ORIGINAL ARTICLE
Open Access

Successfully Engaging Private Providers to Improve Diagnosis, Notification, and Treatment of TB and Drug-Resistant TB: The EQUIP Public-Private Model in Chennai, India

Ramya Ananthakrishnan, M. D'Arcy Richardson, Susan van den Hof, Radha Rangaswamy, Rajeswaran Thiagesan, Sheela Auguesteen and Netty Kamp
Global Health: Science and Practice March 2019, 7(1):41-53; https://doi.org/10.9745/GHSP-D-18-00318

Figures & Tables

Figures

  • Figure

    Simple guidance steps and vouchers provided by the project allowed private providers to easily refer patients for TB diagnostic testing. © Jasper Hamann

  • FIGURE 1
    FIGURE 1

    The Private Provider Engagement Process Under Project EQUIP

    Abbreviations: EQUIP, Enhanced Use of Quality Drugs and Utilization of Innovative Diagnostics for TB Management in the Private Sector; PP, private provider.

  • FIGURE 2
    FIGURE 2

    Benefits of the EQUIP Model for Participating Groups

    Abbreviations: CXR, chest x-ray; EQUIP, Enhanced Use of Quality Drugs and Utilization of Innovative Diagnostics for TB Management in the Private Sector; MDR-TB, multidrug-resistant tuberculosis; RNTCP, Revised National TB Control Program; TB, tuberculosis.

  • FIGURE 3
    FIGURE 3

    Private-Sector TB Patient Pathway to Cure in the EQUIP Model

    Abbreviations: EQUIP, Enhanced Use of Quality Drugs and Utilization of Innovative Diagnostics for TB Management in the Private Sector; PP, private provider; RNTCP, Revised National TB Control Program; TB, tuberculosis.

  • FIGURE 4
    FIGURE 4

    Private Provider Engagement, Referrals for TB Diagnosis, and TB Cases, October 2015–June 2017

  • Figure

    A staff member at an EQUIP center supports a patient to improve TB treatment literacy and adherence. © Jasper Hamann

Tables

  • TABLE 1.

    Number of TB Referrals by Individual Providers

    No. of ReferralsNo. (%) of ProvidersCumulativePercentage
    1–5142 (62.6)62.6
    6–1033 (14.5)77.1
    11–3031 (13.7)90.7
    31–5014 (6.2)96.9
    51–702 (0.9)97.8
    71–1002 (0.9)98.7
    >1003 (1.3)100.0
    Total227 (100.0)
  • TABLE 2.

    Number and Yield of TB Referrals by Type of Provider and Quarter

    Quarter and YearChest PhysicianGeneral PractitionerSpecialty PhysicianTotal
    No. of ReferralsNo. of TB CasesYield (%)No. of ReferralsNo. of TB CasesYield (%)No. of ReferralsNo. of TB CasesYield (%)No. of ReferralsNo. of TB CasesYield (%)
    Q4 2015402870.0463984.88675.0947377.7
    Q1 2016814353.115410165.6321959.426716361.0
    Q2 20161016059.41286953.9301550.025914455.6
    Q3 20161106155.520710852.225936.034217852.0
    Q4 20161094743.123310444.6481837.539016943.3
    Q1 20171538253.638013936.6651726.259823839.8
    Q2 20171517851.744315535.0773444.267126739.8
    Total74539953.6159171544.928511841.42621123247.0

    • Abbreviations: Q, quarter; TB, tuberculosis.

  • TABLE 3.

    Number and Yield of TB Referrals Among Super-Referrers Only (>30 Referrals), by Type of Provider

    Type of ProviderNo. of ReferralsNo. of TB CasesYield (%)
    Chest physician (n=8)45824453.3
    General practitioner (n=11)71629741.5
    Specialty physician (n=2)902022.2
    Total (N=21)126456144.4

    • Abbreviation: TB, tuberculosis.

  • TABLE 4.

    Number of Patients Referred to EQUIP by Type of Private Provider

    Provider TypeTotal (n=227)
    Chest Physicians (n=40)General Practitioners (n=143)Specialists (n=44)
    No. of referred patients7421,5922872,621
    No. of patients referred for GeneXpert testing6201,1581671,945
    No. of patients diagnosed with TB3967161201,232
    No. (%) of patients diagnosed with TB with bacteriological confirmation (GeneXpert/SSM)243 (61.3%)436 (60.8%)48 (40.0%)727 (59.0%)
    No. (%) of patients confirmed with RR-TBNANANA26 (3.7%)

    • Abbreviations: EQUIP, Enhanced Use of Quality Drugs and Utilization of Innovative Diagnostics for TB Management in the Private Sector; RR-TB, rifampicin-resistant tuberculosis; SSM, sputum smear microscopy; TB, tuberculosis.

  • TABLE 5.

    Treatment Outcomes for Patients Without Confirmed RR-TB and Who Received Treatment Support Through EQUIP

    Treatment OutcomesPatients Referred by:Total (n=868)
    Chest Physicians (n=226)General Practitioners (n=513)Specialist Physicians (n=129)
    Completed, No.182350108640
    Cured, No.2110312136
    Treatment success, No. (%)203 (89.8%)453 (88.3%)120 (93.0%)776 (89.4%)
    Died, No.920534
    Lost to follow-up, No.1329446
    Transferred to private facility treatment, No.0202
    Transferred to RNTCP facility treatment, No.1506
    Treatment failure, No.0303
    Still on treatment, No.0101

    • Abbreviations: EQUIP, Enhanced Use of Quality Drugs and Utilization of Innovative Diagnostics for TB Management in the Private Sector; RNTCP, Revised National TB Control Program; RR-TB, rifampicin-resistant tuberculosis.

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Successfully Engaging Private Providers to Improve Diagnosis, Notification, and Treatment of TB and Drug-Resistant TB: The EQUIP Public-Private Model in Chennai, India
Ramya Ananthakrishnan, M. D'Arcy Richardson, Susan van den Hof, Radha Rangaswamy, Rajeswaran Thiagesan, Sheela Auguesteen, Netty Kamp
Global Health: Science and Practice Mar 2019, 7 (1) 41-53; DOI: 10.9745/GHSP-D-18-00318
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