Public-private mix for tuberculosis care and control in Myanmar: a strategy to scale up?

Setting: The public-private mix (PPM) tuberculosis (TB) project implemented by the Myanmar Medical Association (MMA) in 105 townships in Myanmar. Objectives: 1) To assess the contribution of the MMA-PPM-TB project to total TB patient notification in the project townships; 2) to evaluate the outcomes of patients treated at the MMA-PPM clinics; and 3) to identify factors associated with unfavourable treatment outcomes, from January to December 2013. Design: A retrospective cohort study. Results: The MMA-PPM-TB project contributed 7501 (12%) of 60 905 TB patient notifications to the National Tuberculosis Programme (NTP) in 105 study townships. Of 2975 TB patients diagnosed and treated at private MMA-PPM clinics, 92% had a favourable outcome (32% cured, 60% completed treatment) and 8% had an unfavourable outcome (2.9% died, 2.5% lost to follow-up, 1.9% failure, 0.6% transfer out). Patient characteristics significantly associated with an unfavourable treatment outcome were age ⩾65 years (adjusted risk ratio [aRR] 5.7, 95% confidence interval [CI] 4.20-7.68), retreatment (aRR 2.44, 95%CI 1.79-3.33) and female sex (aRR 1.44, 95%CI 1.14-1.82). Conclusion: This study supports the continuation and expansion of the MMA-PPM-TB model and/or similar PPM approaches in Myanmar that engage all health providers in the ambitious goals of achieving universal health coverage in this country in transition and ending its TB epidemic by 2035.