Private practitioners and public health: weak links in tuberculosis control

Uplekar, Mukund; Pathania, Vikram; Raviglione, Mario

doi:10.1016/s0140-6736(01)06076-7

Cited by 206 publications

(179 citation statements)

References 2 publications

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“…Further, nonadherence to the TB diagnostic algorithm is common among private practitioners. Unnecessary investigations and symptomatic treatment could have increased the direct costs on TB care [19]. This possibly explains the higher direct costs for those who visited private care first.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India

Prasanna

Jeyashree

Chinnakali

et al. 2018

Global Health Action

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Background: The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016–2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India. Objectives: The objectives of the study were among the newly diagnosed and previously treated tuberculosis (TB) patients, to (a) estimate patient costs during diagnosis and intensive phase of treatment, (b) determine the proportion of households experiencing catastrophic costs, and (c) explore coping strategies. Methods: An explanatory mixed methods design comprising both quantitative cost description and qualitative descriptive component was used. Catastrophic cost was defined as total TB care costs exceeding 20% of annual household income. Results: Of 102 TB patients included, two-thirds (69%) were male, 6% were HIV positive, and 45% reported at least one episode of hospitalization for TB care. The median (IQR) total cost of TB care was US$195 (52.1, 492.9) with a direct cost of US$65.3 (22.3, 156.5) and indirect cost of US$50.2 (0.9, 295.1). Overall, 32.4% of households experienced catastrophic costs due to TB care, significantly higher in patients with HIV coinfection (p = 0.009) and hospitalization (p = 0.009). Pledging jewels and borrowing money were major coping strategies. Cash assistance was the expected remedy from the patient perspective. Conclusion: Despite free TB care under NTP, more than a third incurred catastrophic costs towards TB care.

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Section: Discussionmentioning

confidence: 99%

Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India

Prasanna

Jeyashree

Chinnakali

et al. 2018

Global Health Action

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“…8 Many TB cases are detected and treated in this sector, but are not notified to public authorities and there--fore not recorded in official statistics. 9 Treatment outcomes are also gener--ally poor in this sector. [10][11][12][13] To increase case detection rates, improve successful treatment rates and reduce out-of-pocket expenditures by patients, it is necessary to involve the private sector in DOTS implementation.…”

Section: Cost and Cost-effectiveness Of Ppm-dots For Tuberculosis Conmentioning

confidence: 99%

“…From the late 1990s, WHO has de--veloped a strategy called "Public-Private Mix DOTS" (PPM-DOTS), which is based on field projects in diverse set--tings. 9,14 It consists of DOTS implemen--tation in the private sector, with free drugs and financial support provided by the government and strengthened col--laboration between public and private providers through improved referral and information systems.…”

Section: Cost and Cost-effectiveness Of Ppm-dots For Tuberculosis Conmentioning

confidence: 99%

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Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India

Floyd

Arora

Murthy

et al. 2006

Bull World Health Organ

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Objective To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India. Methods We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews. The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector. Costs for 2002 in US$ were assessed for the public sector, private practitioners, and patients/attendants. Effectiveness was measured as the number of cases successfully treated. Findings The average cost per patient treated was US$ 111-123 for PPM-DOTS and public sector DOTS, and US$ 111-172 for non-DOTS treatment in the private sector. From the public sector's perspective, the cost per patient treated was lower in PPM-DOTS projects than in public sector DOTS programmes (US$ 24-33 versus US$ 63). DOTS implementation in either the public or private sectors improved treatment outcomes and substantially lowered costs incurred by patients and their attendants, compared to non-DOTS treatment in the private sector (US$ 50-60 for DOTS compared to over US$ 100 for non-DOTS). The average cost-effectiveness of PPM-DOTS and public sector DOTS was similar, at US$ 120-140 per patient successfully treated, compared to US$ 218-338 for non-DOTS private sector treatment. Incremental cost-effectiveness analysis showed that PPM-DOTS can improve effectiveness while also lowering costs. Conclusion PPM-DOTS can be an affordable and cost-effective approach to improving TB control in India, and can substantially lower the economic burden of TB for patients. Voir page 443 le résumé en français. En la página 444 figura un resumen en español.

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“…Delegation of TB-control tasks to expanded auxiliary cadres with qualifications that are not recognized internationally is one successful approach 37 . TB programmes have led the way in involvement of the private sector 38 and communities, especially in rural areas 39 , and this might be key to avoid the impact of TB-control staff moving to better resourced ART programmes. Greater use of incentives, more local training opportunities, and better international efforts to limit the drain of such scarce resources all need proper evaluation.…”

Section: Hiv Tb and The Health Systemmentioning

confidence: 99%

Tuberculosis control in the era of HIV

et al. 2005

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| Without HIV, the tuberculosis (TB) epidemic would now be in decline almost everywhere. However, instead of looking forward to the demise of TB, countries that are badly affected by HIV are struggling against a rising tide of HIV-infected patients with TB. As a consequence, global TB control policies have had to be revised and control of TB now demands increased investment. This paper assesses what is being done to address the issue and what remains to be done.

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Private practitioners and public health: weak links in tuberculosis control

Cited by 206 publications

References 2 publications

Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India

Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India

Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India

Tuberculosis control in the era of HIV

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