TY - JOUR T1 - Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT): a market-shaping intervention in India JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2019-001539 VL - 4 IS - 6 SP - e001539 AU - Harkesh Dabas AU - Sarang Deo AU - Manisha Sabharwal AU - Arnab Pal AU - Sachin Salim AU - Lakshmi Nair AU - Kaartikeya Chauhan AU - Prateek Maheshwari AU - Aparna Parulkar AU - Ritu Singh AU - Manasi Chitalia AU - Rigveda Kadam AU - Manjot Kaur AU - Collins Oghor AU - Nirros Ponnudurai AU - Sameer Kumta AU - Peter Small AU - Puneet Dewan AU - Madhukar Pai Y1 - 2019/11/01 UR - http://gh.bmj.com/content/4/6/e001539.abstract N2 - 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. ER -