Private practitioners and multidrug-resistant tuberculosis management: A study from Pune, India

What is it about?

Private practitioners (PPs) play a major role in caring for people with tuberculosis (TB) in India. At the same time, they have limited access to continuing medical education and oversight especially with regards to recent changes in the management of multi-drug resistant (MDR- TB). As a part of a larger study aimed at developing an educational tool for improving multidrug-resistant TB management, we conducted a knowledge assessment of MDR-TB among PPs in suburban areas of Pune City, India during 2022 and 2023. We interviewed 100 PPs, who manage/refer TB and MDR-TB cases in Pimpri-Chinchwad Municipal Corporation (PCMC) areas of Pune in Maharashtra State. The majority of participants were allopathic practitioners (85%) practicing in private clinics (82%). Most practitioners were aware of three main symptoms for suspecting TB: cough for >2 weeks, fever and weight loss. About half of the practitioners knew about first test (Xpert) to diagnose MDR-TB and 32% were unaware of any test. Only 37% practitioners were aware of advanced test (whole genome sequencing) for diagnosis of resistant TB. Twenty percent practitioners selected Mantoux test use for the diagnosis of active TB, which is not recommended as per the guidelines. Less than 25% practitioners knew about the second-line anti-TB drugs (used for treating MDR-TB) and their availability either in the National TB Elimination Program (NTEP) or the private sector. Our study indicates considerable lack of awareness about pulmonary MDR-TB management among allopathic practitioners in the study area and highlights the need for education and creating awareness about the same. It identified specific areas for developing an educational tool for PPs in India and elsewhere.

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Photo by CDC on Unsplash

Photo by CDC on Unsplash

Why is it important?

Private practitioners have a major role in TB management. They are the first point of contact for majority of patients. If practitioners lack awareness and knowledge about pulmonary drug resistant TB, that will eventually delay the correct diagnosis and management. It will result in deterioration of patient's health, economic loss and transmission of drug resistance in the community, threatening public health. Hence there is a need for educating them regarding modern methods of diagnosis and management of drug resistant TB. Our study identified specific areas for educating them.

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