ArticlePLOS global public health2026
Improving private tuberculosis patient notifications in Akot Tuberculosis Unit of Vidarbha region of India: A Plan-Do-Study-Act (PDSA) based approach for enhanced public health reporting.
Article in PLOS global public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
India bears the world's largest tuberculosis (TB) burden, and under-reporting from private-sector providers continues to hinder elimination goals. In the Akot Tuberculosis Unit (TU) of Maharashtra, private notifications remained disproportionately low despite extensive private healthcare presence. This study implemented a structured quality-improvement (QI) model using Plan-Do-Study-Act (PDSA) cycles to enhance TB case notifications from private providers.A mixed-method quality-improvement study was conducted from August to December 2023. Four iterative PDSA cycles were implemented targeting private practitioners, pharmacists, and laboratory technicians. Interventions included sensitization workshops, weekly WhatsApp-based digital outreach, and personalized follow-up visits by Public-Private Mix (PPM) coordinators. Quantitative data were extracted from the Ni-kshay platform and validated through Tuberculosis Unit records. Private notification trends (2018-2024) were analysed using segmented regression to assess temporal trends, while qualitative insights from key informant interviews (n = 6) explored barriers and enablers influencing notification practices. A total of 90 stakeholders participated (45 practitioners, 30 pharmacists, and 15 laboratory technicians). Private TB notifications increased from 16 of 90 total cases (17.8%) during January-July 2023-63 of 121 cases (52.1%) during November-December 2023, reflecting increase during the post-intervention period. The interrupted time-series analysis demonstrated a positive post-intervention trend in private TB notifications (β = +50.5, p = 0.032). Qualitative findings revealed that personalized digital mentoring and hands-on technical support helped address barriers such as Ni-kshay login issues, misconceptions about notification responsibility, and perceived workload. The implementation of a structured PDSA-based quality-improvement approach was associated with improvements in private-sector TB notifications in a previously low-performing tuberculosis unit. The findings suggest that integrating digital engagement, capacity building, and supportive supervision within existing NTEP structures may strengthen TB surveillance and private-sector engagement. These insights may inform scalable strategies to improve TB notification systems in similar programmatic settings.
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