Objectives: To estimate the potential impact of expanding services offered by the Joint Effort for Elimination of Tuberculosis (“JEET”), the largest private sector engagement initiative for tuberculosis (TB) in India.
Design: We developed a mathematical model of TB transmission dynamics, coupled with a cost model.
Setting: Ahmedabad and New Delhi, two cities with contrasting levels of JEET coverage.
Participants: Estimated patients with TB in Ahmedabad and New Delhi.
Interventions: We investigated the epidemiological impact of expanding three different PPSA services: provider recruitment, uptake of CB-NAAT (cartridge-based nucleic acid amplification tests) and uptake of adherence support mechanisms (specifically government supplied fixed-dose combination drugs), all compared to a continuation of current TB services.
Results: Our results suggest that in Delhi, increasing the use of adherence support mechanisms amongst private providers should be prioritised, having the lowest incremental cost-per-case-averted between 2020 and 2035 of $170,000 (110,000 – 310,000). Likewise in Ahmedabad, increasing provider recruitment should be prioritised, having the lowest incremental cost-per-case averted of $18,000 (12,000-29,000).
Conclusion: Results illustrate how intervention priorities may vary in different settings across India, depending on local conditions, and the existing degree of uptake of PPSA services. Modelling can be a useful tool for identifying these priorities for any given setting.