructure
Other characteristics of the private medical providers (PMP) were as follows: 84% practiced allopathic medicine and had a bachelor’s degree (MBBS); 82% had been in medical practice for 10 years or longer, with the majority solely in private practice; 81% had treated 20 or fewer TB patients in the previous year, and 43% had been sensitized in RNTCP guidelines
Summary
As per the World Health Organization (WHO) global TB control report 2011, India continues to bear the highest global burden of TB with an estimated 2.3 million incident cases per annum accounting for more than one-fourth of global TB incidence [1]. The Revised National TB Control Programme (RNTCP) is being implemented in the country since 1997 with complete country coverage by March 2006, with TB diagnostic and treatment services integrated throughout the public health infrastructure. Despite this success, India has a very large unregulated private medical sector. Effective engagement of the private sector is vital to facilitate national TB control strategies
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