{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:20:07Z","timestamp":1787678407198,"version":"build-2784847793"},"reference-count":28,"publisher":"International Union Against Tuberculosis and Lung Disease","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["public health action"],"accepted":{"date-parts":[[2026,6,9]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>SETTINGS<\/jats:title>\n                    <jats:p>Since 2018, India\u2019s National Tuberculosis Elimination Programme has adopted a patient-provider support agency (PPSA) model to engage the private sector using domestic resources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of the PPSA model for private-sector TB notifications, care services, and treatment success in 42 districts across six Indian states and to explore enablers and challenges of PPSA implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN<\/jats:title>\n                    <jats:p>A mixed-methods study. We performed interrupted time-series analysis using the segmental regression model to quantify level and monthly changes in private sector TB indicators before (2019\u20132021) and after PPSA implementation (2021\u20132024) and interviewed stakeholders regarding enablers and challenges of PPSA implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>PPSA initiation significantly increased private-sector TB notification rates (immediate change) from 43.5 in 2019 to 72.7 per 100,000 in 2021 and sustained till 2024. Similarly, number of private facilities notifying TB increased from 1,040 to 1,858 and prescription of free fixed dose combination drugs by private providers increased from &lt;1% to 14%. These gains were not accompanied by improvements in other TB care services and treatment success. Stakeholders offered insights and reasons for these variations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>The PPSA model improved notification and drug uptake and will require strengthening of quality-of-care services for future scale-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5588\/pha.26.0018","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T16:22:32Z","timestamp":1787674952000},"page":"177-182","source":"Crossref","is-referenced-by-count":0,"title":["India\u2019s private sector engagement model improved TB notification and drug uptake"],"prefix":"10.5588","volume":"16","author":[{"given":"S.","family":"Gupta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.K.","family":"Mattoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Rao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Manickam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Selvaraj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Soundappan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.R.","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Shanmugasundaram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.B.","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3554","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"key":"2026082509221717000_16.3.177.1","unstructured":"World Health Organization . Global Tuberculosis Report. Geneva: WHO, 2025."},{"key":"2026082509221717000_16.3.177.2","unstructured":"Central TB Division . National TB elimination programme: India TB report 2024. New Delhi, India: Ministry of Health and Family Welfare, 2024."},{"key":"2026082509221717000_16.3.177.3","unstructured":"Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India . Revised national tuberculosis control programme annual status report 2016. New Delhi, Delhi: Ministry of Health and Family Welfare, 2016. https:\/\/tbcindia-wp.azurewebsites.net\/wp-content\/uploads\/2023\/05\/8139012351TB-India-2016_Part2.pdf."},{"issue":"4","key":"2026082509221717000_16.3.177.4","doi-asserted-by":"crossref","first-page":"544","DOI":"10.5588\/ijtld.15.0423","article-title":"How do patients access the private sector in Chennai, India? An evaluation of delays in tuberculosis diagnosis","volume":"20","author":"Murrison","year":"2016","journal-title":"Int J Tuberc Lung Dis"},{"key":"2026082509221717000_16.3.177.5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0042458"},{"key":"2026082509221717000_16.3.177.6","unstructured":"National Institute for Research in Tuberculosis (ICMR-NIRT) . National TB prevalence survey in India 2019\u20132021. Chennai, India: Indian Council of Medical Research, 2022. https:\/\/tbcindia.mohfw.gov.in\/wp-content\/uploads\/2023\/05\/25032022161020NATBPSReport.pdf."},{"key":"2026082509221717000_16.3.177.7","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.13.0585"},{"issue":"4","key":"2026082509221717000_16.3.177.8","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.ijtb.2015.11.003","article-title":"Public-private mix for TB care in India: concept, evolution, progress","volume":"62","author":"Kulshrestha","year":"2015","journal-title":"Indian J Tuberc"},{"key":"2026082509221717000_16.3.177.9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0149862"},{"key":"2026082509221717000_16.3.177.10","unstructured":"Mutasa RU, Private sector engagement for tuberculosis elimination: India\u2019s journey from pilots to national scale up (2012\u20132021). Washington, DC: World Bank, 2023."},{"key":"2026082509221717000_16.3.177.11","doi-asserted-by":"crossref","first-page":"32","DOI":"10.12688\/gatesopenres.13113.1","article-title":"Effect of public-private interface agency in Patna and Mumbai, India: Does it alter durations and delays in care seeking for drug-sensitive pulmonary tuberculosis?","volume":"4","author":"Mistry","year":"2020","journal-title":"Gates Open Res"},{"key":"2026082509221717000_16.3.177.