Enhancing tuberculosis care in the private sector: Role of innovative private sector engagement model under programmatic settings in India

India’s private sector plays a crucial role in the country’s tuberculosis (TB) healthcare landscape, with >50% of patients seeking initial care from private providers. Recognizing this critical role, the National Tuberculosis Elimination Program implemented and scaled up an innovative private sector engagement model, Patient Provider Support Agency (PPSA), in over 200 districts of the country in 2023 to improve TB care in the private sector. A cross-sectional study was conducted to assess the role of PPSA in improving TB care services among private-sector patients in 2023. We compared districts with PPSA and without PPSA for their TB notification, treatment timeliness, key quality-of-care indicators and treatment outcomes from the private sector at the national level. Data for private sector notification from Ni-kshay (web-enabled TB patient management system) was analyzed. In 2023, districts supported by PPSA (n = 204) recorded an average private sector TB notification rate of 106 per 100,000 and achieved 99.7% of the set target, compared to 529 districts without PPSA, which reported a rate of 45 per 100,000 and reached only 80% of the target. The pretreatment loss to follow-up (2% vs 4%) and the treatment initiation delay >7 days (5% vs 10%) were lower in districts with PPSA. They also reported improved TB care services- comorbidity testing (HIV and diabetes), bank detail linkage for receiving financial support and treatment success with PPSA support. However, districts with PPSA showed lower coverage of upfront nucleic acid amplification testing (17% vs 22%), drug susceptibility testing (21% vs 25%) and uptake of government-supplied drugs (22% vs 33%) compared with districts without PPSA. The PPSA model improved private sector TB notification and reduced treatment delays nationally; however, strategic expansion by focusing on quality-oriented TB care services and their link to results-based financing is essential to maximize its efficiency and overall impact on private sector TB care.