Primary studies included in this systematic review

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Primary study

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Public-private mix for TB and TB-HIV care in Lagos, Nigeria.

Journal The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Year 2013
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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SETTING: Private and public tuberculosis (TB) treatment centres in Lagos State, Nigeria. OBJECTIVE: To assess the contribution of private health care providers to TB and TB-HIV (human immunodeficiency virus) case finding in Lagos State. DESIGN: A retrospective review of programme data submitted to the Lagos State TB and Leprosy Control Programme in 2011 by public, private for-profit (PFP) and private not-for-profit (PNFP) health care providers. RESULTS: A total of 8425 TB cases were notified by 31 private (11 PFP and 20 PNFP) and 99 public health facilities in Lagos State. Overall, the private facilities were responsible for 10.3% (866/8425) of the total TB cases notified. The proportion of TB patients tested for HIV was respectively 86.2%, 53.1% and 96.5% among public, PFP and PNFP facilities. Overall, 22.4% of the TB patients were HIV-positive. The HIV positivity rate among public, PFP and PNFP facilities was respectively 23.8%, 7.8% and 9.9%. Uptake of cotrimoxazole preventive therapy was respectively 69.6%, 25% and 38.2% among public, PFP and PNFP facilities, while that of antiretroviral therapy was respectively 23.8%, 8.3% and 9.1% in public, PFP and PNFP facilities. CONCLUSION: There is a need to scale up collaboration with the private sector, and particularly PNFP health providers.

Primary study

Unclassified

TB/ HIV coordination through Public Private Partnership: lessons from the field.

Authors Dholakia YN
Journal The Indian journal of tuberculosis
Year 2013
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Co-infection with tuberculosis adversely affects the quality of life of HIV infected individuals and additionally, HIV testing among TB patients gives an opportunity for prevention and treatment of HIV infection. TB-HIV coordination activities are therefore a good public health intervention. METHODS: It was a three-year Public Private Partnership Project, implemented in four districts of Maharashtra, to improve access to public health facilities through community awareness and motivating referrals. Outreach workers were engaged to motivate patients attending Integrated Counselling and Testing Centres (ICTCs) and Designated Microscopy Centres (DMCs) for cross referrals and adherence to services. Community leaders and private health providers were sensitized to issues around TB and HIV/AIDS. OBSERVATIONS: 357 outreach workers referred 17,200 individuals for HIV testing and 32,549 TB suspects were referred for testing. An average of 18% TB cases (13% to 26%) and 7% (4% to 13%) HIV infected cases were identified. Involvement of PLHA and cured TB patients can better motivate symptomatics to avail of diagnostic services. Erratic funding affects smooth implementation of programmes. CONCLUSION: Public Private Partnerships improve access to care. Constant dialogue between all stake holders is essential for successful implementation of such partnerships.

Primary study

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Estimation of the contribution of private providers in tuberculosis case notification and treatment outcome in Pakistan.

Journal Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ
Year 2013
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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To improve involvement of the private sector in the national tuberculosis (TB) programme in Pakistan various public-private mix projects were set up between 2004 and 2009. A retrospective analysis of data was made to study 6 different public-private mix models for TB control in Pakistan and estimate the contribution of the various private providers to TB case notification and treatment outcome. The number of TB cases notified through the private sector increased significantly from 77 cases in 2004 to 37,656 in 2009. Among the models, the nongovernmental organization model made the greatest contribution to case notification (58.3%), followed by the hospital-based model (18.9%). Treatment success was highest for the district-led model (94.1%) and lowest for the hospital-based model (74.2%). The private sector made an important contribution to the national data through the various public-private mix projects. Issues of sustainability and the lack of treatment supporters are discussed as reasons for lack of success of some projects.

Primary study

Unclassified

Promoting public-private mix for TB-DOTs: a multi-country study from the WHO Eastern Mediterranean Region.

Authors Haq Z , Khan W , Seita A
Journal Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ
Year 2012
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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This study was carried out to document the implementation status of public-private mix (PPM) in 6 member countries of the World Health Organization Eastern Mediterranean Region, with a particular focus on advocacy, communication and social mobilization (ACSM) specific to PPM. Interviews and focus group discussions were held with staff of national tuberculosis control programmes and partners. Four PPM models were being practised. For all models, ACSM specific to PPM was at the elementary stage. Participants perceived that promoting private partners was difficult, specific policy guidelines were deficient and human resources and capacity for both initiatives were lacking across the region. Building ACSM capacity is required along with the development of guidelines and the implementation of country-specific communication plans to carry out local-level advocacy, strategic communication and effective social mobilization to maximize the benefits of PPM.

Primary study

Unclassified

Implementing a public-private mix model for tuberculosis treatment in urban Pakistan: lessons and experiences.

