Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases.
BACKGROUND
Successful point-of-care testing, namely ensuring the completion of the test and treat cycle in the same encounter, has immense potential to reduce diagnostic and treatment delays, and impact patient outcomes. However, having rapid tests is not enough, as many barriers may prevent their successful implementation in point-of-care testing programs. Qualitative research on diagnostic practices may help identify such barriers across different points of care in health systems.


METHODS
In this exploratory qualitative study, we conducted 78 semi-structured interviews and 13 focus group discussions in an urban and rural area of Karnataka, India, with healthcare providers (doctors, nurses, specialists, traditional healers, and informal providers), patients, community health workers, test manufacturers, laboratory technicians, program managers and policy-makers. Participants were purposively sampled to represent settings of hospitals, peripheral labs, clinics, communities and homes, in both the public and private sectors.


RESULTS
In the Indian context, the onus is on the patient to ensure successful point-of-care testing across homes, clinics, labs and hospitals, amidst uncoordinated providers with divergent and often competing practices, in settings lacking material, money and human resources. We identified three overarching themes affecting point-of-care testing: the main theme is 'relationships' among providers and between providers and patients, influenced by the cross-cutting theme of 'infrastructure'. Challenges with both result in 'modified practices' often favouring empirical (symptomatic) treatment over treatment guided by testing.


CONCLUSIONS
Even if tests can be conducted on the spot and infrastructure challenges have been resolved, relationships among providers and between patients and providers are crucial for successful point-of-care testing. Furthermore, these barriers do not act in isolation, but are interlinked and need to be examined as such. Also, a test alone has only limited power to overcome those difficulties. Test developers, policy-makers, healthcare providers and funders need to use these insights in overcoming barriers to point-of-care testing programs.
Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
Nora
N
Engel
Institute of Public Health, Bangalore, India.
Gayatri
G
Ganesh
Institute of Public Health, Bangalore, India.
Mamata
M
Patil
Institute of Public Health, Bangalore, India.
Vijayashree
V
Yellappa
Division of Clinical Epidemiology, Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada.
Nitika
N
Pant Pai
McGill International TB Centre, Department of Epidemiology & Biostatistics, McGill University, Montreal, Canada.
Caroline
C
Vadnais
McGill International TB Centre, Department of Epidemiology & Biostatistics, McGill University, Montreal, Canada.
Madhukar
M
Pai
D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D000067716:Point-of-Care Testing; D012424:Rural Population