What question did this study set out to answer?

To assess the impact of the Patient Provider Support Agency model on tuberculosis care in India's private sector.

May 10, 2026PLOS Global Public Health2 citationsOpen Access

Enhancing tuberculosis care in the private sector: Role of innovative private sector engagement model under programmatic settings in India

SGSandhya Gupta RRRaghuram Rao KSKathirvel Soundappan

Key Points

To assess the impact of the Patient Provider Support Agency model on tuberculosis care in India's private sector.
Conducted a cross-sectional study comparing TB service delivery in districts with and without the PPSA model.
Analyzed data from Ni-kshay for over 200 districts in 2023.
Evaluated TB notification rates, treatment timeliness, quality indicators, and treatment outcomes.
Average TB notification rate in PPSA districts was 106 per 100,000, achieving 99.7% of targets, compared to 45 per 100,000 in non-PPSA districts at 80% of targets.
Lower pretreatment loss to follow-up in PPSA districts (2% vs 4%) and reduced treatment initiation delays (>7 days) (5% vs 10%).
PPSA model linked to improvements in comorbidity testing and financial support but showed lower coverage of advanced testing and drug uptake.

Abstract

India’s private sector plays a crucial role in the country’s tuberculosis (TB) healthcare landscape, with >50% of patients seeking initial care from private providers. Recognizing this critical role, the National Tuberculosis Elimination Program implemented and scaled up an innovative private sector engagement model, Patient Provider Support Agency (PPSA), in over 200 districts of the country in 2023 to improve TB care in the private sector. A cross-sectional study was conducted to assess the role of PPSA in improving TB care services among private-sector patients in 2023. We compared districts with PPSA and without PPSA for their TB notification, treatment timeliness, key quality-of-care indicators and treatment outcomes from the private sector at the national level. Data for private sector notification from Ni-kshay (web-enabled TB patient management system) was analyzed. In 2023, districts supported by PPSA (n = 204) recorded an average private sector TB notification rate of 106 per 100,000 and achieved 99.7% of the set target, compared to 529 districts without PPSA, which reported a rate of 45 per 100,000 and reached only 80% of the target. The pretreatment loss to follow-up (2% vs 4%) and the treatment initiation delay >7 days (5% vs 10%) were lower in districts with PPSA. They also reported improved TB care services- comorbidity testing (HIV and diabetes), bank detail linkage for receiving financial support and treatment success with PPSA support. However, districts with PPSA showed lower coverage of upfront nucleic acid amplification testing (17% vs 22%), drug susceptibility testing (21% vs 25%) and uptake of government-supplied drugs (22% vs 33%) compared with districts without PPSA. The PPSA model improved private sector TB notification and reduced treatment delays nationally; however, strategic expansion by focusing on quality-oriented TB care services and their link to results-based financing is essential to maximize its efficiency and overall impact on private sector TB care.

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