Abstract
SettingPrivate 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.ObjectiveTo evaluate rapid testing practices and identify priorities for novel POC TB tests among private practitioners in Chennai.DesignWe 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.ResultsAmong 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.ConclusionAs 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.
Highlights
IntroductionDespite efforts to increase case detection, 3 million new tuberculosis (TB) cases are not notified to national TB programs each year; over one-quarter (27%) of these “missed cases” are estimated to occur in India [1,2]
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
Despite efforts to increase case detection, 3 million new tuberculosis (TB) cases are not notified to national TB programs each year; over one-quarter (27%) of these “missed cases” are estimated to occur in India [1,2]
Summary
Despite efforts to increase case detection, 3 million new tuberculosis (TB) cases are not notified to national TB programs each year; over one-quarter (27%) of these “missed cases” are estimated to occur in India [1,2]. Improvements in case detection through increased diagnostic capabilities could substantially reduce the gap between notified cases and estimated incidence [1]. Any efforts to implement novel TB diagnostic tests in India (and other similar countries) would need to engage private practitioners. As TB control programs worldwide begin to prioritize molecular diagnostics that are more sensitive than smear microscopy [8], it is imperative to consider the implementation of tests for TB that could be deployed at the point-of-care [9,10]
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