Journal The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Year 2012
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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SETTING: Six towns of Karachi, Pakistan. OBJECTIVES: 1) To strengthen the capacity of general practitioners (GPs) in providing tuberculosis (TB) treatment through DOTS; and 2) to enhance collaboration between the public and private sectors in TB management and case reporting. DESIGN: A quasi-experimental study design was adopted to ensure enrolment of TB patients through trained GPs with the support of laboratory networks and to improve the case detection rate. RESULTS: The following challenges were faced during implementation of the model in urban settings: no systematic list of GPs was available; the majority of the GPs were untrained health practitioners working in squatter settlements, where formally trained GPs are most needed; the motivation of GPs with high patient loads is very low; and access to a laboratory is difficult. Of 35 patients enrolled in the first quarter (third quarter 2009), 87% completed their treatment successfully. CONCLUSION: Public-private mix (PPM) DOTS is feasible in the cities of Pakistan. However, the cost, time and effort required to establish the programme is higher than in many other developing countries.

Primary study

Unclassified

Provider perceptions of pharmacy-initiated tuberculosis referral services in Cambodia, 2005-2010.

Journal The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Year 2012
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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SETTING: Since 2005, private pharmacies linked to the National Tuberculosis Programme (NTP) and the Municipal Health Department in Phnom Penh have referred tuberculosis (TB) symptomatic patients to public sector TB clinics. OBJECTIVE: To investigate the attitudes and practices of pharmacy-initiated referral service providers in Phnom Penh from 2005 to 2010. METHODS: In a qualitative study, participants were purposively selected from the register of pharmacy owners providing referral services. Discussions were conducted in Khmer by trained facilitators. Participants discussed topics relating to their experiences and participation in the referral programme. RESULTS: In January 2011, 54 pharmacy owners participated in six focus group discussions held in Phnom Penh. Interpreted data showed consistency of message across all topics. The emergent themes-altruism, pragmatism and professionalism-underpinned owner commitment to programme goals. Issues associated with patient counselling, fear of infection and quality of care in public sector clinics were of concern to participants. Owners believed ongoing professional support, improved public sector patient care and media campaigns would strengthen their role. CONCLUSION: Pharmacy outlets provide further options for NTPs engaging with private sector providers. Recognising private provider needs and aspirations may be an essential component of public/private mix programmes to meet public health goals.

Primary study

Unclassified

Engaging the private sector to increase tuberculosis case detection: an impact evaluation study.

Journal The Lancet. Infectious diseases
Year 2012
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This article is included in 1 Systematic review Systematic reviews (1 reference) 1 Broad synthesis Broad syntheses (1 reference)

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BACKGROUND: In many countries with a high burden of tuberculosis, most patients receive treatment in the private sector. We evaluated a multifaceted case-detection strategy in Karachi, Pakistan, targeting the private sector. METHODS: A year-long communications campaign advised people with 2 weeks or more of productive cough to seek care at one of 54 private family medical clinics or a private hospital that was also a national tuberculosis programme (NTP) reporting centre. Community laypeople participated as screeners, using an interactive algorithm on mobile phones to assess patients and visitors in family-clinic waiting areas and the hospital's outpatient department. Screeners received cash incentives for case detection. Patients with suspected tuberculosis also came directly to the hospital's tuberculosis clinic (self-referrals) or were referred there (referrals). The primary outcome was the change (from 2010 to 2011) in tuberculosis notifications to the NTP in the intervention area compared with that in an adjacent control area. FINDINGS: Screeners assessed 388,196 individuals at family clinics and 81,700 at Indus Hospital's outpatient department from January-December, 2011. A total of 2416 tuberculosis cases were detected and notified via the NTP reporting centre at Indus Hospital: 603 through family clinics, 273 through the outpatient department, 1020 from self-referrals, and 520 from referrals. In the intervention area overall, tuberculosis case notification to the NTP increased two times (from 1569 to 3140 cases) from 2010 to 2011--a 2·21 times increase (95% CI 1·93-2·53) relative to the change in number of case notifications in the control area. From 2010 to 2011, pulmonary tuberculosis notifications at Indus Hospital increased by 3·77 times for adults and 7·32 times for children. INTERPRETATION: Novel approaches to tuberculosis case-finding involving the private sector and using laypeople, mobile phone software and incentives, and communication campaigns can substantially increase case notification in dense urban settings. FUNDING: TB REACH, Stop TB Partnership.

Primary study

Unclassified

Tuberculosis in the workplace: developing partnerships with the garment industries in Bangladesh.

