The a resulting gap between actual TB incidence

The scale of
India’s private medical sector cannot be underestimated; about 80% of Indians
seek private healthcare in general, and an estimated 50% of TB patients are
managed outside the RNTCP TB
control: challenges and opportunities for India
https://academic.oup.com/trstmh/article-abstract/110/3/158/2578778?redirectedFrom=fulltext
The private sector in India is vast, fragmented, made up of diverse types of
healthcare providers, and is largely unregulated.

A rather negative feature of healthcare provision in
India is that for the majority of TB patients treatment is first received
within the largely unorganized and unregulated private sector. Patients from
low income households will often lose several months of their income in the
process of paying for inappropriate diagnostics and treatments before starting
approved therapy.

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Primarily in
the large and fragmented private sector, underreporting of TB cases a resulting
gap between actual TB incidence and reported cases. 

•       India accounted for 33% of global TB
deaths among HIV-negative people, and for 26% of the combined total of TB
deaths in HIV-negative and HIV-positive people

•       Most of the global increase in
notifications of new TB cases since 2013 is explained by a 37% increase in
India 2013–2016

•       https://www.ncbi.nlm.nih.gov/pubmed/27780217
The WHO estimated that there were 2,700,000 (95%CI: 1,800,000-3,800,000)
prevalent TB patients in India in 2013. Of these patients, we estimate that
1,938,027 (72%) TB patients were evaluated at RNTCP facilities; 1,629,906 (60%)
were successfully diagnosed; 1,417,838 (53%) got registered for treatment;
1,221,764 (45%) completed treatment; and 1,049,237 (95%CI:
1,008,775-1,083,243), or 39%, of 2,700,000 TB patients achieved the optimal
outcome of 1-y recurrence-free survival.

•       The
overall TB prevalence and associated mortality, declines in incidence rates
have been outrun by the growth of the global population.

•      
India
faces a triple burden of TB, HIV and MDR-TB (see WHO 2017 report)

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