Modelling the impact of effective private provider engagement on tuberculosis control in urban India

Arinaminpathy, N and Deo, S and Singh, S and Khaparde, S and Rao, R and Vadera, B and Kulshrestha, N and Gupta, D and Rade, K and Nair, S A and Dewan, P (2019) Modelling the impact of effective private provider engagement on tuberculosis control in urban India. Scientific Reports.

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Abstract

In India, the country with the world’s largest burden of tuberculosis (TB), most patients first seek care in the private healthcare sector, which is fragmented and unregulated. Ongoing initiatives are demonstrating effective approaches for engaging with this sector, and form a central part of India’s recent National Strategic Plan: here we aimed to address their potential impact on TB transmission in urban settings, when taken to scale. We developed a mathematical model of TB transmission dynamics, calibrated to urban populations in Mumbai and Patna, two major cities in India where pilot interventions are currently ongoing. We found that, when taken to sufficient scale to capture 75% of patient-provider interactions, the intervention could reduce incidence by upto 21.3% (95% Bayesian credible interval (CrI) 13.0–32.5%) and 15.8% (95% CrI 7.8–28.2%) in Mumbai and Patna respectively, between 2018 and 2025. There is a stronger impact on TB mortality, with a reduction of up to 38.1% (95% CrI 20.0–55.1%) in the example of Mumbai. The incidence impact of this intervention alone may be limited by the amount of transmission that has already occurred by the time a patient first presents for care: model estimates suggest an initial patient delay of 4–5 months before first seeking care, followed by a diagnostic delay of 1–2 months before ultimately initiating TB treatment. Our results suggest that the transmission impact of such interventions could be maximised by additional measures to encourage early uptake of TB services.

Affiliation: Indian School of Business
ISB Creators:
ISB CreatorsORCiD
Deo, S0000-0002-3233-6014
Item Type: Article
Uncontrolled Keywords: TB, Tuberculosis, HIV
Subjects: Socio Political System
Depositing User: Veeramani R
Date Deposited: 19 Mar 2019 12:51
Last Modified: 19 Mar 2019 12:51
URI: http://eprints.exchange.isb.edu/id/eprint/689
Publisher URL: https://doi.org/10.1038/s41598-019-39799-7
Publisher OA policy: http://www.sherpa.ac.uk/romeo/issn/2045-2322/
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