Barriers to Point Of Care Testing in India
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.
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.
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.
- 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.
- 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.
- 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).
- Nora Engel, Vijayashree Yellappa, Malika Davids, Keertan Dheda, Nitika Pant Pai, Madhukar Pai. Assessment of Barriers to Point of Care Testing in India and South Africa. 47th World Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease, UK,Liverpool October 2016. Int J Tuberc Lung Dis 2015: 19 (12 Suppl 2): S1 – S588
Dr Madhukar Pai
Associate professor Dept of Epidemiology and Biostatistics,
Dr Nora Engel
Department of Health, Ethics and Society, Research school for public health and primary care Maastricht University, Netherlands
Dr Mamata R. Patil
(Institute of Public Health)