Public-Private Partnership For Tuberculosis Control In India: Are The Private Practitioners Anywhere Near To Thisrntcp Sponsored Mission?

Background: Revised National Tuberculosis Control Program (RNTCP) sponsored Public Private Partnership (PPP) is undermined by poor participation by private practitioners (PPs).There is an urgent need to realizefactors influencing private practitioners’ preference of directly observed treatment short course (DOTS) for their patients. We attempted to study the knowledge and current practice characteristics of PPs while managing TB patients and to identify factors influencing their referral preferences for sputum microscopy and treatment under DOTS. Methods: This was a cross-sectional survey involving 100 allopathic medical practitioners in private sector from an urban area. A self designed and pretested questionnaire was administered to obtain data. Results: The participants on an average managed 6.15 ± 14.87 patients with tuberculosis (TB). Most of them relied on sputum microscopy for diagnosis however only 49% referred their patients to Designated microscopy centres. A significant number participants still used serological and mantoux testing for diagnosing TB. Very few participants knew correct regimens, dosage and duration of anti TB therapy but only 46% referred their patients for DOTS based treatment. Frequent use of fluoroquinolones in anti TB therapy was noted. Factors predicting referrals to DOTS were younger age of participants,recent years in clinical practice with lesser outpatient turnover and better awareness about DOTS services. TB notification rate was low (41%) possibly due to lack of awareness about procedure involved. A lack of communication was noted between RNTCP staffs and participants indicating a significant drift in the “partnership”. Conclusion: This study has highlighted fallacies in TB management in private sector and identified correctable factors leading to sluggish involvement of PPs in DOTS based management. We recommend large scale interventional studies to evolve strategies for further strengthen the Public Private Partnership.