Tuberculosis patients not covered by treatment in public health services: findings from India's National Family Health Survey 2015-16.

OBJECTIVE: Half of the TB patients in India seek care from private providers resulting in incomplete notification, varied quality of care and out-of-pocket expenditure. The objective of this study was to describe the characteristics of TB patients who remain outside the coverage of treatment in public health services. METHODS: Cross-sectional data from National Family Health Survey-4 (2015-16) were analysed using logistic regression analysis. TB treatment was the dependent variable. Sociodemographic factors and place where households generally seek treatment were independent variables. RESULTS: Prevalence of self-reported TB was 308.17/100 000 population (95% CI: 309.44-310.55/100 000 population) and 38.8% (95% CI: 36.5-41.1%) of TB patients were outside care of public health services - 3.3% did not seek treatment and 35.3% accessed treatment from private sector. Factors associated with not seeking treatment were age <10 years [OR = 3.43; 95% CI (1.52-7.77); P = 0.00]; no/preschool education [OR = 1.82; 95% CI (1.10-3.34); P = 0.02]; poorest wealth index [OR = 1.86; 95% CI (1.01-3.34); P = 0.04] and household's general rejection of the public sector when seeking health care [OR = 1.69; 95% CI (1.69-2.26); P = 0.00]. Factors associated with seeking treatment from private providers were female sex [OR = 1.29; 95% CI (1.11-1.50); P = 0.001], younger age of the patient [OR = 2.39; 95% CI (1.62-3.53); P = 0.00], higher education [OR = 1.82; 95% CI (1.11-2.98); P = 0.02] and household's general rejection of the public sector when seeking health care [OR = 4.56; 95% CI (3.95-5.27); P = 0.00]. Patients from households reporting 'poor quality of care' as the reason for not generally preferring public health services were more likely (OR = 1.48, 95% CI = 1.19-1.65; P = 00) to access private treatment. CONCLUSION: The study provides insights for efforts to involve the private health sector for accurate surveillance and patient groups requiring targeted interventions for linking them to the national programme.