title: Implications of private sector Hib vaccine coverage for the introduction of public sector Hib-containing pentavalent vaccine in India: evidence from retrospective time series data.
abstract: OBJECTIVE
  Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage.
  
  
  METHODS
  16 of 29 states in India, 2009-2012.
  
  
  METHODS
  Retrospective descriptive secondary data analysis.
  
  
  METHODS
  (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys.
  
  
  METHODS
  State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status.
  
  
  RESULTS
  The overall private sector Hib vaccine coverage among the 2009-2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians' prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009-2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector.
  
  
  CONCLUSIONS
  If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is undefined as yet but it should not be neglected as a useful complement to public sector services.
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Warren A
authors.initials: WA
authors.lastname: Kaplan
authors.affiliation: Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India.
authors.forename: Maulik
authors.initials: M
authors.lastname: Chokshi
authors.affiliation: Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India.
authors.forename: Habib
authors.initials: H
authors.lastname: Hasan Farooqui
authors.affiliation: Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India.
authors.forename: Sanjay P
authors.initials: SP
authors.lastname: Zodpey
mesh_terms: D016667:Bacterial Capsules; D003362:Cost-Benefit Analysis; D006192:Haemophilus Infections / Q000453:epidemiology / Q000517:prevention & control*; D018073:Haemophilus Vaccines / Q000008:administration & dosage*; D019741:Haemophilus influenzae type b / Q000276:immunology*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007194:India / Q000453:epidemiology; D017149:Private Sector; D017150:Public Sector; D012189:Retrospective Studies; D019472:Universal Health Insurance; D017778:Vaccines, Combined
chemical_list: D018073:Haemophilus Vaccines; C044237:Haemophilus influenzae type b polysaccharide vaccine; D017778:Vaccines, Combined
keywords: Private-sector Hib vaccine coverage