Tuberculosis management practices by private practitioners in Andhra Pradesh, India

Abstract

Setting: Private medical practitioners in Visakhapatnam district, Andhra Pradesh, India.

Objectives: To 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.

Design: Cross- sectional survey using semi-structured interviews.

Results: Of 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.

Conclusion: Few 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.

Figure 1. Box 1- Diagnostic and treatment standards in International Standards of Tuberculosis Care.

The principles of diagnostic and treatment standards in the International Standards of TB Care with their rationale and references are summarized.

Figure 2. Box 2- Decision aid for analysis.

This is a decision aid for the purpose of analysis of data; the type of question asked in the questionnaire, subject of the question and the responses which should be considered as compliant against each diagnostic and treatment standard are summarized.

Figure 3. Selection of Private Practitioners (study participants) in Visakhapatnam, Andhra Pradesh.

A master list of 3956 private practitioners was prepared from the year 2010 list of IMA*, RNTCP*** practitioners and AYUSH**. Of these 877 were excluded due to death, 195 relocated out of district, 164 non-practicing status and 486 were duplicate entries. Of the remaining 3079 practitioners, a random sample of 296 were contacted for interview. Of those contacted, 95 (32%) were non-responders, 23 did not consent for the study, 33 not reached after 3 attempts and 39 reported seeing zero TB**** patients in one year. So, Private Practitioners interviewed for compliance with TB diagnostic and treatment practices were N = 201 (68%). IMA* = Indian Medical Association; RNTCP** = Revised National TB Control Programme of India; AYUSH*** = Ayurveda, Unani, Siddha, Homeopathy; TB**** = tuberculosis.