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Background: Pakistan ranks among high tuberculosis (TB) burden countries, with about 200,000 missing TB cases. Despite significant increase in case detection and treatment outcomes through public-private mix (PPM) globally, the contribution of the private sector may vary in different parts of Pakistan Methods: This was a cross sectional study conducted in state of Azad Jammu and Kashmir (AJK), Pakistan. The study was a retrospective record review of routine TB notification and treatment outcomes for 2015 to 2016 in districts with and without a PPM approach. The study was conducted in all districts of AJK, including all public and private health facilities. Intra-district comparison in PPM supported districts was also carried out.  Results: Total notified TB cases during 2015-16 were 11479. Districts with PPM support has notified 5882 (51.24%) of TB cases while districts without PPM support contributed 5597 (48.87%). Pulmonary clinical diagnosis was higher in PPM supported districts (45.43%) as compared to districts without PPM support (31.11%). Notification of extra pulmonary TB cases was lower in PPM supported districts (1256; 21.35%) as compared to districts without PPM support (1877; 33.54%). Unfavourable treatment outcomes (treatment failure, died, lost to follow-up) was higher in PPM facilities (5.84%). Conclusion: The study shows minimal increase in TB case finding through the PPM approach. While this is an important aspect in END TB strategy, this needs more careful evaluation.

Is the public-private mix approach increasing tuberculosis case notification in Azad Jammu and Kashmir, Pakistan? A cross-sectional study