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      Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs

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          Abstract

          Background

          The core objective of any point-of-care (POC) testing program is to ensure that testing will result in an actionable management decision (e.g. referral, confirmatory test, treatment), within the same clinical encounter (e.g. POC continuum). This can but does not have to involve rapid tests. Most studies on POC testing focus on one specific test and disease in a particular healthcare setting. This paper describes the actors, technologies and practices involved in diagnosing major diseases in five Indian settings – the home, community, clinics, peripheral laboratories and hospitals. The aim was to understand how tests are used and fit into the health system and with what implications for the POC continuum.

          Methods

          The paper reports on a qualitative study including 78 semi-structured interviews and 13 focus group discussions with doctors, nurses, patients, lab technicians, program officers and informal providers, conducted between January and June 2013 in rural and urban Karnataka, South India. Actors, diseases, tests and diagnostic processes were mapped for each of the five settings and analyzed with regard to whether and how POC continuums are being ensured.

          Results

          Successful POC testing hardly occurs in any of the five settings. In hospitals and public clinics, most of the rapid tests are used in laboratories where either the single patient encounter advantage is not realized or the rapidity is compromised. Lab-based testing in a context of manpower and equipment shortages leads to delays. In smaller peripheral laboratories and private clinics with shorter turn-around-times, rapid tests are unavailable or too costly. Here providers find alternative measures to ensure the POC continuum. In the home setting, patients who can afford a test are not/do not feel empowered to use those devices.

          Conclusion

          These results show that there is much diagnostic delay that deters the POC continuum. Existing rapid tests are currently not translated into treatment decisions rapidly or are not available where they could ensure shorter turn-around times, thus undermining their full potential. To ensure the success of POC testing programs, test developers, decision-makers and funders need to account for such ground realities and overcome barriers to POC testing programs.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12913-015-1223-3) contains supplementary material, which is available to authorized users.

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          Most cited references33

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          Point-of-Care Testing for Infectious Diseases: Diversity, Complexity, and Barriers in Low- And Middle-Income Countries

          Madhukar Pai and colleagues discuss a framework for envisioning how point-of-care testing can be applied to infectious diseases in low- and middle-income countries.
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            Point-of-Care Tests to Strengthen Health Systems and Save Newborn Lives: The Case of Syphilis

            Rosanna Peeling and colleagues describe their experience of introducing point-of-care testing to screen for syphilis in pregnant women living in low- and middle-income countries.
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              Is Open Access

              Tuberculosis Management by Private Practitioners in Mumbai, India: Has Anything Changed in Two Decades?

              Setting Mumbai, India. A study conducted in Mumbai two decades ago revealed the extent of inappropriate tuberculosis (TB) management practices of private practitioners. Over the years, India's national TB programme has made significant progress in TB control. Efforts to engage private practitioners have also been made with several successful documented public-private mix initiatives in place. Objective To study prescribing practices of private practitioners in the treatment of tuberculosis, two decades after a similar study conducted in the same geographical area revealed dismal results. Methods Survey questionnaire administered to practicing general practitioners attending a continuing medical education programme. Results The participating practitioners had never been approached or oriented by the local TB programme. Only 6 of the 106 respondents wrote a prescription with a correct drug regimen. 106 doctors prescribed 63 different drug regimens. There was tendency to over treat with more drugs for longer durations. Only 3 of the 106 respondents could write an appropriate prescription for treatment of multidrug-resistant TB. Conclusions With a vast majority of private practitioners unable to provide a correct prescription for treating TB and not approached by the national TB programme, little seems to have changed over the years. Strategies to control TB through public sector health services will have little impact if inappropriate management of TB patients in private clinics continues unabated. Large scale implementation of public-private mix approaches should be a top priority for the programme. Ignoring the private sector could worsen the epidemic of multidrug-resistant and extensively drug-resistant forms of TB.
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                Author and article information

                Contributors
                +31/43 3881128 , n.engel@maastrichtuniversity.nl
                gayatriganesh@yahoo.com
                drmamatap@gmail.com
                vijayashree@iphindia.org
                caroline.vadnais@mail.mcgill.ca
                nitika.pai@mcgill.ca
                madhukar.pai@mcgill.ca
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                14 December 2015
                14 December 2015
                2015
                : 15
                : 550
                Affiliations
                [ ]Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Postbus 616, Maastricht, MD NL - 6200 The Netherlands
                [ ]Institute of Public Health, #250, 2nd C Main, 2nd C Cross, Girinagar I Phase, Bangalore, 560 085 India
                [ ]Department of Epidemiology & Biostatistics, McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2 Canada
                [ ]Division of Clinical Epidemiology, Department of Medicine, McGill University and McGill University Health Centre, V Building, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, H3A1A1 Canada
                Article
                1223
                10.1186/s12913-015-1223-3
                4677441
                26652014
                9f93d877-a2bb-499c-9b83-3f38818b2d2e
                © Engel et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 10 April 2015
                : 8 December 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Health & Social care
                point-of-care,testing,diagnostics,india,qualitative
                Health & Social care
                point-of-care, testing, diagnostics, india, qualitative

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