PATH, Mumbai, India.
Department of Health, Muncipal Corporation of Greater Mumbai, India.
Indian J Tuberc. 2020 Apr;67(2):189-201. doi: 10.1016/j.ijtb.2020.01.007. Epub 2020 Jan 22.
India carries one-fourth of the global tuberculosis (TB) burden. Hence the country has drafted the ambitious National Strategic Plan to eliminate tuberculosis by 2025. To realise this goal, India's Revised National Tuberculosis Control Programme (RNTCP) and partners piloted a novel strategy to engage private-providers for tuberculosis care via a "Private-provider Interface Agency" (PPIA) in Mumbai and other locations.
The program mapped and engaged private-providers, chemists, and laboratories; facilitated TB notification via call centers and field staff; provided free tuberculosis diagnostic tests and anti-TB drugs using novel electronic vouchers; monitored quality of care; and supported patients to ensure anti-TB treatment adherence and completion. This report summarises the descriptive analysis of PPIA implementation data piloted in Mumbai from 2014 to 2017.
The program mapped 8789 private doctors, 3438 chemists, and 985 laboratories. Of these, 3836 (44%) doctors, 285 (29%) laboratories, and 353 (10%) chemists were prioritized and engaged in the program. Over three and a half years, the program recorded 60,366 privately-notified tuberculosis patients, of which, 24,146 (40%) were microbiologically-confirmed, 5203 (9%) were rifampicin-resistant, and 4401 (7%) were paediatric TB patients. Mumbai's annual total TB case notification rate increased from a pre-program baseline of 272 per 100,000/year in 2013 to 416 per 100,000/year in 2017. Overall, 42,300 (78%) patients completed the TB treatment, and 4979 (9%) could not be evaluated.
The PPIA program in Mumbai demonstrated that private-providers can be effectively engaged for TB control in urban India. This program has influenced national policy and has been adapted and funded for a country-wide scale up. The model may also be considered in conditions where private-provider engagement is needed to improve access and quality of care for any area of public health.
印度承担着全球四分之一的结核病（TB）负担。因此，该国制定了到 2025 年消除结核病的宏伟国家战略计划。为了实现这一目标，印度修订后的国家结核病控制规划（RNTCP）和合作伙伴在孟买和其他地方试点了一项新策略，通过“私人提供者接口机构”（PPIA）让私人提供者参与结核病护理。
该计划对私人提供者、药剂师和实验室进行了映射和接触；通过呼叫中心和现场工作人员促进结核病通知；使用新型电子凭证提供免费的结核病诊断测试和抗结核药物；监测护理质量；并支持患者确保抗结核治疗的坚持和完成。本报告总结了 2014 年至 2017 年在孟买试点的 PPIA 实施数据的描述性分析。
该计划对 8789 名私人医生、3438 名药剂师和 985 个实验室进行了映射。其中，有 3836 名（44%）医生、285 名（29%）实验室和 353 名（10%）药剂师被优先考虑并参与了该计划。在三年半的时间里，该计划记录了 60366 名私人报告的结核病患者，其中 24146 名（40%）为微生物学确诊，5203 名（9%）为利福平耐药，4401 名（7%）为儿科结核病患者。孟买的年度总结核病病例报告率从 2013 年的 272/100000/年的项目前基线增加到 2017 年的 416/100000/年。总体而言，42300 名（78%）患者完成了结核病治疗，4979 名（9%）无法评估。
孟买的 PPIA 计划表明，私人提供者可以有效地参与印度城市的结核病控制。该计划影响了国家政策，并已适应并为全国范围内的扩大提供资金。在需要私人提供者参与以改善任何公共卫生领域的获得和护理质量的情况下，也可以考虑该模式。
