Use of Rapid, Point-of-Care Assays by Private Practitioners in Chennai, India: Priorities for Tuberculosis Diagnostic Testing.
METHODS
Private practitioners are frequently the first point of healthcare contact for patients with tuberculosis (TB) in India. As new molecular tests are developed for point-of-care (POC) diagnosis of TB, it is imperative to understand these individuals' practices and preferences for POC testing.


OBJECTIVE
To evaluate rapid testing practices and identify priorities for novel POC TB tests among private practitioners in Chennai.


METHODS
We conducted a cross-sectional survey of 228 practitioners practicing in the private sector from January 2014 to February 2015 who saw at least one TB patient in the previous year. Practitioners were randomly selected from both the general community and a list of practitioners who referred patients to a public-private mix program for TB treatment. We used standardized questionnaires to collect data on current practices related to point-of-care diagnosis and interest in hypothetical POC tests. We used multivariable Poisson regression with robust estimates of standard error to calculate measures of association.


RESULTS
Among 228 private practitioners, about half (48%) utilized any rapid testing in their current practice, most commonly for glucose (43%), pregnancy (21%), and malaria (5%). Providers using POC tests were more likely to work in hospitals (56% vs. 43%, P = 0.05) and less likely to be chest specialists (21% vs. 54%, P<0.001). Only half (51%) of providers would use a hypothetical POC test for TB that was accurate, equipment-free, and took 20 minutes to complete. Chest specialists were half as likely to express interest in performing the hypothetical POC TB test in-house as other practitioners (aPR 0.5, 95%CI: 0.2-0.9). Key challenges to performing POC testing for TB in this study included time constraints, easy access to local private labs and lack of an attached lab facility.


CONCLUSIONS
As novel POC tests for TB are developed and scaled up, attention must be paid to integrating these diagnostics into healthcare providers' routine practice and addressing barriers for POC testing.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, United States of America.
Liza
http://orcid.org/0000-0002-8668-3898
L
Bronner Murrison
REACH, Chennai, India.
Ramya
R
Ananthakrishnan
REACH, Chennai, India.
Sumanya
S
Sukumar
REACH, Chennai, India.
Sheela
S
Augustine
REACH, Chennai, India.
Nalini
N
Krishnan
McGill International TB Centre & Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
Madhukar
M
Pai
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, United States of America.
David W
DW
Dowdy
D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D015999:Multivariate Analysis; D010820:Physicians / Q000706:statistics & numerical data*; D019095:Point-of-Care Systems; D010818:Practice Patterns, Physicians'; D011331:Private Practice / Q000706:statistics & numerical data*; D017149:Private Sector / Q000706:statistics & numerical data; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000175:diagnosis* / Q000628:therapy; D014481:United States; D014492:United States Public Health Service / Q000706:statistics & numerical data