Journal The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Year 2012
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVES: To implement and evaluate a public-private partnership model involving garment factories to reduce the tuberculosis (TB) burden in this workforce. DESIGN: We used operational research to develop and evaluate a mechanism for effective and sustainable TB control in workplaces in three areas of Dhaka, Bangladesh. Strategies, protocols, guides and tools were developed with stakeholders. We assessed the impact of the project using quantitative and qualitative measures: changes in TB outcomes were calculated using standard indicators based on factory and DOTS centre records; changes in TB care-seeking behaviour were assessed using qualitative in-depth interviews with factory managers and medical personnel, and focus group discussions with factory workers, including TB patients. FINDINGS: The project brought positive changes in knowledge, attitudes and practices of managers, workers and health care providers on TB care and control. During 2008-2010, a total of 3372 workers from a workforce of 69,000 were referred for sputum microscopy and 598 were diagnosed with smear-positive TB, 145 of whom received care at their workplace. The overall treatment success rate was 100%. CONCLUSION: It is feasible to engage factories in TB control activities in Bangladesh, and thereby increase case notifications and improve treatment outcomes.

Primary study

Unclassified

Implementation of RNTCP in a private medical college: five years' experience.

Journal The Indian journal of tuberculosis
Year 2012
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Revised National Tuberculosis Control Programme (RNTCP) recognizes the need for involvement of all sectors, public and private, to create an epidemiological impact on Tuberculosis control. The private health sector in the country is an important source of care, even with the availability of public health services and Directly Observed Treatment Strategy (DOTS). The data regarding Private-Private mix in our country is lacking. AIM: To evaluate the contribution of {private health sector (Private Medical Colleges and Private practioners (PP)} in TB case-detection, diagnosis and treatment outcomes in Delhi NCR, Ghaziabad, India. METHODOLOGY: We analyzed the TB registers from May 2006-Dec 2010 from our institution and recruited the patients in our study, irrespective of the source. We strengthened the referral by promoting educational intra and inter departmental activities and awareness programme with more stress on retrieval action by contact tracing and counselling. We made a list of PP in our drainage area and regularly met them and tried to understand the barriers in referring cases to DOTS centre. During the study, we tried to maintain the flow of information working as a single window information system. We regularly passed on the information of follow up of patients to private practioners referred to us by them to generate confidence in them. During the study, no incentive was offered to any patient. Various indicators and data were collected annually and analyzed statistically. STATISTICS: Retrospective, Descriptive Analysis. RESULTS: There was a substantial increase of 116.3% in the total patients referred from all sources to Santosh Hospital. The proportion of extra-pulmonary cases was 29.1% to 34.4% of all total cases from the year 2006 to 2010. During subsequent years, we found a significant increase in referral from Private Practioners that was the result of our activities performed in private set up. It was 12.5%, 21.2%, 30.8%, 27.3%, and 29% during 2006, 2007, 2008, 2009 and 2010 respectively. The outcome in our study was in accordance with the outcome at national level under RNTCP. CONCLUSION: Because of extensive educational activities, single window information system and referring the patients back to private sector after completion of treatment increased the confidence amongst the private physicians. These results strengthen the Private-Private Collaboration and show that a stronger link can be developed between medical college and private setup, leading to implementation of successful Private-Private Strategy.

Primary study

Unclassified

Sustaining PPM-DOTS: the case of Pimpri Chinchwad, Maharashtra, India.

Journal The Indian journal of tuberculosis
Year 2011
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Globally, Public-Private Mix (PPM) models of service delivery are recommended as a strategy for improving tuberculosis (TB) control. Several models of PPM-DOTS have been initiated under the Revised National TB Control Programme (RNTCP) in India, but scaling up and sustaining successful projects has remained a challenge. AIM: This paper examines factors accounting for the sustainability of a PPM-DOTS initiated in 1998 in Pimpri Chinchwad (PC), a city in Maharashtra, India. METHODS: A two-year intervention research project documented the workings of the PPM-DOTS programme. This paper draws on in-depth interviews with programme officers and staff, and semi-structured interviews with private practitioners (PP) practising in the study area. RESULTS: PPM-DOTS was originally introduced in PC, in order to increase access to DOTS. Over the years it has become an integral part of the RNTCP. Multiple approaches were employed to involve and sustain private providers' participation in PPM-DOTS. Systems were developed for supervision and monitoring DOTS in the private sector. Systematic use of operations research and successful mobilisation of available local resources helped set future direction for expanding and strengthening the PPM. The private sector's contribution to case detection and treatment success has increased, however ensuring referrals of TB suspects from all private providers continues to present a challenge. CONCLUSION: PPM-DOTS in PC is one of the few Indian models implemented as envisaged by global and national policy makers. Its successful operation for over a decade reiterates the importance of public sector initiative and leadership and makes it an interesting case for study and replication.