Quality of tuberculosis care in India: a systematic review
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.
Document Type: Research Article
Affiliations: 1: 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 2: 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 3: 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 4: Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, California, USA 5: Life Sciences Library, McGill University, Montreal, Canada 6: Development Economics Research Group, World Bank, Washington DC, USA 7: The Fenway Institute and Beth Israel Deaconess Medical Center, Boston Massachusetts, USA 8: 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 9: Department of Epidemiology, Biostatistics and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
Publication date: July 1, 2015
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