Private tuberculosis care provision associated with poor treatment outcome: comparative study of a semi-private lung clinic and the NTP in two urban districts in Ho Chi Minh City, Vietnam. National Tuberculosis Programme.
METHODS
Ho Chi Minh City, Vietnam.


OBJECTIVE
To compare tuberculosis case management and treatment outcome between a semi-private chest clinic and a publicly run national tuberculosis programme (NTP).


METHODS
Prospective, non-randomised, comparative cohort study. Case-management and treatment outcome was determined for 176 patients treated in the semi-private clinic and 326 patients treated in the NTP.


RESULTS
In the semi-private clinic cohort, significantly fewer patients completed treatment and/or were cured than in the NTP cohort (48.9% vs. 85.0%, P < 0.001). Among patients with sputum-positive pulmonary TB, significantly fewer were cured in the semi-private clinic cohort compared to the NTP cohort (22.2% vs. 79.2%, P < 0.001), and treatment success was significantly lower (35.2% vs. 79.7%. P < 0.001). Adjustment for a number of potential confounders did not change these findings significantly.


CONCLUSIONS
Treatment outcome was considerably better in the NTP than in the semi-private clinic. The difference is not likely to be due to differences in patient characteristics or in provider knowledge. Different financial incentives for the providers in the two settings and ways of paying for services by patients are possible reasons for the observed difference in the quality of case management and treatment outcome.
Lönnroth
K
K
Department of Social Medicine, Göteborg University, Göteborg, Sweden. knut.lonnroth@socmed.gu.se
Thuong
L M
LM
Lambregts
K
K
Quy
H T
HT
Diwan
V K
VK
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration* / Q000592:standards; D019090:Case Management / Q000592:standards*; D015331:Cohort Studies; D003151:Community Health Centers / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration / Q000592:standards; D017149:Private Sector / Q000592:standards*; D011446:Prospective Studies; D017150:Public Sector / Q000592:standards*; D012959:Socioeconomic Factors; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000628:therapy*; D019037:Urban Health Services / Q000458:organization & administration* / Q000592:standards; D014744:Vietnam