Enhancing the role of private practitioners in tuberculosis prevention and care activities in India.
Enhancing the role of private practitioners in tuberculosis prevention and care activities in India.
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DOI：
10.4103/0970-2113.217577
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发表时间：
2017-11
期刊：
影响因子：
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通讯作者：
Chadha SS
中科院分区：
文献类型：
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作者：
Anand T;Babu R;Jacob AG;Sagili K;Chadha SS
印度是全球结核病病例数最多的国家。因此，为了影响全世界的结核病发病率，迫切需要解决并加速该国的结核病控制活动。近一半的结核病患者首先在私营部门寻求结核病护理。然而，私人医生（PP）在结核病预防和护理方面的参与并不充分，而且公共部门和私营部门之间存在不信任。 PP 通常有不同的诊断和治疗方法，这些方法并不充分，而且会增加耐药性的风险。因此，如果我们要在全球范围内实现结核病控制，他们作为关键利益相关者的监管和参与对于印度的结核病预防和护理至关重要。然而，仍然存在某些障碍和差距，阻碍了它们的升级。本文旨在讨论印度私营部门参与结核病预防和护理的现状。文件还讨论了政府在这方面采取的策略和举措，因为有证据表明，私营部门参与短期直接观察治疗（DOTS）有助于加强病例发现和治疗结果；它通过更大的地理覆盖范围提高了优质结核病护理的可及性。除了公私混合之外，DOTS 被发现更具成本效益并减轻患者的经济负担。本文还提出了一些政策和项目层面的更多解决方案，以扩大 PP 参与国家结核病控制项目的力度。
India accounts for the highest number of incident tuberculosis (TB) cases globally. Hence, to impact the TB incidence world over, there is an urgent need to address and accelerate TB control activities in the country. Nearly, half of the TB patients first seek TB care in private sector. However, the participation of private practitioners (PPs) has been patchy in TB prevention and care and distrust exists between public and private sector. PPs usually have varied diagnostic and treatment practices that are inadequate and amplify the risk of drug resistance. Hence, their regulation and involvement as key stakeholders are important in TB prevention and care in India if we are to achieve TB control at global level. However, there remain certain barriers and gaps, which are preventing their upscaling. The current paper aims to discuss the status of private sector involvement in TB prevention and care in India. The paper also discusses the strategies and initiatives taken by the government in this regard as evidence shows that the involvement of private sector in co-opting directly observed treatment short-course (DOTS) helps to enhance case finding and treatment outcomes; it improves the accessibility of quality TB care with greater geographic coverage. Besides public-private mix, DOTS has been found more cost-effective and reduces financial burden of patients. The paper also offers to present some more solutions both at policy and program level for upscaling the engagement of PPs in the national TB control program.