Kundu Debashish, Chopra Kamal, Khanna Ashwani, Babbar Neeti, Padmini T J
RNTCP Medical Consultant, Delhi, India.
Director, New Delhi TB Centre, India.
Indian J Tuberc. 2016 Jan;63(1):8-12. doi: 10.1016/j.ijtb.2016.02.002. Epub 2016 Apr 29.
In India, almost half of all patients with tuberculosis (TB) seek care in the private sector as the first point of care. The national programme is unable to support such TB patients and facilitate effective treatment, as there is no information on TB and Multi or Extensively Drug Resistant TB (M/XDR-TB) diagnosis and treatment in private sector.
To improve this situation, Government of India declared TB a notifiable disease for establishing TB surveillance system, to extend supportive mechanism for TB treatment adherence and standardised practices in the private sector. But TB notification from the private sector is a challenge and still a lot needs to be done to accelerate TB notification.
Delhi State TB Control Programme had taken initiatives for improving notification of TB cases from the private sector in 2014. Key steps taken were to constitute a state level TB notification committee to oversee the progress of TB notification efforts in the state and direct 'one to one' sensitisation of private practitioners (PPs) (in single PP's clinic, corporate hospitals and laboratories) by the state notification teams with the help of available tools for sensitising the PP on TB notification - TB Notification Government Order, Guidance Tool for TB Notification and Standards of TB Care in India.
As a result of focussed state level interventions, without much external support, there was an accelerated notification of TB cases from the private sector. TB notification cases from the private sector rose from 341 (in 2013) to 4049 (by the end of March 2015).
Active state level initiatives have led to increase in TB case notification.
在印度,几乎一半的结核病患者将私立医疗机构作为首诊机构。由于缺乏私立医疗机构中结核病及耐多药或广泛耐药结核病(M/XDR-TB)诊断与治疗的相关信息,国家项目无法为这些结核病患者提供支持并促进有效治疗。
为改善这种情况,印度政府宣布将结核病列为须上报的疾病,以建立结核病监测系统,扩大对私立医疗机构结核病治疗依从性的支持机制及规范做法。但来自私立医疗机构的结核病上报是一项挑战,仍有许多工作需要做以加速结核病上报。
德里邦结核病控制项目于2014年采取措施改善私立医疗机构的结核病病例上报情况。采取的关键步骤包括成立邦级结核病上报委员会,以监督该邦结核病上报工作的进展,并由邦上报团队借助现有的结核病上报宣传工具——《结核病上报政府令》、《结核病上报指导工具》和《印度结核病护理标准》,对私立执业医生(在单个执业医生诊所、企业医院和实验室)进行“一对一”宣传。
由于邦级有针对性的干预措施,在没有太多外部支持的情况下,私立医疗机构的结核病病例上报加速。私立医疗机构上报的结核病病例从2013年的341例增至2015年3月底的4049例。
邦级的积极举措使结核病病例上报数量增加。