Patient pathways to care and provider utilization of diagnostic technologies: Operational considerations for diagnosis and treatment of tuberculosis in the private sector in India
Background: India shoulders 26% of the world's burden of incident tuberculosis (TB) cases. The Indian government provides diagnostic and treatment services for TB, but many TB patients initially seek care in the private sector. The practices of providers in the private sector and the pathways of patients accessing private care for TB are not well understood. Objectives: To investigate patient behaviors and provider practices for TB diagnosis and treatment in the Indian private sector by: (1) describing care-seeking behaviors among patients with TB-related symptoms or being treated for TB; (2) evaluating differences in care-seeking behaviors across subgroups of patients; (3) investigating knowledge, attitudes, and practices of private sector providers related to TB; and (4) providing data for a combined operational-transmission model of the impact of different strategies for deploying TB diagnostics in India. Methods: We will conduct a cross-sectional survey to assess factors associated with patient pathways to care and diagnostic practices used by providers in the private sector in Chennai, India. Working with a local organization with over 10 years of experience engaging with the private sector, we aim to recruit and interview 150 symptomatic patients seeking care, 200 patients being treated for TB, and 30 private sector clinicians, using structured questionnaires. With these data, we will describe diagnostic pathways (e.g., patient delay in seeking healthcare, time delays between healthcare visits), evaluate provider practices (e.g., number of encounters for respiratory symptoms resulting in microbiological test for TB), and compare diagnostic processes and outcomes across groups of patients and providers.