How feasible is to deliver TB care at private clinics – Pakistan Experience.

How feasible is to deliver TB care at private clinics – Pakistan Experience.

This ongoing study is done in partnership with National TB Control Programme, Pakistan. This Intervention was implemented by The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).

Background and Objectives: End TB strategy (WHO) emphasizes ‘reaching the unreached’ patients. In Pakistan, only about 69% of the estimated TB cases are currently being detected/ notified. Around 2,000 private clinics have been engaged to deliver quality TB care in Pakistan. These clinics: screen, diagnose, prescribe, educate and follow-up TB patients. A process evaluation was conducted to assess the fidelity and feasibility of TB care; also inform the need of further modifications (if any).

Methods: The study in four selected districts employed a sequential mixed methods design. The clinical records of 2,783 TB patients at 120 clinics were included for clinical outcomes; whereas 4 doctors, 4 clinical assistants, 4 male and 4 female TB patient were interviewed at 4 selected clinics.

Findings: During one year: 120 clinics got 8,064 patients with cough ≥ 2 weeks smear-examined; and registered 951 smear-positive and 2,799 all type TB cases. The use of smear results and chest X-rays to diagnose pulmonary TB varied widely across clinics. The drug prescription was found in-line with program protocols. At completion of first two month; around 93% of smear-positive patients got smear-examined; and 93.7% of the examined were found converted. The smear-positive TB cases achieved 93.7% success rate (i.e. cured plus completed) at private clinics. The estimated average cost of treating a smear-positive and all type TB case at a private clinic was USD: 125 and USD: 44 respectively.

Conclusion: The study supports continued provision of TB care at private clinics, through district-led public-private partnership approach.