Study identifies need to improve patient retention in the National TB Elimination Programme, highlights patients' trust relationship with private providers

Researchers found long delays in care access, with patients shuttling back and forth between providers and health sectors (private vs. public) before they are eventually enrolled on effective treatment.

Written by Anuradha Mascarenhas

Pune | October 31, 2021 12:44 PM IST

3 min read

The study identified the need to improve patient retention in the NTEP and highlight patients' trust relationship with private providers. (Representational/File)

Given the complexity of Multi Drug Resistance – Tuberculosis MDR-TB diagnosis and care, a new study sought to address key knowledge gaps in MDR risk factors, care delays, and drivers of delay to help guide disease control.

Additional evidence for recent transmission of drug-resistant TB in crowded localities/slum areas was also found, researchers said in their study “Tuberculosis Pathways to Care and Transmission of Multidrug-Resistance in India” published in a top ranked – American Journal of Respiratory and Critical Care Medicine on October 27 this year

The research team, including Dr. Sachin Atre of Pune based D. Y. Patil Medical College and the Johns Hopkins Center for Clinical Global Health Education and Dr. Maha Reda Farhat, assistant Professor of Biomedical Informatics at Harvard Medical School, Boston, USA.

“We believe these findings are of current interest to the Indian public given that Covid-19 has further limited testing and diagnosis capacity for TB in India over the last 18 months,” Dr Atre said.

Researchers conducted interviews with adults registered with the National TB Elimination Program (NTEP) for MDR (n=128) and non-MDR-TB (n=269) treatment to quantitatively and qualitatively study care pathways. The study conducted in 2018-19 was funded by Harvard-Dubai Centre for Global Health Delivery and it was done among patients who are registered with the National TB Elimination Control Program (NTEP) in Maharashtra.

They collected treatment records and GeneXpert-TB/RIF diagnostic reports. MDR-TB was associated with young age, and crowded residence. GeneXpert rifampicin resistance diversity was measured at 72.5% .Delay decreased with wider access to GeneXpert testing. Pathways to care were complex with a median of 4 providers. Of MDR-TB patients, 68% had their first encounter in the private sector and this was associated with a larger number of subsequent healthcare encounters and huge expenditures.

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The association of MDR with young age, crowded locality and low genotypic diversity (means many patients have the same resistant TB strain which may cause an epidemic situation) raise concerns of ongoing MDR-TB transmission which is fueled by long delays in care.

Delays are decreasing with GeneXpert use, suggesting the need for routine use in presumptive TB and provision for that. The study identified the need to improve patient retention in the NTEP and highlight patients’ trust relationship with private providers.

Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More

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Tuberculosis

Study identifies need to improve patient retention in the National TB Elimination Programme, highlights patients’ trust relationship with private providers

Researchers found long delays in care access, with patients shuttling back and forth between providers and health sectors (private vs. public) before they are eventually enrolled on effective treatment.