Barriers to Point of Care Testing in India and South Africa

Nora Engel,Madhukar Pai,Keertan Dheda,Nitika Pant Pai,Malika Davids,Vijayashree Yellappa

doi:10.1007/978-3-319-91068-0_7

Nora Engel, Madhukar Pai + Show 4 more

Open Access

https://doi.org/10.1007/978-3-319-91068-0_7

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Abstract

Point of care (POC) testing in communities, home settings, and primary healthcare centers is believed to have tremendous potential in reducing delays in diagnosing and initiating treatment for diseases such as HIV, tuberculosis, syphilis, and malaria. Quick diagnosis and further management decisions completed in the same clinical encounter or at least the same day, while the patient waits, promise to overcome delays associated with conventional laboratory-based testing. However, the availability of cheap, simple, and rapid tests that can be conducted outside laboratories does not automatically ensure successful POC testing. In order to understand the new roles and challenges medical devices such as these encounter, we need to study how diagnostics are used at the POC and integrated into workflow and patient pathways. This chapter reviews selected results from a qualitative research project on barriers to POC testing in India and South Africa and discusses them comparatively. The project used semi-structured interviews and focus group discussions to examine diagnostic practices across major diseases and actors in homes, clinics, communities, hospitals, and laboratories in South Africa and India. In comparing selected results, it becomes clear that both countries have very different diagnostic eco-systems that provide very different conditions for POC testing. The chapter concludes by reflecting on how to take such insights into account when designing POC testing programs.

Highlights

Point of care (POC) testing in communities, home settings, and primary healthcare centers is widely believed by the global health community to have tremendous potential in reducing delays in diagnosing and initiating treatment for diseases such as HIV, tuberculosis, syphilis, and malaria
Using a framework that envisions POC testing as programs, rather than just tests, across five settings (Pant Pai et al 2012), we examined diagnostic practices across major diseases and actors in homes, clinics, communities, hospitals, and laboratories in South Africa and India
Patients carry the main responsibility for ensuring a POC continuum

Summary

Introduction

Point of care (POC) testing in communities, home settings, and primary healthcare centers is widely believed by the global health community to have tremendous potential in reducing delays in diagnosing and initiating treatment for diseases such as HIV, tuberculosis, syphilis, and malaria. The idea is that testing nearer to the patient, at the point of care, allows for quick diagnosis and further management decisions (referral, follow-up testing or treatment) completed in the same clinical encounter or at least the same day, while the patient waits. In this way, the POC continuum is ensured (Pant Pai et al 2012). POC testing promises to overcome long turnaround times and delays associated with conventional laboratory-based testing These problems can result in the loss of patients from testing and treatment pathways with detrimental consequences for the development of advanced disease stages and drug resistance. We review selected results, discuss them comparatively, and reflect on the implications for medical device design

Qualitative Project on Barriers to POC Testing

Ethics Approval

Results

South Africa

Discussion and Conclusion