title: Impact of advocacy on the tuberculosis management practices of private practitioners in Chennai City, India.
abstract: BACKGROUND
  Innovative schemes to ensure the participation of private practitioners (PPs) in the Revised National Tuberculosis Control Programme (RNTCP) are necessary to identify and treat all patients with tuberculosis (TB). We developed a novel public-private mix (PPM) model to encourage PPs to practise DOTS and participate in the RNTCP while retaining their patients.
  
  
  METHODS
  The Resource Group for Education and Advocacy for Community Health (REACH) developed and implemented the programme in partnership with the Chennai local health authority and the Tuberculosis Research Centre, Chennai, India. PPs were sensitised to the RNTCP and DOTS through a one-to-one approach or group meetings, and were assisted in referring patients. Surveys were carried out at baseline and at the completion of the study to assess changes in attitudes and practices.
  
  
  RESULTS
  Six hundred PPs underwent sensitisation about the RNTCP, after which the proportion of PPs adopting DOTS increased significantly (P < 0.001), and the majority (72.8%) used sputum testing for diagnosing TB. The proportion of PPs who used X-ray alone for diagnosis declined to 16.0% from a baseline of 45.4%.
  
  
  CONCLUSIONS
  This PPM model, which emphasises sustained advocacy for DOTS and allows PPs to retain private patients, looks promising and needs to be tested at other sites.
authors.affiliation: Resource Group for Education and Advocacy for Community Health, Chennai, India. nalinikrishnan@gmail.com
authors.forename: N
authors.initials: N
authors.lastname: Krishnan
authors.forename: R
authors.initials: R
authors.lastname: Ananthakrishnan
authors.forename: S
authors.initials: S
authors.lastname: Augustine
authors.forename: N K
authors.initials: NK
authors.lastname: Vijayalakshmi
authors.forename: P G
authors.initials: PG
authors.lastname: Gopi
authors.forename: V
authors.initials: V
authors.lastname: Kumaraswami
authors.forename: P R
authors.initials: PR
authors.lastname: Narayanan
mesh_terms: D003140:Communicable Disease Control / Q000458:organization & administration*; D003153:Community Health Services / Q000458:organization & administration; D003254:Consumer Advocacy; D023801:Directly Observed Therapy; D006801:Humans; D007194:India; D017146:Models, Organizational; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D055818:Public-Private Sector Partnerships / Q000458:organization & administration*; D014376:Tuberculosis / Q000188:drug therapy / Q000517:prevention & control*; D019037:Urban Health Services / Q000458:organization & administration*; D014505:Urban Population / Q000706:statistics & numerical data