Involving private practitioners in the Indian tuberculosis programme: a randomised trial.

Area of Science:

• Public Health
• Infectious Disease Control
• Health Systems Research

Background:

• Private practitioners (PPs) play a crucial role in tuberculosis (TB) case detection, but their involvement in referral to national programs can be suboptimal.
• Effective strategies are needed to enhance PP participation in referral systems for presumptive pulmonary TB (PTB) to national control programs like the Revised National TB Control Programme (RNTCP).

Purpose of the Study:

• To evaluate a multicomponent intervention designed to boost private practitioner engagement in referring presumptive PTB cases to the RNTCP for sputum examination.
• To assess the impact of health system strengthening and direct PP-focused activities on referral rates and TB case-finding.

Main Methods:

• A randomized controlled trial was conducted with 189 eligible PPs in Tumkur city, South India, allocated to either an intervention or control arm.
• The intervention included RNTCP staff capacity building, SMS feedback, PP training, provision of referral materials, and regular PPs visits.
• Negative binomial regression was used to calculate referral and PTB case-finding rate ratios.

Main Results:

• The intervention group showed significantly higher proportions of referring PPs, mean referral rates per PP-year, and smear-positive PTB case-finding rates per PP-year compared to the control group.
• Specifically, referring PPs were 0.59 in the intervention vs. 0.42 in the control arm, with referral rates of 5.7 vs. 1.8 per PP-year, respectively.
• PP referrals contributed to 20% of sputum smear-positive PTB cases detected by RNTCP in the study area, with 14% from the intervention arm PPs.

Conclusions:

• A health system-oriented intervention effectively improved private practitioner referrals of presumptive PTB cases to the RNTCP.
• The findings highlight the success of a multifaceted approach in enhancing PP participation and contributing to national TB control efforts.