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Public-Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective.

ABSTRACT: Introduction: Pakistan ranks fifth in the globally estimated burden of tuberculosis (TB) case incidence. Annually, a gap of 241,688 patients with TB exists between estimated TB incidence and actual TB case notification in Pakistan. These undetected/missed TB cases initiate TB care from providers in the private healthcare system who are less motivated to notify patients to the national database that leads to significant underdetection of actual TB cases in the Pakistani community. To engage these private providers in reaching out to missing TB cases, a national implementation trial of the Public-Private Mix (PPM) model was cohesively launched by National TB Control Program (NTP) Pakistan in 2014. The study aims to assess the implementation, contribution, and relative treatment outcomes of cohesively implemented PPM model in comparison to the non-PPM model. Methods: A retrospective record review of all forms (new and relapse) patients with TB notified from July 2015 to June 2016 was conducted both for PPM- and non-PPM models. Results: The PPM model was implemented in 92 districts in total through four different approaches and contributed 25% (81,016 TB cases) to the national TB case notification. The PPM and non-PPM case notification showed a strong statistical difference in proportions among compared variables related to gender (p < 0.001), age group (p < 0.000), and province (p < 0.000). Among PPM approaches, general practitioners and non-governmental-organization facilities achieve a treatment success of 94-95%; private hospitals achieve 82% success, whereas Parastatals are unable to follow more than half of their notified TB cases. Discussion: The PPM model findings in Pakistan are considerably consistent with countries that have prioritized PPM for an increasing trend in the TB case notification to their national TB control programs. Different PPM approaches need to be scaled up in terms of PPM implemented districts, PPM coverage, PPM coverage efficiency, and PPM coverage outcome in the Pakistani healthcare system in the future.

SUBMITTER: Ullah W

PROVIDER: S-EPMC8383070 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe World Health Organization (WHO) recommends the use of mobile health (mHealth) technologies as emerging opportunities to closing the gaps in Tuberculosis (TB) care through enhancing Public Private Mix (PPM). However, little is known about mHealth interventions that have been used for enhancing PPM in TB care, those that worked and those that did not.ObjectiveThis review summarizes the published evidence on the utilization and effectiveness of mHealth interventions for public private mix in TB care from literature.MethodsGoogle scholar, PUBMED, IEEE Xplore and ScienceDirect databases were searched for peer reviewed literature from 1st January 2003 to 31st December 2020 for studies about the mHealth interventions for public private mix in TB care. This was guided by the scoping review methodology proposed by Arksey and O' Malley. In order to assess the quality of the selected studies, mHealth evidence reporting and assessment (mERA) checklist was utilized. Studies that discussed the utilization of mHealth interventions for implementing PPM in TB care were included. Nine studies met the inclusion criteria and were analyzed for review.ResultsThe review found out the application of mHealth in Public Private Mix in TB care through the following ways; 1) TB screening, 2) TB case notification 3) TB treatment adherence 4) data collection and management 5) patient referral and follow up, and 6) education. This resulted into high user experience, significant time reduction in data aggregation, increased case notification and referrals and proactive tracking and provision of follow up care hence reduced treatment and completion gaps. One study yielded suboptimal utilization due to the technical and operational challenges encountered by the healthcare workers.ConclusionAlthough this scoping review highlights the role of mHealth technologies in enhancing PPM in TB care, its utilization is still limited in African settings. No Africa-based study was identified by this review. Future studies should focus on assessing the utilization of mHealth for PPM in Africa.

Project description:IntroductionThe STOP TB Partnership aims to improve global tuberculosis (TB) control through expanding access to the directly observed treatment short course (DOTS) strategy. One approach to this is 'Engaging all Care Providers', which evolved from 'Public-Private Mix (PPM) DOTS'. The overall aim of this study was to systematically assess whether and to what degree the STOP TB Partnership's four global objectives of engaging all care providers are met through existing PPM interventions. These four objectives are; 1) Increase TB case detection; 2) Improve TB treatment outcomes; 3) Enhance access and equity; 4) Reduce financial burden on patients. The specific objectives of this assessment were to 1) Understand what PPM means to the STOP TB Partnership's PPM Subgroup and to National Tuberculosis Programme managers; 2) Scope the nature of existing country-level PPM interventions and 3) Review PPM practice against the global PPM objectives.MethodsWe undertook a systematic, multi-facetted assessment. The methods included interviews with National Tuberculosis Programme managers from high burden countries, clarification of key issues with the STOP TB Partnership PPM secretariat and a review of publicly accessible reports and published articles on PPM projects. Both the literature review and interviews with the National Tuberculosis Programme managers yielded data on project characteristics; PPM models at country level; National Tuberculosis Programme partners; and mechanisms for engagement. Matrices were developed from the literature review and the interviews to show the relationship between services and service providers for different PPM projects. Data from the literature were assessed against each of the four global PPM objectives.ResultsTwelve National Tuberculosis Programme managers from high burden countries were interviewed about the scope of PPM partnerships. Understanding of PPM and types of engaged providers varied considerably; 'private-for-profit qualified clinical providers' were the dominant category. The literature review yielded information on 22 projects in which 'private-for-profit qualified clinical providers' were again the dominant category. The contributions made by 'private-for-profit qualified clinical providers' and 'Non Governmental Organisation qualified clinical providers', were assessed against the four global PPM objectives. Reporting on tuberculosis case detection and treatment outcomes was generally good and demonstrated important PPM contributions in these areas. Reporting on equity, access and reduced patient costs was often lacking or inconclusive.ConclusionsPPM has improved case detection and treatment outcomes among patients seeking care with private providers. Evidence on reducing patient costs is inconclusive, and there is scope for increasing equity in access to care by systematically engaging those providers who are the primary agents for poor people seeking health care. Guidelines outlining which types of providers best contribute to achieving the four global objectives, along with the resources required by National Tuberculosis Programs for such engagement is needed.

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Public-Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective.

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