Quality of tuberculosis care in India: a systematic review.
Satyanarayana, S;
Subbaraman, R;
Shete, P;
Gore, G;
Das, J;
Cattamanchi, A;
Mayer, K;
Menzies, D;
Harries, AD;
Hopewell, P;
+1 more...Pai, M;
(2015)
Quality of tuberculosis care in India: a systematic review.
The international journal of tuberculosis and lung disease, 19 (7).
pp. 751-763.
ISSN 1027-3719
DOI: https://doi.org/10.5588/ijtld.15.0186
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BACKGROUND: While Indian studies have assessed care providers' knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care. METHODS: We searched multiple sources to identify studies (2000-2014) on providers' knowledge and practices. We used the International Standards for TB Care to benchmark quality of care. RESULTS: Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector. CONCLUSIONS: Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India.