Setting
Private
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.
Design
A
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.
Results
Among
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).
Conclusion
TB 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.
Below: Mean annual volume of patients with tuberculosis (TB) in the past year according to practitioner training among private practitioners in Chennai
Below: Distribution of aggregate practitioner-reported adherence scores to ten of the International Standards for TB Care by practitioner training in the private sector in Chennai
Full article at: http://goo.gl/ikN7R1
By:
Liza Bronner Murrison, David W. Dowdy
Department of Epidemiology,
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United
States of America
Liza Bronner Murrison, David W. Dowdy
Center for Tuberculosis
Research, Johns Hopkins University, Baltimore, Maryland, United States of
America
Ramya Ananthakrishnan, Sumanya Sukumar, Sheela Augustine,
Nalini Krishnan
REACH, Chennai, India
Madhukar Pai
McGill International TB Centre
& Department of Epidemiology, Biostatistics, and Occupational Health,
McGill University, Montreal, Quebec, Canada
More at: https://twitter.com/hiv insight
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