Is the public-private mix approach increasing tuberculosis case notification in Azad Jammu and Kashmir, Pakistan? A cross-sectional study

Abstract

Background: Pakistan ranks among high tuberculosis (TB) burden countries, with about 200,000 missing TB cases. Despite significant increase in case detection and treatment outcomes through public-private mix (PPM) globally, the contribution of the private sector may vary in different parts of Pakistan Methods: This was a cross sectional study conducted in state of Azad Jammu and Kashmir (AJK), Pakistan. The study was a retrospective record review of routine TB notification and treatment outcomes for 2015 to 2016 in districts with and without a PPM approach. The study was conducted in all districts of AJK, including all public and private health facilities. Intra-district comparison in PPM supported districts was also carried out.    Results: Total notified TB cases during 2015-16 were 11479. Districts with PPM support has notified 5882 (51.24%) of TB cases while districts without PPM support contributed 5597 (48.87%). Pulmonary clinical diagnosis was higher in PPM supported districts (45.43%) as compared to districts without PPM support (31.11%). Notification of extra pulmonary TB cases was lower in PPM supported districts (1256; 21.35%) as compared to districts without PPM support (1877; 33.54%). Unfavourable treatment outcomes (treatment failure, died, lost to follow-up) was higher in PPM facilities (5.84%). Conclusion: The study shows minimal increase in TB case finding through the PPM approach. While this is an important aspect in END TB strategy, this needs more careful evaluation.