Awareness of management of pulmonary multidrug-resistant tuberculosis (MDR-TB) among private practitioners in suburban areas of Pune city, India: Input for developing an educational tool

Private practitioners (PPs) play a major role in caring for people with tuberculosis (TB) in India. At the same time, PPs have limited access to continuing medical education and oversight especially with regards to recent changes in the management of multi-drug resistant (MDR- TB). As a part of a larger study aimed at developing an educational tool for improving multidrug-resistant TB management, we conducted a baseline knowledge assessment of MDR-TB among PPs in suburban areas of Pune City, India. This study with a cross-sectional design was conducted during July 2022 to May 2023 among 100 PPs, who either refer and/treat TB and MDR-TB cases in Pimpri-Chinchwad Municipal Corporation (PCMC) areas of Pune in Maharashtra State. The inquiry was made using an interview schedule focused on suspicion of pulmonary TB and MDR-TB, their diagnosis and treatment. The majority of PPs were allopathic practitioners (85%) practicing in private clinics (82%). Most PPs reported that they suspect TB based on three cardinal symptoms: cough for >2 weeks (97%), fever (93%) and weight loss (82%). While 54% PPs considered the Xpert assay as the first test to diagnose MDR-TB, 32% were unaware of any test.Only 37% PPs were aware of whole genome sequencing for MDR diagnosis. A fifth of PPs selected Mantoux test use for the diagnosis of active TB. Less than a fourth of PPs knew about the second-line anti-TB drugs such as bedaquiline, delamanid or linezolid etc. and their availability either in the National TB Elimination Program (NTEP) or the private sector. Our study indicates considerable lack of awareness about pulmonary MDR-TB management among allopathic PPs in the study area and highlights the need for education and creating awareness about the same. It identified specific areas for developing an educational tool for PPs in India and elsewhere.