Extent of Involvement of Private Practitioners in Public-Private Mix-Directly Observed Treatment Short Course (PPM-DOTS) for Tuberculosis Management in South Coastal India

Abstract

Background: Ensuring the effective participation of both public and private healthcare providers is essential to fulfill the goals of universal access to tuberculosis (TB) care. Objectives: The objective was to assess the knowledge, attitude, and practice about TB, Directly Observed Treatment Short (DOTS) program and Public-Private Mix-DOTS course (PPM-DOTS) strategy among allopathic private practitioners (PP) and to explore their extent of involvement in PPM-DOTS strategy in the diagnosis, notification, and management of TB in Puducherry, India. Materials and Methods: A sequential explanatory mixed-method study was conducted from November 2017 to February 2018 with quantitative survey using a pretested semistructured questionnaire followed by in-depth interview (IDI) using field guide. Descriptive manual content analysis was performed after verbatim transcription of the manuscripts from IDIs. Results: Qualitative data based on survey revealed that 97.66% of PPs were aware of subjecting patients with cough for more than 2 weeks for sputum examination and 93.75% were aware of mandatory TB notification. About 88.28% preferred to get the investigation done for presumptive TB cases from nearby DOTS centers. About 89.06% preferred to refer TB cases to nearby primary health centers whereas only 20.31% preferred to notify TB cases. IDIs revealed that PPM-DOTS was not utilized optimally due to the following reasons: minimal TB caseload to collaborate and function with DOTS centers, fear of losing the patient, distrust in PP, busy schedule, availability of Anti-tubercular treatment (ATT) in the nearby pharmacy, breach of confidentiality while notification and finally the easy referral mechanism due to nearby DOTS centers. Conclusions: Involvement of PPs in PPM-DOTS remains sub-optimal. Strategies such as conducting regular workshops, providing timely information about policy changes, and constructive communications individually with PPs to dispel any misconceptions might enhance PPM-DOTS.