Dewan Puneet K, Lal S S, Lonnroth Knut, Wares Fraser, Uplekar Mukund, Sahu Suvanand, Granich Reuben, Chauhan Lakhbir Singh
International Research and Programs Branch, Division of Tuberculosis Elimination, 1600 Clifton Road, MS E-10, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
BMJ. 2006 Mar 11;332(7541):574-8. doi: 10.1136/bmj.38738.473252.7C. Epub 2006 Feb 8.
To review the characteristics of public-private mix projects in India and their effect on case notification and treatment outcomes for tuberculosis.
Literature review.
Review of surveillance records from Indian tuberculosis programme project, evaluation reports, and medical literature for public-private mix projects in India.
Project characteristics, tuberculosis case notification of new patients with sputum smear results positive for acid fast bacilli, and treatment outcome.
Of 24 identified public-private mix projects, data were available from 14 (58%), involving private practitioners, corporations, and non-governmental organisations. In all reviewed projects, the public sector tuberculosis programme provided training and supervision of private providers. Among the five projects with available data on historical controls, case notification rates were higher after implementation of a public-private mix project. Among seven projects involving private practitioners, 2796 of 12 147 (23%) new patients positive for acid fast bacilli were attributed to private providers. Corporate based and non-governmental organisations served as the main source for tuberculosis programme services in seven project areas, detecting 9967 new patients positive for acid fast bacilli. In nine of 12 projects with data on treatment outcomes, private providers exceeded the programme target of 85% treatment success for new patients positive for acid fast bacilli.
Public-private mix activities were associated with increased case notification, while maintaining acceptable treatment outcomes. Collaborations between public and private providers of health care hold considerable potential to improve tuberculosis control in India.
回顾印度公私合营项目的特点及其对结核病病例报告和治疗结果的影响。
文献综述。
对印度结核病项目的监测记录、评估报告以及印度公私合营项目的医学文献进行综述。
项目特点、痰涂片抗酸杆菌结果呈阳性的新患者的结核病病例报告以及治疗结果。
在确定的24个公私合营项目中，14个（58%）有数据，涉及私人执业者、公司和非政府组织。在所有审查的项目中，公共部门结核病项目对私人提供者进行培训和监督。在有历史对照数据的5个项目中，实施公私合营项目后病例报告率更高。在涉及私人执业者的7个项目中，12147名痰涂片抗酸杆菌呈阳性的新患者中有2796名（23%）来自私人提供者。在7个项目地区，公司和非政府组织是结核病项目服务的主要来源，发现了9967名痰涂片抗酸杆菌呈阳性的新患者。在有治疗结果数据的12个项目中的9个项目中，私人提供者超过了新项目痰涂片抗酸杆菌呈阳性患者85%的治疗成功率目标。
公私合营活动与病例报告增加相关，同时保持了可接受的治疗结果。公共和私人医疗保健提供者之间的合作在改善印度结核病控制方面具有巨大潜力。