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijtb.2020.01.007"},{"key":"2026082509221717000_16.3.177.13","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.ijtb.2024.08.010","article-title":"Enhancing tuberculosis care in Madhya Pradesh through public-private partnerships: an evaluation of the patient provider support agency (PPSA) model","volume":"72","author":"Kourav","year":"2025","journal-title":"Indian J Tuberc"},{"issue":"9","key":"2026082509221717000_16.3.177.14","doi-asserted-by":"crossref","first-page":"3352","DOI":"10.18203\/2394-6040.ijcmph20232703","article-title":"Impact of patient provider support agency on private sector engagement in Tuberculosis care in Eastern India","volume":"10","author":"Narain","year":"2023","journal-title":"Int J Community Med Public Health"},{"issue":"5","key":"2026082509221717000_16.3.177.15","doi-asserted-by":"crossref","first-page":"e0006333","DOI":"10.1371\/journal.pgph.0006333","article-title":"Enhancing tuberculosis care in the private sector: role of innovative private sector engagement model under programmatic settings in India","volume":"6","author":"Gupta","year":"2026","journal-title":"PLOS Glob Public Health"},{"key":"2026082509221717000_16.3.177.16","unstructured":"Ministry of Health and Family Welfare Government of India . Tuberculosis notification measures. New Delhi, India: Ministry of Health and Family Welfare, Government of India. The Gazette of India: extraordinary. 2018: pp. 1-14. https:\/\/dhs.kerala.gov.in\/wp-content\/uploads\/2021\/01\/Gazette-Notification.pdf."},{"key":"2026082509221717000_16.3.177.17","unstructured":"Central TB Division . Nikshay portal. New Delhi, India: Central TB Division, Ministry of Health and Family Welfare, Government of India, 2025. https:\/\/nikshay.in\/."},{"key":"2026082509221717000_16.3.177.18","unstructured":"Central TB Division . Guidance Document on Partnerships Revised National Tuberculosis Control Program [Internet]. New Delhi, India: Central TB Division, Ministry of Health and Family Welfare, Government of India, 2019. https:\/\/tbcindia.mohfw.gov.in\/wp-content\/uploads\/2023\/05\/9531588006Guidance-Doucument-on-Partnerships-RNTCP-2019.pdf."},{"key":"2026082509221717000_16.3.177.19","unstructured":"Ministry of Health and Family Welfare, Goverment of India . Operational Manual for Partneship under National Tuberculosis Elimination Programme. New Delhi, India: Central TB Division, Ministry of Health and Family Welfare, Government of India, 2023. https:\/\/tbcindia.mohfw.gov.in\/wp-content\/uploads\/2023\/05\/3641774273Final-Operations-Manual-for-Partnerships_10-04-23.pdf."},{"key":"2026082509221717000_16.3.177.20","unstructured":"Lewin K . Field theory in social science: selected theoretical papers. New York, NY: Harper & Row, 1951."},{"issue":"Suppl 2","key":"2026082509221717000_16.3.177.21","first-page":"14","article-title":"Private sector contributions to National Malaria Surveillance Systems in elimination settings: lessons learned from Cambodia, Lao PDR, Myanmar, and Vietnam","volume":"108","author":"Potter","year":"2022","journal-title":"Am J Trop Med Hyg"},{"issue":"1","key":"2026082509221717000_16.3.177.22","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s12913-024-12202-6","article-title":"Enhancing tuberculosis case notifications through mapping sales of medicine in the private sector: a quasi-experimental study in Punjab province, Pakistan","volume":"25","author":"Kirubi","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"2026082509221717000_16.3.177.23","unstructured":"Ministry of Health and Family Welfare, Goverment of India . Creating synergies to ensure quality TB care: compendium of best practices to engage the private sector providers and patients in India. New York, NY: Central TB Division, Ministry of Health and Family Welfare, Government of India, 2023. https:\/\/tbcindia.mohfw.gov.in\/wp-content\/uploads\/2023\/05\/6897926685Creating-synergies-to-ensure-quality-TB-care_Compendium-of-PPSA-best-practices.pdf."},{"key":"2026082509221717000_16.3.177.24","unstructured":"FIND and WJCF . Joint effort for elimination of TB report (2018\u20132020). New Delhi, India: FIND and WJCF, 2020. https:\/\/www.projectjeet.in\/wp-content\/uploads\/2022\/01\/JEET-report-2018-2020.pdf."},{"key":"2026082509221717000_16.3.177.25","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-023-08396-5"},{"issue":"1","key":"2026082509221717000_16.3.177.26","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12875-023-02244-w","article-title":"Exploring private sector perspectives on barriers and facilitators in availing tuberculosis care cascade services: a qualitative study from the Indian state","volume":"25","author":"Shah","year":"2024","journal-title":"BMC Prim Care"},{"key":"2026082509221717000_16.3.177.27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0194960"},{"issue":"4","key":"2026082509221717000_16.3.177.28","first-page":"e240034","article-title":"Facilitators and barriers for private health sector engagement for TB care in India: a systematic review and meta-synthesis of qualitative research","volume":"12","author":"Ps","year":"2024","journal-title":"Glob Heal Sci Pract"}],"container-title":["Public Health Action"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.5588\/pha.26.0018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T16:22:36Z","timestamp":1787674956000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.theunion.org\/lookup\/doi\/10.5588\/pha.26.0018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,8,1]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.5588\/pha.26.0018"],"URL":"https:\/\/doi.org\/10.5588\/pha.26.0018","relation":{},"ISSN":["2220-8372"],"issn-type":[{"value":"2220-8372","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}