Madhukar Pai
Datos Biográficos
| ID | 3581834 |
|---|---|
| NOMBRE | Madhukar Pai |
| NOMBRES | Madhukar |
| APELLIDO | Pai |
| FIRMA | PAI M |
| AFILIACIONES | McGill University |
| ORCID | 0000-0003-3667-4536 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 88 |
| TOTAL DE CITAS | 7 |
| TOTAL COMO AUTOR | 51 |
| TOTAL COMO EDITOR | 37 |
| PRIMER AÑO DE PUBLICACIÓN | 2009 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2026 |
| ÍNDICE H | 2 |
Delays in tuberculosis diagnosis and treatment in India
Tuberculosis (TB) care for people with TB in India are often fragmented, undermining timely diagnosis and treatment. Understanding patient journeys is critical to strengthening TB care delivery and advancing elimination goals. We conducted a cross-sectional study of 400 people with TB diagnosed between 2020–2022 in two Indian cities: Mumbai (n = 200) and Patna (n = 200). Using structured interviews, we assessed care-seeking behavior, delays to di…
Globalisation, rising authoritarianism, declining solidarity, and retreating multilateralism
Antibiotic dispensing practices and determinants among informal healthcare providers in low- and middle-income countries
INTRODUCTION: Antimicrobial stewardship efforts in low- and middle-income countries (LMICs) largely focus on qualified practitioners, yet informal healthcare providers (IPs) deliver much of the primary care. Although these providers frequently dispense antibiotics, their practices remain poorly documented and are not captured in existing surveillance systems. METHODS: Using the Joanna Briggs Institute methodology, this scoping review synthesised …
A methodological review of patient healthcare-seeking journeys from symptom onset to receipt of care
BACKGROUND: For many diseases, early diagnosis and treatment are more cost-effective, reduce community spread of infectious diseases and result in better patient outcomes. However, healthcare-seeking and diagnoses for several diseases are unnecessarily delayed. For example, in 2022, 3 million and 5.6 million people living with tuberculosis (TB) and HIV, respectively, were undiagnosed. Many patients never access appropriate testing, remain undiagn…
Health and tuberculosis systems resilience, the role of the private sector and pandemic preparedness
Introduction The COVID-19 pandemic was an unprecedented challenge to health systems worldwide and had a severe impact on tuberculosis (TB) case notifications and service delivery. India, Indonesia and Nigeria are high TB-burden countries where the majority of initial care-seeking happens in the private health sector. The objectives of this study were to (1) explore policy-makers’ perspectives on the impact of the COVID-19 pandemic on private sect…
Scanned
Fighting tuberculosis hand in hand
Tuberculosis (TB) is an infectious disease closely intertwined with stigma, discrimination, and the social determinants of health. Communities of people affected by TB are experts in their care pathways, but the TB field continues to fall short of meaningfully engaging communities in TB research. This is a missed opportunity to improve the quality, relevance, person-centeredness, positive impact, and sustainability of TB research outputs. We ackn…
Distribution and transmission of M. tuberculosis in a high-HIV prevalence city in Malawi
Delays in identifying and treating individuals with infectious tuberculosis (TB) contribute to poor health outcomes and allow ongoing community transmission of M. tuberculosis ( Mtb ). Current recommendations for screening for tuberculosis specify community characteristics (e.g., areas with high local tuberculosis prevalence) that can be used to target screening within the general population. However, areas of higher tuberculosis burden are not n…
Can we unplug global health education from The Matrix
“You can’t see what you’ve never had to live”—Cultivating imagination and solution spaces in global health and development
Improving the efficiency of the regulatory approvals of HIV in vitro diagnostics in low- and middle-income countries
In vitro diagnostics (IVDs) play a pivotal role in healthcare for the prevention, diagnosis, and treatment of infectious diseases, especially during epidemic and pandemic outbreaks. Improving access to IVDs holds promise for better healthcare outcomes, particularly in resource-limited settings. However, challenges persist, such as regulatory disparities and financial constraints, hindering broad access to IVDs. To address these challenges, the In…
Provider perspectives on empirical antibiotic treatment for tuberculosis-like symptoms in South Africa’s private general practice sector
While tuberculosis (TB) in South Africa is commonly treated in the public sector, some clients first seek care in the private sector. Research has demonstrated that private general practitioners (GPs) perform less well than do public sector care providers in TB testing and drug-dispensing practices. We aimed to describe GPs’ decision-making practices related to empiric antibiotic treatment when presented with symptoms that may be related to TB, t…
Individual journeys to tuberculosis care in Nigeria’s private sector during the Covid-19 pandemic
