title: Tuberculosis management practices of private practitioners in Pune municipal corporation, India.
abstract: BACKGROUND
  Private Practitioners (PP) are the primary source of health care for patients in India. Limited representative information is available on TB management practices of Indian PP or on the efficacy of India's Revised National Tuberculosis Control Programme (RNTCP) to improve the quality of TB management through training of PP.
  
  
  METHODS
  We conducted a cross-sectional survey of a systematic random sample of PP in one urban area in Western India (Pune, Maharashtra). We presented sample clinical vignettes and determined the proportions of PPs who reported practices consistent with International Standards of TB Care (ISTC). We examined the association between RNTCP training and adherence to ISTC by calculating odds ratios and 95% confidence intervals.
  
  
  RESULTS
  Of 3,391 PP practicing allopathic medicine, 249 were interviewed. Of these, 55% had been exposed to RNTCP. For new pulmonary TB patients, 63% (158/249) of provider responses were consistent with ISTC diagnostic practices, and 34% (84/249) of responses were consistent with ISTC treatment practices. However, 48% (120/249) PP also reported use of serological tests for TB diagnosis. In the new TB case vignette, 38% (94/249) PP reported use of at least one second line anti-TB drug in the treatment regimen. RNTCP training was not associated with diagnostic or treatment practices.
  
  
  CONCLUSIONS
  In Pune, India, despite a decade of training activities by the RNTCP, high proportions of providers resorted to TB serology for diagnosis and second-line anti-TB drug use in new TB patients. Efforts to achieve universal access to quality TB management must account for the low quality of care by PP and the lack of demonstrated effect of current training efforts.
authors.affiliation: Office of the World Health Organization (WHO) Representative in India, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Bharaswadkar
authors.affiliation: Office of the World Health Organization (WHO) Representative in India, New Delhi, India.
authors.forename: Avinash
authors.initials: A
authors.lastname: Kanchar
authors.affiliation: Directorate of Health Services, Pune Municipal Corporation, Maharashtra, India.
authors.forename: Narendra
authors.initials: N
authors.lastname: Thakur
authors.affiliation: Directorate of Health Services, Pune Municipal Corporation, Maharashtra, India.
authors.forename: Shubhangi
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Community Medicine, MIMER Medical College, Talegaon, Pune, India.
authors.forename: Brinda
authors.initials: B
authors.lastname: Patnaik
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
authors.forename: Eleanor S
authors.initials: ES
authors.lastname: Click
authors.affiliation: International Union Against TB and Lung Diseases, Regional Office for Southeast Asia, New Delhi, India.
authors.forename: Ajay M V
authors.initials: AM
authors.lastname: Kumar
authors.affiliation: Office of the World Health Organization (WHO) Representative in India, New Delhi, India.
authors.forename: Puneet Kumar
authors.initials: PK
authors.lastname: Dewan
mesh_terms: D003430:Cross-Sectional Studies; D019468:Disease Management; D019538:Health Care Surveys; D006801:Humans; D007194:India; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011331:Private Practice / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*