Kelamane Santosha, Satyanarayana Srinath, Nagaraja Sharath Burugina, Panibatla Vikas, Dasari Ramesh, Khan Amera, Kamineni Vishnuvardhan
TB Alert India, Hyderabad, India.
Independent Public Health Consultant, New Delhi, India.
Tuberc Res Treat. 2021 Jun 22;2021:9579167. doi: 10.1155/2021/9579167. eCollection 2021.
Informal (unqualified) health care providers are an important source of medical care for persons with presumptive TB (PPTB) in India. A project (titled RIPEND) was implemented to engage informal providers for the identification of PPTBs and TB patients in 4 districts of Telangana State, India, during October 2018-December 2019 project period. Engagement involved sensitizing the informal providers about TB, providing them financial incentives to identify PPTBs, and linking these PPTBs to diagnostic and treatment services provided by the Government of India's National TB Elimination Programme.
To describe (a) the characteristics of the informal providers, along with their self-reported practices on TB diagnosis, treatment, and challenges encountered by the RIPEND project staff in engaging them in the project and (b) the outputs and outcomes of this engagement.
We used a combination of one-on-one interviews with informal providers, group interviews with RIPEND project staff, and secondary analysis of data available within the project's recording and reporting systems.
A total of 555 informal providers were actively engaged under the project. The majority (87%) had a nonmedicine-related graduate degree and had been providing medical care for more than 10 years. Most (95%) were aware that a cough for 2 weeks or more is a symptom of pulmonary TB and that such patients should be referred for sputum-smear microscopy at a government health facility. Challenges in engaging the informal providers included motivating them to participate in the study, suboptimal mobile usage for referral services, and delays in providing financial incentives to them for referring PPTBs. During the project period (October 2018-December 2019), 8342 PPTBs were identified of which 1003 TB patients were detected and linked to TB treatment services.
This project showed that engaging informal providers is feasible and that a large number of PPTB and TB patients can be identified through this effort. The Government of India should consider engaging informal providers for the early diagnosis of TB to reduce the missing TB cases in the country.
在印度，非正规（无资质）医疗服务提供者是疑似结核病患者（PPTB）医疗服务的重要来源。2018年10月至2019年12月项目期间，印度特伦甘纳邦实施了一个名为“RIPEND”的项目，让非正规医疗服务提供者参与识别PPTB和结核病患者。参与方式包括提高非正规医疗服务提供者对结核病的认识，为他们识别PPTB提供经济激励，并将这些PPTB与印度政府国家结核病消除计划提供的诊断和治疗服务相联系。
描述（a）非正规医疗服务提供者的特征，以及他们自我报告的结核病诊断、治疗做法，和RIPEND项目工作人员在让他们参与项目过程中遇到的挑战；（b）这种参与的产出和结果。
我们采用了对非正规医疗服务提供者进行一对一访谈、对RIPEND项目工作人员进行小组访谈，以及对项目记录和报告系统中的现有数据进行二次分析相结合的方法。
该项目共积极吸纳了总计555名非正规医疗服务提供者。大多数（87%）拥有与医学无关的研究生学位，且提供医疗服务超过10年。大多数（95%）知道咳嗽两周或更长时间是肺结核的症状，这类患者应转诊至政府医疗机构进行痰涂片显微镜检查。让非正规医疗服务提供者参与面临的挑战包括激励他们参与研究、转诊服务的手机使用不理想，以及向他们提供识别PPTB的经济激励存在延迟。在项目期间（2018年10月至2019年12月），共识别出8342名PPTB，其中检测出1003名结核病患者并将其与结核病治疗服务相联系。
该项目表明让非正规医疗服务提供者参与是可行的，通过这种努力可以识别出大量的PPTB和结核病患者。印度政府应考虑让非正规医疗服务提供者参与结核病的早期诊断，以减少该国结核病病例的漏报。
