Public-private mix for tuberculosis care and control in Myanmar: a strategy to scale up?
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SUBMITTER: Thet Lwin ZM
PROVIDER: S-EPMC5526479 | biostudies-other | 2017 Mar
REPOSITORIES: biostudies-other
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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.
| S-EPMC3238294 | biostudies-literature
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.
| S-EPMC8350595 | biostudies-literature
Project description: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.
| S-EPMC8383070 | biostudies-literature
Project description:BackgroundThe national Public-Private Mix (PPM) tuberculosis (TB) control project provides for the comprehensive management of TB patients at private hospitals in South Korea. Surveillance and monitoring of TB under the PPM project are essential toward achieving TB elimination goals.MethodsTB is a nationally notifiable disease in South Korea and is monitored using the surveillance system. The Korea Centers for Disease Control and Prevention quarterly generates monitoring indicators for TB management, used to evaluate activities of the PPM hospitals by the central steering committee of the national PPM TB control project. Based on the notification date, TB patients at PPM hospitals were enrolled in each quarter, forming a cohort, and followed up for at least 12 months to identify treatment outcomes. This report analyzed the dataset of cohorts the first quarter of 2016 through the fourth quarter of 2017.ResultsThe coverage of sputum, smear, and culture tests among the pulmonary TB cases were 92.8% and 91.5%, respectively. The percentage of positive sputum smear and culture test results were 30.7% and 61.5%, respectively. The coverage of drug susceptibility tests among the culture-confirmed cases was 92.8%. The treatment success rate among the smear-positive drug-susceptible cases was 83.2%. The coverage of latent TB infection treatment among the childhood TB contacts was significantly higher than that among the adult contacts (85.6% vs. 56.0%, p=0.001).ConclusionThis is the first official report to analyze monitoring indicators, describing the current status of the national PPM TB control project. To sustain its effect, strengthening the monitoring and evaluation systems is essential.
| S-EPMC7362746 | biostudies-literature
Project description:In South Korea, public-private mix (PPM) was launched in 2011. This retrospective cohort study sought to determine the rate of loss to follow-up (LTFU) among drug-susceptible tuberculosis (DS-TB) patients in all nationwide PPM institutions, and the risk factors for LTFU. National notification data for DS-TB patients diagnosed between August 2011 and July 2014 in PPM institutions were analysed. Determination of LTFU included detection of instances where patients were transferred out, but when they did not attend at other TB centres in the following two months. Univariable and multivariable competing risk models were used to determine risk factors for LTFU. 73,046 patients with 78,485 records were enrolled. Nominally, 3426 (4.4%) of records were LTFU. However, after linking the multiple records in each patient, the percentage of LTFU was 12.3% (9004/73,046). Risk factors for LTFU were: being foreign-born (3.13 (95% CI 2.77-3.53)), prior LTFU (2.31 (2.06-2.59)) and greater distance between the patient's home and the TB centre (4.27 (4.03-4.53)). 'Transfer-out' was a risk factor in patients managed by treatment centres close to home (1.65 (1.49-1.83)), but protective for those attending centres further (0.77 (0.66-0.89)) or far-away (0.52 (0.46-0.59)) from home. By considering the complete picture of a patient's interactions with healthcare, we identified a much higher level of LTFU than previously documented. This has implications for how outcomes of treatment are reported and argues for a joined-up national approach for the management and surveillance of TB patients, in nations with similar healthcare systems.
| S-EPMC9300674 | biostudies-literature
Project description:BackgroundData are scarce regarding the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients in Bangladesh. This study was undertaken to estimate the number needed to screen (NNS) to identify a case of DM among those with TB symptoms and those with confirmed TB disease, and to identify factors predicting treatment outcomes of TB patients with and without DM.MethodsPersons attending public-private model screening centres in urban Dhaka for the evaluation of TB were offered free blood glucose testing in addition to computer-aided chest X-ray and sputum Xpert MTB/RIF.ResultsAmong 7647 people evaluated for both TB and DM, the NNS was 35 (95% confidence interval (CI) 31-40) to diagnose one new case of DM; among those diagnosed with TB, the NNS was 21 (95% CI 17-29). Among those with diagnosed TB, patients with DM were more likely to have cavitation on chest X-ray compared to those without DM (31% vs 22%). Treatment failure (odds ratio (OR) 18.9, 95% CI 5.43-65.9) and death (OR 2.08, 95% CI 1.11-3.90) were more common among TB patients with DM than among TB patients without DM. DM was the most important predictor of a poor treatment outcome in the classification analysis for TB patients aged 39 years and above.ConclusionsA considerable burden of DM was found among patients accessing TB diagnostics through a public-private model in urban Bangladesh, and DM was associated with advanced TB disease and a high rate of poor treatment outcome.
