India's Revised National Tuberculosis Control Programme: looking beyond detection and cure.
METHODS
Pune District, Maharashtra State, India.


OBJECTIVE
To examine delays experienced by patients in accessing directly observed treatment.


METHODS
Data were collected from 117 new sputum-positive patients using a semi-structured interview schedule.


RESULTS
Patient delays as well as diagnostic and treatment delays, which reflect the performance of a National TB Programme, were minimal. Provider delays, however, contributed significantly to delayed entry into India's Revised National TB Control Programme (RNTCP). Patients had to resort to multiple contacts with providers due to limitations of these providers in diagnosing or directing patients to the RNTCP. Patients who consulted a private provider participating in the public-private mix (PPM) were more likely to be suspected (OR 2.63, 90% CI 1.04-6.64) and referred (OR 6.8, 95%CI 2.08-22.21) to the RNTCP. Once the patients entered the RNTCP, the response of the system was rapid, with diagnosis offered and treatment initiated within on average 7 days.


CONCLUSIONS
Interventions aimed at providers to encourage early suspicion and referral to the RNTCP, such as the PPM, are more important in improving patient access to TB care than those focusing on reducing patient delays.
Kelkar-Khambete
A
A
Maharashtra Association of Anthropological Sciences, Centre for Health Research and Development, Pune, India.
Kielmann
K
K
Pawar
S
S
Porter
J
J
Inamdar
V
V
Datye
A
A
Rangan
S
S
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D023801:Directly Observed Therapy; D042241:Early Diagnosis; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009313:National Health Programs / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D011331:Private Practice; D015397:Program Evaluation; D012017:Referral and Consultation; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
D000995:Antitubercular Agents