Barriers to point of care testing in India and South Africa

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.