| S-EPMC9006482 | biostudies-literature
Project description:OBJECTIVE:The private healthcare providers (PHCP) are believed to improve access to healthcare services in public-private mix (PPM) projects, as they are considered first point of contact for healthcare. The purpose of this study was to determine the satisfaction level of tuberculosis (TB) patients. DESIGN:A questionnaire-based, cross-sectional study was carried out during November and December 2017 for 572 under-treatment patients registered with PHCPs in the PPM project. Lot quality assurance sampling technique was used to randomly select 19 districts from a sample frame of 75 districts. In each selected district, the data collector retrieved a TB register of 8 months (January-August 2017) and systematically selected patients by fixed periodic interval. SPSS version 24.0 (IBM Corp, Amonk, NY, USA) was used to analyze the data. RESULTS:This study included 53% (n = 301) males and 47% (n = 271) females, with mean age of 38 years (SD, ±18). Almost half of the participants were illiterate (51%, n = 289), and 64% (n = 365) were non-earning members of the family. In practice, most of the participants visit private providers (71%, n = 407), including private hospitals/clinics (44%) and traditional practitioners (27%; n = 153); 55% of participants visited their current doctor because of the clinic's proximity to their residence. Of the participants, 82% (n = 469) were satisfied with TB care services and 85% (n = 488) said that they would recommend this clinic to others. Conclusion: PHCPs are preferred providers for individuals, which is consistent with findings of other studies. Though they are satisfied with TB care and services, interventions should be introduced to reduce the financial burden on the patient. Partnering PHCP is a way forward to ensure universal health coverage and better health outcomes of the population.
| S-EPMC6955770 | biostudies-literature
Project description:ObjectiveTo review the characteristics of public-private mix projects in India and their effect on case notification and treatment outcomes for tuberculosis.DesignLiterature review.Data sourcesReview of surveillance records from Indian tuberculosis programme project, evaluation reports, and medical literature for public-private mix projects in India.Data extractionProject characteristics, tuberculosis case notification of new patients with sputum smear results positive for acid fast bacilli, and treatment outcome.Data synthesisOf 24 identified public-private mix projects, data were available from 14 (58%), involving private practitioners, corporations, and non-governmental organisations. In all reviewed projects, the public sector tuberculosis programme provided training and supervision of private providers. Among the five projects with available data on historical controls, case notification rates were higher after implementation of a public-private mix project. Among seven projects involving private practitioners, 2796 of 12 147 (23%) new patients positive for acid fast bacilli were attributed to private providers. Corporate based and non-governmental organisations served as the main source for tuberculosis programme services in seven project areas, detecting 9967 new patients positive for acid fast bacilli. In nine of 12 projects with data on treatment outcomes, private providers exceeded the programme target of 85% treatment success for new patients positive for acid fast bacilli.ConclusionsPublic-private mix activities were associated with increased case notification, while maintaining acceptable treatment outcomes. Collaborations between public and private providers of health care hold considerable potential to improve tuberculosis control in India.
| S-EPMC1397734 | biostudies-literature
Project description:BackgroundThe Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public health care providers in the fight against tuberculosis using international health care standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal.MethodsWe conducted key informant interviews with 20 participants, 14 of whom were from private clinics, polyclinics, and hospitals where the PPM approach was used, two from government hospitals, and four from policymakers. All data were audio-recorded, transcribed, and translated into English. The transcripts of the interviews were manually organized, and themes were generated and categorized into 1. TB case detection, 2. patient-related barriers, and 3. health-system-related barriers.ResultsA total of 20 respondents participated in the study. Barriers to PPM were identified into following three themes: (1) Obstacles related to TB case detection, (2) Obstacles related to patients, and (3) Obstacles related to health-care system. PPM implementation was challenged by following sub-themes that included staff turnover, low private sector participation in workshops, a lack of trainings, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies.ConclusionGovernment stakeholders can significantly benefit by applying a proactive role working with the private in monitoring and supervision. The joint efforts with private sector can then enable all stakeholders to follow the government policy, practice and protocols in case finding, holding and other preventive approaches. Future research are essential in exploring how PPM could be optimized.
| S-EPMC10244665 | biostudies-literature
Project description:ObjectivesTo examine the effect of individual and area-level characteristics on the probability of public-private mix (PPM) support (PPM coverage) for tuberculosis (TB).MethodsThis study is a retrospective cohort design using TB reporting and treatment management data in Korea. We analyzed PPM coverage through multilevel logistic regression and empirical Bayesian estimation according to individual and area-level characteristics and their interaction.ResultsPatients aged 0-29 years, women, of Korean nationality, treated at a general hospital, a one-time reporting, urban areas, and the lowest deprivation index (DI) showed higher PPM coverage. Due to the cross-level interaction, PPM coverage in the urban areas (slope=-0.048, p<0.001) had a higher level but a steeper negative deprivation gradient than in rural areas (slope= -0.015, p<0.001). For a general hospital, the PPM coverage in urban is high but more significantly decreased than in rural areas with the higher DI (urban: slope=-0.047, p<0.001; rural: slope=-0.031, p<0.001). For clinics and hospitals, the effect of DI did not appear in urban areas, but in rural areas, the higher the DI, the higher the PPM coverage with a slope of 0.046 (p<0.001) and 0.063 (p<0.001), respectively.ConclusionsThe PPM program created a significant disparity in PPM coverage between urban-rural areas and type of healthcare provider according to DI. Considering the high risk of TB incidence in areas with higher DI, institutional improvement and program redesign are needed to improve accessibility and equity.
| S-EPMC10266928 | biostudies-literature