Knowledge, attitudes and practices of private sector providers of tuberculosis care: a scoping review [Review article]

SETTING: The past decade has seen a significant increase in private sector provision of tuberculosis (TB) care. While patients often seek and select treatment from private providers at significant out-of-pocket expense, treatment outcomes remain largely unknown.

OBJECTIVE: To investigate the knowledge, attitudes and practices of private sector TB care providers in high-burden countries.

METHODS: Medline, PubMed, Embase, International Pharmaceutical Abstracts and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched using Medical Subject Headings terms, Emtree terms and key words. Searches were limited to the English language and published between 1998 and week 2 of November 2009. Studies were included if they reported the knowledge, attitudes or practice behaviours of private health care providers working in one of 22 high-TB-burden countries. Each included study was critically assessed using a structured data extraction tool. Data extracted included the study setting, objective, design, sample, response rate, outcomes and limitations.

RESULTS: The 34 studies that met review inclusion criteria encompassed diverse study methods and designs. All categories of TB care providers lacked comprehensive knowledge of national treatment guidelines. Procedures for referral, treatment monitoring, record keeping and case holding were not systematically implemented. However, there was a high degree of willingness to collaborate with national TB programmes.

CONCLUSION: Research using standardised data collection methods may assist in identifying gaps in knowledge and practice among all providers of TB care. Further studies in developing and evaluating needs-based interventions should be undertaken; systematic reviews of such studies may then assist in strategic decision making in public-private mix DOTS expansion.