Tuberculosis case notification by private practitioners in Pune, India: how well are we doing?

Setting: Pimpri Chinchwad Municipal Corporation area, Pune, India. Objective: To assess the proportion of private practitioners (PPs) who notified tuberculosis (TB) patients during February–April 2013 and their contribution to the overall number notified, and to determine their perceived challenges in reporting TB cases. Design: Mixed-method study including an analysis of notification data, followed by in-depth interviews with PPs. Interviews were transcribed and inductive content analysis was performed to derive themes. Results: Of 831 PPs, 533 (64%) participated in case notification; of these 87 (16%) notified at least one TB case during the study period. In all, 138 TB cases were notified by PPs, accounting for 20% of the total TB cases notified. Emerging themes among perceived challenges and barriers were lack of complete knowledge about TB notification, fear of a breach of patient confidentiality, lack of a simplified operational mechanism of notification, and lack of trust and coordination with the government health system. Conclusion: About two thirds of PPs participated in case notification and contributed significantly to the overall TB cases notified. India's national TB programme should focus on training PPs and targeted media communication campaigns, and establish alternative mechanisms for notification, such as the internet and mobile telephones, to overcome perceived barriers.