BACKGROUND: Pre-COVID-19, individuals with tuberculosis (TB) in Nigeria were often underdiagnosed and untreated. TB services were mostly in the public sector with only 15% of new cases in 2019 reported from the private sector. Reports highlighted challenges in accessing care in the private sector, which accounted for 67% of all initial care-seeking. Our study examined patients' health seeking pathways for TB in Nigeria's private sector and explor…
Private sector tuberculosis care quality during the Covid-19 pandemic
Only a third of tuberculosis (TB) cases in Nigeria in 2020 were diagnosed and notified, in part due to low detection and under-reporting from the private health sector. Using a standardised patient (SP) survey approach, we assessed how management of presumptive TB in the private sector aligns with national guidelines and whether this differed from a study conducted before the start of the COVID-19 pandemic. 13 SPs presented a presumptive TB case …
Unlocking the potential of informal healthcare providers in tuberculosis care
In 2022, tuberculosis (TB) remained a major global health concern, second only to COVID-19 in mortality from a single infectious agent
Community-friendly diagnostics
From lemming to leader
Nearly 90 years after Simon Kuznets first introduced Gross Domestic Product (GDP) for the limited purpose of measuring economic growth (by measuring the monetary value of all local goods and services within a given period of time), calls continue to mount for decision-makers to stop using GDP and its derivate, Gross National Income (GNI), for purposes far beyond their original design [1].This is particularly true in the case of the development as…
Navigating time equity
Since the start of the COVID-19 pandemic, there have been a surge in calls for equity to protect the world from future crises. Calls have emphasized equitable distribution of vaccines, a fair access and benefit sharing (ABS) system, and health systems strengthening, all leading to negotiation of a Pandemic Treaty
Conflicts in Gaza and around the world create a perfect storm for infectious disease outbreaks
The global history of conflicts has revealed that infectious diseases resulting from displacement, overcrowding, healthcare collapse, destruction of critical water and sanitation infrastructure, and malnutrition can cause death rates equal or beyond those from direct violence The crisis in Gaza is no exception and has created a perfect storm for infectious disease outbreaks
The role of epistemic trust and epistemic disruption in vaccine hesitancy, conspiracy thinking and the capacity to identify fake news
Epistemic trust ‐ defined as readiness to regard knowledge, communicated by another agent, as significant, relevant to the self, and generalizable to other contexts–has recently been applied to the field of developmental psychopathology as a potential risk factor for psychopathology. The work described here sought to investigate how the vulnerability engendered by disruptions in epistemic trust may not only impact psychological resilience and int…
Case fatality among people with drug-susceptible TB enrolled in a private health sector TB treatment support program in Bihar, India during the first year of the Covid-19 pandemic
Experiencing 27% of the global tuberculosis (TB) burden, India’s TB epidemic is the largest in the world. Due to COVID-19-related disruptions to TB programs, India has also seen the largest drop in TB case notifications of any country globally. We estimated case fatality among people treated for TB in India during the pandemic and compared these to pre-pandemic estimates. A random sample of 4,000 adults enrolled in World Health Partners (WHP), a …
Drivers of success in global health outcomes
Applying a positive outlier lens is one effective approach for generating evidence to inform global health policy, program, and funding decisions. Exemplars in Global Health (EGH) is a program that studies positive outlier countries that have made extraordinary progress in health outcomes (despite limited resources) and disseminates their successes through multiple types of outputs. To date, EGH has studied, or is studying, 14 global health topic…
The shifting landscape of private healthcare providers before and during the Covid-19 pandemic
Introduction COVID-19 pandemic changed many aspects of healthcare services and deliveries, including among private healthcare providers (i.e., private healthcare facilities [HCFs] and private practitioners [PPs]). We aimed to compare the spatial distribution of private providers and describe changes in characteristics and services offered during and before the COVID-19 pandemic, and explore the tuberculosis (TB) and COVID-19-related services offe…
Potential implications of the climate crisis on diagnostics
From barrier to enabler
Why language
Simulated patients and their reality
Simulated standardized patients (SSP) have emerged as close to a 'gold standard' for measuring the quality of clinical care. This method resolves problems of patient mix across healthcare providers and allows care to be benchmarked against preexisting standards. Nevertheless, SSPs are not real patients. How, then, should data from SSPs be considered relative to clinical observations with 'real' patients in a given health system? Here, we reject t…
Tuberculosis in times of Covid-19
