The Role of Private Doctor and Private-Public Mix Systems in Tuberculosis Detection in Developing Countries: A Systematic Review

Abstract

Background: Despite the significant efforts in tuberculosis (TB) management, TB case detection remains a challenge in developing countries. Traditional methods such as Directly Observed Treatment Short-course (DOTS) have often underperformed, necessitating the implementation of the public-private mix (PPM) strategy in recent decades. However, varied PPM models yielded varied results across different countries. Hence, this systematic review assesses the effectiveness of various PPM models and seeks innovative strategies to enhance TB detection.

Methods: A systematic search was conducted using PubMed, Scopus, Embase, and Web of Science up to August 2024. Studies evaluating the efficacy of PPM models on TB case detection in developing countries were pooled. From the initial 731 potential studies, a total of 10 studies were finally included in this systematic review.

Results: The review identified a variety of PPM interventions, including mass campaigns, mobile screening units, home-based tracking, and digital CXR examination. These approaches significantly raised tuberculosis detection rates compared to control groups or previous years. Notably, private sector involvement and novel approaches, such as application-based tracking in Vietnam and mobile vans equipped with digital X-rays in India, yielded favorable results. However, the variation in effectiveness rate underscored the importance of personalized approaches based on local contexts.

Conclusion: PPM models, especially those with innovative techniques, significantly enhance TB case detection. Scaling up and modifying these strategies to various country circumstances is critical to meeting global TB reduction targets.

Keywords: Developing countries; Public-private mix; Systematic review; Tuberculosis.

Fig. 1:

PRISMA flow diagram