Barriers to Point Of Care Testing in India

Introduction
Global health experts see immense potential in  Point of Care Test (POC) tests to reduce delays in diagnosing and initiating treatment for diseases like TB, HIV, syphilis and malaria. However, the mere availability of rapid or simple tests does not automatically ensure their adoption or scale-up as a POC test. Sometimes rapid tests are not implemented rapidly, they get misused or underused, or their results are not used to impact treatment decisions in a timely manner.

Objectives
The aim of the study was to conduct qualitative research on ‘why some POC tests are used at the point-of-care and others are not, with a special focus on well-established Rapid Diagnostic Tests of global health importance: HIV, malaria, syphilis, hepatitis, and dengue, and to better understand “user needs” in terms of TB diagnostics’. Our overall objective was to understand whether POC testing is happening and where, and if not, why it is not happening.

Methodology
We conducted qualitative research on diagnostic practices in five settings in India (home, community, lab, clinic, hospital), for different diseases, in urban/rural and public/private set-ups, and across a variety of providers and patients. A total of 78 semi-structured interviews were conducted with healthcare providers (doctors, nurses, specialists, traditional healers, and informal providers), patients, community health workers(CHWs) , test manufacturers, laboratory technicians, program managers and policy-makers. Participants were purposively sampled to represent the five settings of hospitals, peripheral labs, clinics, communities and homes, in both the public/private sector and rural/urban setting . Additionally, 13 focus group discussions were conducted with TB and diabetic patients, CHWs, laboratory technicians, TB program staff and medical officers at public clinics and with public hospital nurses, selected on a convenience basis to represent the different settings. The total number of FGD participants was 94, with a median group size of six.

 

  1. Nora Engel, Gayatri Ganesh, Mamatha Patil, Vijayashree Yellappa, Caroline, Vadnais, Nitika Pant Pai, Madhukar Pai. Barriers to point-of-care testing in India: Results from qualitative research across different settings, users and major diseases. Plos One; 2015. 10(8): e0135112.
  2. Nora Engel, Gayatri Ganesh, Mamatha Patil, Vijayashree Yellappa, Caroline, Vadnais, Nitika Pant Pai, Madhukar Pai. Point-of-care testing in India: missed opportunities to realize the true potential of Point of Care testing programs. Bio Med Central. 2015;15:550. DOI 10.1186/s12913-015-1223-3.
  3. Vijayashree Yellappa, Narayanan Devadasan, Anja Krumeich, Nitika Pant Pai, Caroline Vadnais, Madhukar Pai, Nora Engel. How patients navigate a fragmented health system to reach a diagnosis: A qualitative study from India. Global Health Action. 2017 (In Press).

Duration of project

January 2013

to

June 2014


Funders

Bill & Melinda Gates Foundation (BMGF OPP1061487)


 

Admissions open for eSWaRM

Study Team

Dr Madhukar Pai

Associate professor Dept of Epidemiology and Biostatistics,

(McGill University, West Montreal,  Canada)

Dr Mamata R. Patil

Ex-Staff,

(Institute of Public Health)