The COVID-19 pandemic has caused widespread disruptions to tuberculosis (TB) care and service delivery in 2020, setting back progress in the fight against TB by several years. As newer COVID-19 variants continue to devastate many low and middle-income countries in 2021, the extent of this setback is likely to increase. Despite these challenges, the TB community can draw on the comprehensive approaches used to manage COVID-19 to help restore progr…
One Million Lives Saved Per Year
This report presents a cost–benefit analysis of increased spending on tuberculosis (TB) using impacts and costs drawn from the Global Plan to End Tuberculosis, 2023–2030. The analysis indicates that the return on TB spending is substantial with a centrally estimated benefit–cost ratio (BCR) of 46, meaning every US$ 1 invested in TB yields US$ 46 in benefits. Alternative specifications using different baselines, interventions, cost profiles, and d…
Profile of adults seeking voluntary HIV testing and counseling in rural Central India
Rural India has an undetected load of HIV-positive individuals. Few rural adults present for HIV testing and counseling due to stigma, discrimination, and fear of social ostracization. In this rural hospital clinic-based study, we document profiles of rural adults seeking voluntary testing and counseling, and analyze correlates of HIV seropositivity. This cross-sectional study was conducted in 450 participants presenting to the outpatient clinics…
Diagnosing at Point of Care in South India
Point-of-care testing promises to cut diagnostic and treatment delays by ensuring patients receive a management decision based on a diagnostic test within one encounter with a provider. Adding to STS work on diagnostics and the sociology of diagnosis, this paper examines the work involved in enacting point-of-care testing, how technology features and the embedded assumptions regarding patients. Using focus group discussions with providers and pat…
How patients navigate the diagnostic ecosystem in a fragmented health system
BACKGROUND: Depending on a country's diagnostic infrastructure, patients and providers play different roles in ensuring that correct and timely diagnosis is made. However, little is known about the work done by patients in accessing diagnostic services and completing the 'test and treat' loop. OBJECTIVE: To address this knowledge gap, we traced the diagnostic journeys of patients with tuberculosis, diabetes, hypertension and typhoid, and examined…
Will global health survive its decolonisation?
Differential yield of universal versus selective drug susceptibility testing of patients with tuberculosis in high-burden countries
Global health degrees
Allopolyploidization is a biological process that has played a major role in plant speciation and evolution. Genomic changes are common consequences of polyploidization, but their dynamics over time are still poorly understood. Coffea arabica, a recently formed allotetraploid, was chosen to study genetic changes that accompany allopolyploid formation. Both RNA-seq and DNA-seq data were generated from two genetically distant C. arabica accessions.…
Finding the missing millions
box In 2019, 10.0 million people developed tuberculosis (TB) yet 2.9 million were not notified to National TB programmes (NTPs).1 This is largely due to limited accessibility to healthcare services, underdeveloped health reporting systems, insufficient human resources and poor linkages between private providers and national authorities.2 There are various global initiatives to address this challenge, including the Find.Treat.All #EndTB initiative…
Missing men with tuberculosis
Tuberculosis (TB) is treatable but is the leading infectious cause of death worldwide, with men over-represented in some key aspects of the disease burden. Men’s TB epidemiological scenario occurs within a wider public health and historical context, including their prior sidelining in health discussions. Differences are however noticeable in how some Western countries and high TB and HIV burden low and middle-income countries (LMIC) including in …
Tuberculosis case fatality in India
India’s syndemic of tuberculosis and Covid-19
Chromatin instability and loss of protein homeostasis (proteostasis) are two well-established hallmarks of aging, which have been considered largely independent of each other. Using microfluidics and single-cell imaging approaches, we observed that, during the replicative aging of S.cerevisiae , proteostasis decline occurred specifically in the fraction of cells with decreased stability at the ribosomal DNA (rDNA) region. A screen of 170 yeast RN…
Antibiotic overuse in the primary health care setting
INTRODUCTION: Determining whether antibiotic prescriptions are inappropriate requires knowledge of patients' underlying conditions. In low-income and middle-income countries (LMICs), where misdiagnoses are frequent, this is challenging. Additionally, such details are often unavailable for prescription audits. Recent studies using standardised patients (SPs) offer a unique opportunity to generate unbiased prevalence estimates of antibiotic overuse…
Addressing power asymmetries in global health
The Coronavirus Disease 2019 (COVID-19AU : PleasenotethatCOVID 19hasbeendefinedasCoro ) pandemic, the Black Lives Matter and Women in Global Health movements, and ongoing calls to decolonise global health have all created space for uncomfortable but important conversations that reveal serious asymmetries of power and privilege that permeate all aspects of global health.
