OBJECTIVE: To describe the outcomes of implementation of a public-private mix Directly Observed Treatment Short-course (DOTS) strategy for tuberculosis (TB) prevention and control in a highly-urbanized city in the Philippines.
METHODS: Data on case-finding and case-holding activities of two facilities engaged as part of the public-private mix DOTS (PPMD) from 2006-2013 were abstracted from reports submitted to, and validated by, the city National Tuberculosis Program (NTP) coordinator. Additionality to local case-finding efforts was measured through case detection and case notification rates, while effectiveness of case-holding mechanisms was measured through determination of treatment outcomes of new smear-positive cases.
RESULTS: A total of 314 cases of tuberculosis (average of 40 cases annually) were reported by the two facilities for the period 2006 to 2013. Most of the discovered cases of TB were new cases (81%). Fifty nine percent (59%) were bacteriologically confirmed TB cases through sputum microscopy. New smear-positive cases of TB increased the local case detection rate by an average of four percentage points for the observation period. In absolute terms, this translates to an addition by private institutions of five new smear-positive cases per 100,000 population to those reported by public facilities from 2006 to 2013. Proportionately, the two private hospitals contributed an average of 5% to the total new smear-positive cases detected in the city from 2006 to 2013. In terms of treatment outcome of the cohort of smear positive patients admitted from 2006 to 2012, seven out of ten cases were cured (mean cure rate of 70%), and nearly all (90%) were successfully treated. Over the observation period, the cure rate among new smear-positive cases increased from 50% in 2006 to 86% in 2012, and was comparable to the national benchmark of 85% in 2011 and 2012. On the other hand, treatment success rates were highly variable, but have remained above the 80% mark starting 2007.
CONCLUSION: Engaging private healthcare providers to practice DOTS as the main strategy for TB prevention and control has had some modest impact on local NTP accomplishments. Current efforts need to be scaled up to include a wider range of private practitioners. A triple win situation for the patient, the private practitioner and NTP should be the end goal of all such efforts.