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

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...

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Autores principales: Ullah, Waseem, Wali, Ahmad, Haq, Mahboob Ul, Yaqoob, Aashifa, Fatima, Razia, Khan, Gul Majid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383070/
https://www.ncbi.nlm.nih.gov/pubmed/34447737
http://dx.doi.org/10.3389/fpubh.2021.703631
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author Ullah, Waseem
Wali, Ahmad
Haq, Mahboob Ul
Yaqoob, Aashifa
Fatima, Razia
Khan, Gul Majid
author_facet Ullah, Waseem
Wali, Ahmad
Haq, Mahboob Ul
Yaqoob, Aashifa
Fatima, Razia
Khan, Gul Majid
author_sort Ullah, Waseem
collection PubMed
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.
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spelling pubmed-83830702021-08-25 Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective Ullah, Waseem Wali, Ahmad Haq, Mahboob Ul Yaqoob, Aashifa Fatima, Razia Khan, Gul Majid Front Public Health Public Health 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. Frontiers Media S.A. 2021-08-10 /pmc/articles/PMC8383070/ /pubmed/34447737 http://dx.doi.org/10.3389/fpubh.2021.703631 Text en Copyright © 2021 Ullah, Wali, Haq, Yaqoob, Fatima and Khan. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Ullah, Waseem
Wali, Ahmad
Haq, Mahboob Ul
Yaqoob, Aashifa
Fatima, Razia
Khan, Gul Majid
Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective
title Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective
title_full Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective
title_fullStr Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective
title_full_unstemmed Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective
title_short Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective
title_sort public–private mix models of tuberculosis care in pakistan: a high-burden country perspective
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383070/
https://www.ncbi.nlm.nih.gov/pubmed/34447737
http://dx.doi.org/10.3389/fpubh.2021.703631
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