Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT): a market-shaping intervention in India

Abstract

A majority of patients with tuberculosis (TB) in India are diagnosed and treated in the private sector. Yet, most private providers do not use most recent WHO-endorsed microbiological tests such as liquid cultures, line probe assays and Xpert MTB/RIF due to a combination of factors such as lack of awareness, misaligned incentives and high prices that are unaffordable for patients. We designed a market-based approach to transform a high-price, low-volume market equilibrium into a low-price, high-volume equilibrium to improve the uptake of these tests. Toward this end, a non-profit consortium of private laboratories, called Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT) was formed in India in March 2013. It negotiated lower pricing on equipment and reagents with manufacturers, closer to that offered to the public sector. In return, IPAQT assured that this discount was passed on to patients, who typically paid for these tests out of their pockets, through an informally agreed on retail ceiling price. IPAQT also invested in demand generation activities that complemented the supply-side effort. IPAQT membership grew from 56 laboratories in 2013 to 211 in 2018. During this period, the initiative resulted in a 10-fold increase in the uptake of Xpert and a 30%–50% reduction in price. This initiative is planned to be expanded to other South Asian countries with similar TB epidemic and private market structure and dynamics. However, long-term sustainability of the initiative would require developing more cost-effective marketing activities and integration with broader private sector engagement agenda of the national TB programme.

Integrating Xpert MTB/RIF for TB diagnosis in the private sector: evidence from large-scale pilots in Patna and Mumbai, India

“…Similar increases in case notification have been observed from implementation of Xpert among pediatric and HIV patients in the public sector [38,39]. In the private sector, creating a consortium of private laboratories was found to increase Xpert testing volumes of private providers during the same time as our study period [40]. However, this approach differs from the program studied here in two important aspects.…”

Enhanced Private Sector Engagement for Tuberculosis Diagnosis and Reporting through an Intermediary Agency in Ho Chi Minh City, Viet Nam

“…Increased acceptance of Xpert testing has also been observed to result in a reduction of clinical diagnosis [40], so that increasing private-sector Xpert uptake could substantially reduce the rate of over-diagnosis and contribute to improved individual and public health outcomes. Efforts to optimize NAAT access have proven effective in several settings through the Initiative for Promoting Affordable, Quality TB tests [24,38,41].…”

Field sales force model to increase adoption of a novel tuberculosis diagnostic test among private providers: evidence from India

“…Under this initiative, manufacturers and distributors agreed to provide test cartridges at reduced input costs to the member labs who, in turn, agreed to set the retail price of these tests at or below a predetermined ceiling price that yielded acceptable margins to all players across the value chain. 33 A secretariat, funded by the Bill and Melinda Gates Foundation and staffed by the Clinton Health Access Initiative, designed and implemented the initiative (including the determination of the ceiling price) and undertook monitoring and evaluation efforts to ensure compliance by the consortium members.…”