Using the Covid-19 pandemic to reimagine global health teaching in high-income countries
Quality of care for tuberculosis and HIV in the private health sector
BACKGROUND: South Africa has high burdens of tuberculosis (TB) and TB-HIV, yet the quality of patient care in the private sector is unknown. We describe quality of TB and TB-HIV care among private general practitioners (GPs) in two South African cities using standardised patients (SPs). METHODS: Sixteen SPs presented one of three cases during unannounced visits to private GPs in selected high-TB burden communities in Durban and Cape Town: case 1,…
PLOS Global Public Health, charting a new path towards equity, diversity and inclusion in global health
Engaging pharmacies in tuberculosis control
Prescribing practices for presumptive TB among private general practitioners in South Africa
INTRODUCTION: Medicine prescribing practices are integral to quality of care for leading infectious diseases such as tuberculosis (TB). We describe prescribing practices in South Africa's private health sector, where an estimated third of people with TB symptoms first seek care. METHODS: Sixteen standardised patients (SPs) presented one of three cases during unannounced visits to private general practitioners (GPs) in Durban and Cape Town: TB sym…
How we classify countries and people—and why it matters
Tuberculosis diagnosis and management in the public versus private sector
BACKGROUND: There are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors. METHODS: We used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai. RESULTS: SPs presented a 'classic, suspected TB' scenario and a 'recurrence or drug-resistance' scenario. In the private sector, SPs completed 643 interactions. In the public s…
Global health education in high-income countries
Contemporary global health education is overwhelmingly skewed towards high-income countries (HICs). HIC-based global health curricula largely ignore colonial origins of global health to the detriment of all stakeholders, including trainees and affected community members of low- and middle-income countries. Using the Consortium of Universities for Global Health’s Global Health Education Competencies Tool-Kit , we analyse the current structure and …
Tracking changes in national BCG vaccination policies and practices using the BCG World Atlas
The BCG vaccine is a widely given vaccine against tuberculosis (TB), yet studies on effectiveness have shown considerable heterogeneity; as a result, BCG vaccine policies vary greatly across the globe and change across geography, and with time and disease burden. The recently updated third BCG World Atlas ( www.bcgatlas.org ) is a publicly available online database with information on BCG practices across 194 countries. This helpful resource has …
Most common reasons for primary care visits in low- and middle-income countries
With the Covid-19 pandemic and the introduction of the WHO’s Essential Diagnostics List (EDL), increasing global attention is focused on the crucial role of diagnostics in achieving universal health coverage. To create national EDLs and to aid health system planning, it is vital to understand the most common conditions with which people present at primary care health facilities. We undertook a systematic review of the most common reasons for prim…
The great Texas Covid tragedy
The United States of America leads all high-income nations in COVID-19 deaths, even though as a nation at had the greatest access to antiviral vaccines and therapeutics. To understand this disconnect we can look to the COVID-19 deaths and disability in the State of Texas. Because of COVID-19, Texas is enduring one of the greatest human tragedies in its 186-year history. It did not have to be this way
Lifesaving, cost-saving
Aastha Gupta is a consultant to the Global Alliance for TB Drug Development (TB Alliance), a non-profit organization dedicated to the discovery and development of improved TB therapeutics
When it comes to stopping tuberculosis, what is actually “missing”
Medicine (60 obras) · Political science (29 obras) · Health care (27 obras) · Nursing (27 obras) · Tuberculosis Research and Epidemiology (24 obras) · Environmental health (23 obras) · Economic growth (22 obras) · Tuberculosis (22 obras) · Business (20 obras) · Family medicine (18 obras)