Tuberculosis Management Practices of Private Practitioners in Pune Municipal Corporation, India

<div><p>Background</p><p>Private Practitioners (PP) are the primary source of health care for patients in India. Limited representative information is available on TB management practices of Indian PP or on the efficacy of India’s Revised National Tuberculosis Control Programme (RNTCP) to improve the quality of TB management through training of PP.</p><p>Methods</p><p>We conducted a cross-sectional survey of a systematic random sample of PP in one urban area in Western India (Pune, Maharashtra). We presented sample clinical vignettes and determined the proportions of PPs who reported practices consistent with International Standards of TB Care (ISTC). We examined the association between RNTCP training and adherence to ISTC by calculating odds ratios and 95% confidence intervals.</p><p>Results</p><p>Of 3,391 PP practicing allopathic medicine, 249 were interviewed. Of these, 55% had been exposed to RNTCP. For new pulmonary TB patients, 63% (158/249) of provider responses were consistent with ISTC diagnostic practices, and 34% (84/249) of responses were consistent with ISTC treatment practices. However, 48% (120/249) PP also reported use of serological tests for TB diagnosis. In the new TB case vignette, 38% (94/249) PP reported use of at least one second line anti-TB drug in the treatment regimen. RNTCP training was not associated with diagnostic or treatment practices.</p><p>Conclusion</p><p>In Pune, India, despite a decade of training activities by the RNTCP, high proportions of providers resorted to TB serology for diagnosis and second-line anti-TB drug use in new TB patients. Efforts to achieve universal access to quality TB management must account for the low quality of care by PP and the lack of demonstrated effect of current training efforts.</p></div

Association between exposure of private providers to Public Private Mix (PPM) and self-reported TB clinical treatment and diagnostic practices that are in accordance with international standards-Pune Municipal Corporation, India 2010.

<p>*Exposed to RNTCP training- Attended training programme.</p><p>**International Standards of TB Care.</p>†<p>Odds ratio relates to doctors who adhered to guidelines, by attendance of training relative to those who did not attend.</p

Characteristics of private providers based on reported exposure to RNTCP training in Pune Municipal Corporation, India, 2010.

<p>*Exposure to RNTCP was defined as participating in a RNTCP training module of at least 4 hours at any time from 1999 through 2010.</p><p>**Revised National TB Control Programme of India.</p>+<p>Allopathy practitioner (Bachelor of Medicine and Bachelor of Surgery).</p>++<p>Doctors practicing homeopathy, Ayurveda, Unani.</p>+++<p>Number of years in clinical practice after completion of medical training.</p>†<p>Information not available for two study participants.</p

Association between exposure to Public Private Mix (PPM) and self-reported investigation methods used for diagnosis of new pulmonary TB among private providers – Pune Municipal Corporation, India, 2010.

<p>*Exposed to RNTCP training- Attended training programme.</p><p>**Odds ratio relates to doctors who reported choice of a particular investigation, by history of attendance of CME relative to those who did not attend.</p

Characteristics of private providers participating in the study – Pune Municipal Corporation, India, 2010.

+<p>Allopathy doctor (Bachelor of Medicine and Bachelor of Surgery).</p>++<p>Doctors practicing homeopathy, Ayurveda, Unani.</p>+++<p>Number of years in clinical practice after completion of medical training.</p>†<p>Information not available for two study participants.</p

Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015–2020

Objectives We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.Design A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.Setting National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.Participants Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measures We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015.Results The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra.Conclusion TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020