title: Quality of tuberculosis care in India: a systematic review.
abstract: BACKGROUND
  While Indian studies have assessed care providers' knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care.
  
  
  METHODS
  We searched multiple sources to identify studies (2000-2014) on providers' knowledge and practices. We used the International Standards for TB Care to benchmark quality of care.
  
  
  RESULTS
  Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector.
  
  
  CONCLUSIONS
  Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada; Center for Operations Research, International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Satyanarayana
authors.affiliation: Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Partners for Urban Knowledge, Action and Research, Mumbai, India.
authors.forename: R
authors.initials: R
authors.lastname: Subbaraman
authors.affiliation: Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA; Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, California, USA.
authors.forename: P
authors.initials: P
authors.lastname: Shete
authors.affiliation: Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, California, USA.
authors.forename: G
authors.initials: G
authors.lastname: Gore
authors.affiliation: Life Sciences Library, McGill University, Montreal, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Das
authors.affiliation: Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA; Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, California, USA.
authors.forename: A
authors.initials: A
authors.lastname: Cattamanchi
authors.affiliation: Development Economics Research Group, World Bank, Washington DC, USA.
authors.forename: K
authors.initials: K
authors.lastname: Mayer
authors.affiliation: The Fenway Institute and Beth Israel Deaconess Medical Center, Boston Massachusetts, USA.
authors.forename: D
authors.initials: D
authors.lastname: Menzies
authors.affiliation: Center for Operations Research, International Union Against Tuberculosis and Lung Disease, Paris, France; Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Canada.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA; Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, California, USA.
authors.forename: P
authors.initials: P
authors.lastname: Hopewell
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Pai
mesh_terms: D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D017149:Private Sector / Q000592:standards*; D017150:Public Sector / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000592:standards*; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology