Enhancing quality of TB services through STEPS center: Experience from a private tertiary care hospital in Uttar Pradesh, India.

BACKGROUND: In India, nearly half of patients with tuberculosis (TB) seek care from the private healthcare sector, where concerns regarding quality of TB care, microbiological confirmation, and adherence to Standards for TB Care in India (STCI) continue to exist. The System for TB Elimination in Private Sector (STEPS) model was developed to strengthen quality-assured TB care through a patient-centric single-window approach within private hospitals. This study describes the implementation of a STEPS Centre and its impact on indicators of quality TB care in a private tertiary care hospital in northern India. METHODS: A retrospective comparative operational research study was conducted at a private tertiary care hospital in Uttar Pradesh, India. Programmatic indicators from the pre-implementation period (2023) were compared with post-implementation data from 2024 to 2025 following establishment of the STEPS Centre in March 2024. Data were obtained from Nikshay records, laboratory registers, radiology records, and STEPS Centre program records. Indicators assessed included microbiological confirmation, baseline rifampicin resistance testing using Nucleic Acid Amplification Test (NAAT), NAAT offering among clinically diagnosed TB cases, HIV and diabetes mellitus status documentation, and treatment outcomes. RESULTS: Following implementation of the STEPS Centre, utilization of TB diagnostic services increased substantially. The number of NAATs performed increased from 1485 in 2023 to 2418 in 2025, while chest X-rays increased from 31,405 to 39,353 during the same period. The proportion of microbiologically confirmed TB cases increased from 22% (87/395) in 2023 to 30% (118/392) in 2025. Baseline rifampicin resistance testing using NAAT improved from 11% (43/395) to 65% (256/392) over the period of two years. Among clinically diagnosed TB patients, the proportion offered NAAT increased from 20% to 59%. Documentation of diabetes mellitus status improved from 0% to 91%. TB deaths among notified patients decreased from 3.3% (13/395) in 2023 to 2.3% (9/392) in 2025. CONCLUSION: Implementation of the STEPS Centre was associated with improvement in microbiological confirmation, baseline drug resistance testing, co-morbidity assessment, and adherence to STCI recommendations in a private tertiary care hospital. The findings support the potential role of STEPS as a practical and scalable model for strengthen the quality TB care in the private healthcare sector.