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

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.