Barriers in Notification of Tuberculosis Cases by Private Practitioners of an Administrative Block of District Una, Himachal Pradesh: A Mixed Method Study

Abstract

Background: Notification of tuberculosis (TB) cases is an important step in its elimination from India by 2025. However, there has not been much rise in the notification from the private sector; COVID-19 is one of the reasons. Objective: The objective is to determine the notification of TB cases by private practitioners (PPs), their current practices in treatment, enablers, and barriers to TB notification from Una district, Himachal Pradesh. Methodology: The PPs of two TB units were enrolled in the study. A mixed method study design was used. The quantitative component comprised of interviewer-introduced questionnaire-based cross-sectional study. The qualitative component was conducted using a grounded theory design to provide an explanation behind the current notification practice. Results: Out of 71 practitioners, 20 were treating presumptive TB patients. Eighty percent of these were aware of the NIKSHAY portal and 75% were aware of mandatory reporting of TB patients through the portal. The focused group discussions with the study population yielded a major theme, “Barriers to notification,” which had the following themes, namely affective attitude, logistic problems, provider misconceptions regarding non-directly observed treatment shortcourse (DOTS) regimens, patient confidentiality, stigma and discrimination and lack of cohesion and coordination between the public and private sectors. Conclusion: The ignorance and lack of education regarding ever-changing management policy of TB were one of the important barriers in notifying TB cases.