TUBERCULOSIS PATIENTS AND PRACTITIONERS IN PRIVATE CLINICS IN INDIA

SETTING: Rural and urban areas of Maharashtra, a large state in Wester n India.OBJECTIVE: To understand tuberculosis (TB) management practice s among private medical practitioners (PPs) and the treatment behaviou r of the patients they manage. DESIGN: Prospective study of help-seeki ng patterns and treatment behaviour among 173 pulmonary TB patients di agnosed in private clinics, and the TB management practices of 122 PPs treating these patients. RESULTS: The first source of help for 86% of patients was a PP. The diagnostic and treatment practices of PPs were inadequate; 15% did not consider sputum examination to be necessary, and 79 different treatment regimens were prescribed by 105 reporting P Ps. Sixty-seven percent of the patients diagnosed in private clinics r emained with the private sector, and the rest shifted to public health services within six months of treatment. The treatment adherence rate among the patients in private clinics was 59%. There were discrepanci es between the reported management practices of the PPs and what their patients actually followed. CONCLUSION: The study identifies and high lights the need to educate PPs and their TB patients, and indicates wa ys in which PPs could be meaningfully involved in efforts to revitalis e the national TB control programme.