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Open Access Public-private mix for tuberculosis care and control in Myanmar: a strategy to scale up?

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Setting: The public-private mix (PPM) tuberculosis (TB) project implemented by the Myanmar Medical Association (MMA) in 105 townships in Myanmar.

Objectives: 1) To assess the contribution of the MMA-PPM-TB project to total TB patient notification in the project townships; 2) to evaluate the outcomes of patients treated at the MMA-PPM clinics; and 3) to identify factors associated with unfavourable treatment outcomes, from January to December 2013.

Design: A retrospective cohort study.

Results: The MMA-PPM-TB project contributed 7501 (12%) of 60 905 TB patient notifications to the National Tuberculosis Programme (NTP) in 105 study townships. Of 2975 TB patients diagnosed and treated at private MMA-PPM clinics, 92% had a favourable outcome (32% cured, 60% completed treatment) and 8% had an unfavourable outcome (2.9% died, 2.5% lost to follow-up, 1.9% failure, 0.6% transfer out). Patient characteristics significantly associated with an unfavourable treatment outcome were age 65 years (adjusted risk ratio [aRR] 5.7, 95% confidence interval [CI] 4.20–7.68), retreatment (aRR 2.44, 95%CI 1.79–3.33) and female sex (aRR 1.44, 95%CI 1.14–1.82).

Conclusion: This study supports the continuation and expansion of the MMA-PPM-TB model and/or similar PPM approaches in Myanmar that engage all health providers in the ambitious goals of achieving universal health coverage in this country in transition and ending its TB epidemic by 2035.
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Keywords: Myanmar; PPM; SORT IT; TB; operational research; treatment outcomes

Document Type: Research Article

Affiliations: 1: Save the Children International, Yangon, Myanmar 2: Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India 3: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya 4: Department of Preventive and Social Medicine, JIPMER, Puducherry, India 5: Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia

Publication date: March 21, 2017

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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