Summary
The vision of the Government of India (GoI) is for a ‘TB free India’. To achieve this, the GoI has adopted a new strategy in the Revised National TB Control Programme (RNTCP) to provide ‘universal access for quality diagnosis and treatment for all TB patients by engaging all health care providers’. Private Practitioners (PPs) paly an important role in provision of TB care in India. However evidence shows that treatment offered in the private health sector being sub-standard and inconsistent. Also, many times retail private pharmacists (RPPs), act as primary care givers by dispensing drugs over the counter. Given the challenges of involving PPs and RPPs in the RNTCP, we have formulated a package of interventions to increase the involvement of PPs and RPPs. One set of interventions is targeted towards general strengthening of the RNTCP services, and the other is targeted towards intervention PPs and RPPs. Intervention activities include training, improving communication between RNTCP and private health sector players, periodic visits to PP’s and RPP’s facilities by RNTCP staff, etc. The present protocol aims to evaluate whether and how intervention activities improve the collaboration between PPs and RPPs with RNTCP and whether the interventions could be integrated into RNTCP, PP’s and RPP’s routine practice. There will be no direct interaction with patients.

Methods
It is a cluster randomised control trial. We will use Replicating Effective Programme framework for implementing the intervention activities. The proposed model is unique, in terms of its approach and implementation strategy. The research questions are demand driven and framed from the needs identified with relevant stakeholders in the health system. Our study will focus on utilising and building local RNTCP resources and skills, so that a replicable model is created and the knowledge transferred to the government for further scale up of successful approaches.

We will carryout this research in three sub-districts of Tumkur district, located in South India. We will allocate all PPs and RPPs practicing in Kunigal sub-district to the intervention group and all PPs and RPPs practicing in Turuvekere and CN halli sub-districts to the control group.

Outcomes
As main outcomes, we will assess the proportion of PPs and RPPs referring presumptive TB cases to the RNTCP and the proportion of PPs notifying TB cases to the RNTCP, and proportion of RPPs notifying number of patients purchasing anti TB drugs from their shop, in the intervention versus control group at the end of the intervention. The duration of the study is 12 months.

This project is funded by WHO TDR, Second round of IMPACT Grant awardee.