title: How Do Urban Indian Private Practitioners Diagnose and Treat Tuberculosis? A Cross-Sectional Study in Chennai.
abstract: METHODS
  Private practitioners are frequently the first point of healthcare contact for patients with tuberculosis (TB) in India. Inappropriate TB management practices among private practitioners may contribute to delayed TB diagnosis and generate drug resistance. However, these practices are not well understood. We evaluated diagnostic and treatment practices for active TB and benchmarked practices against International Standards for TB Care (ISTC) among private medical practitioners in Chennai.
  
  
  METHODS
  A cross-sectional survey of 228 practitioners practicing in the private sector from January 2014 to February 2015 in Chennai city who saw at least one TB patient in the previous year. Practitioners were randomly selected from both the general community and a list of practitioners who referred patients to a public-private mix program for TB treatment in Chennai. Practitioners were interviewed using standardized questionnaires.
  
  
  RESULTS
  Among 228 private practitioners, a median of 12 (IQR 4-28) patients with TB were seen per year. Of 10 ISTC standards evaluated, the median of standards adhered to was 4.0 (IQR 3.0-6.0). Chest physicians reported greater median ISTC adherence than other MD and MS practitioners (score 7.0 vs. 4.0, P<0.001), or MBBS practitioners (score 7.0 vs. 4.0, P<0.001). Only 52% of all practitioners sent >5% of patients with cough for TB testing, 83% used smear microscopy for diagnosis, 33% monitored treatment response, and 22% notified TB cases to authorities. Of 228 practitioners, 68 reported referring all patients with new pulmonary TB for treatment, while 160 listed 27 different regimens; 78% (125/160) prescribed a regimen classified as consistent with ISTC. Appropriate treatment practices differed significantly between chest physicians and other MD and MS practitioners (54% vs. 87%, P<0.001).
  
  
  CONCLUSIONS
  TB management practices in India's urban private sector are heterogeneous and often suboptimal. Private providers must be better engaged to improve diagnostic capacity and decrease TB transmission in the community.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Liza
authors.initials: L
authors.lastname: Bronner Murrison
authors.affiliation: REACH, Chennai, India.
authors.forename: Ramya
authors.initials: R
authors.lastname: Ananthakrishnan
authors.affiliation: REACH, Chennai, India.
authors.forename: Sumanya
authors.initials: S
authors.lastname: Sukumar
authors.affiliation: REACH, Chennai, India.
authors.forename: Sheela
authors.initials: S
authors.lastname: Augustine
authors.affiliation: REACH, Chennai, India.
authors.forename: Nalini
authors.initials: N
authors.lastname: Krishnan
authors.affiliation: McGill International TB Centre & Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Madhukar
authors.initials: M
authors.lastname: Pai
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: David W
authors.initials: DW
authors.lastname: Dowdy
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011331:Private Practice / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*