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Free Content Implementing a public-private mix model for tuberculosis treatment in urban Pakistan: lessons and experiences

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SETTING: Six towns of Karachi, Pakistan.

OBJECTIVES: 1) To strengthen the capacity of general practitioners (GPs) in providing tuberculosis (TB) treatment through DOTS; and 2) to enhance collaboration between the public and private sectors in TB management and case reporting.

DESIGN: A quasi-experimental study design was adopted to ensure enrolment of TB patients through trained GPs with the support of laboratory networks and to improve the case detection rate.

RESULTS: The following challenges were faced during implementation of the model in urban settings: no systematic list of GPs was available; the majority of the GPs were untrained health practitioners working in squatter settlements, where formally trained GPs are most needed; the motivation of GPs with high patient loads is very low; and access to a laboratory is difficult. Of 35 patients enrolled in the first quarter (third quarter 2009), 87% completed their treatment successfully.

CONCLUSION: Public-private mix (PPM) DOTS is feasible in the cities of Pakistan. However, the cost, time and effort required to establish the programme is higher than in many other developing countries.

Keywords: DOTS; Karachi; NTP

Document Type: Research Article


Affiliations: 1: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan 2: Division of Environmental Health Sciences, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

Publication date: June 1, 2012

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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