RT Journal Article
SR Electronic
T1 Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT): a market-shaping intervention in India
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e001539
DO 10.1136/bmjgh-2019-001539
VO 4
IS 6
A1 Harkesh Dabas
A1 Sarang Deo
A1 Manisha Sabharwal
A1 Arnab Pal
A1 Sachin Salim
A1 Lakshmi Nair
A1 Kaartikeya Chauhan
A1 Prateek Maheshwari
A1 Aparna Parulkar
A1 Ritu Singh
A1 Manasi Chitalia
A1 Rigveda Kadam
A1 Manjot Kaur
A1 Collins Oghor
A1 Nirros Ponnudurai
A1 Sameer Kumta
A1 Peter Small
A1 Puneet Dewan
A1 Madhukar Pai
YR 2019
UL http://gh.bmj.com/content/4/6/e001539.abstract
AB A majority of patients with tuberculosis (TB) in India are diagnosed and treated in the private sector. Yet, most private providers do not use most recent WHO-endorsed microbiological tests such as liquid cultures, line probe assays and Xpert MTB/RIF due to a combination of factors such as lack of awareness, misaligned incentives and high prices that are unaffordable for patients. We designed a market-based approach to transform a high-price, low-volume market equilibrium into a low-price, high-volume equilibrium to improve the uptake of these tests. Toward this end, a non-profit consortium of private laboratories, called Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT) was formed in India in March 2013. It negotiated lower pricing on equipment and reagents with manufacturers, closer to that offered to the public sector. In return, IPAQT assured that this discount was passed on to patients, who typically paid for these tests out of their pockets, through an informally agreed on retail ceiling price. IPAQT also invested in demand generation activities that complemented the supply-side effort. IPAQT membership grew from 56 laboratories in 2013 to 211 in 2018. During this period, the initiative resulted in a 10-fold increase in the uptake of Xpert and a 30%–50% reduction in price. This initiative is planned to be expanded to other South Asian countries with similar TB epidemic and private market structure and dynamics. However, long-term sustainability of the initiative would require developing more cost-effective marketing activities and integration with broader private sector engagement agenda of the national TB programme.