Table 2 Testing in home, community, clinic, peripheral lab and hospital settings

Home

Glucometer, urine pregnancy

Affluent, educated only, done in home or tests bought and taken to doctor

Confirm urine pregnancy test with doctor/lab; visit local doctor/lab directly for monthly monitoring or if have symptoms of high/low sugar;

Patients not able/empowered to use diagnostic devices

Community

Malaria smear (or rapid test if endemic); urine pregnancy

ASHA, at doorstep

Patient and sample referred to PHC; results communicated to CHW (over phone), CHWs visit patient to encourage to seek treatment if transport/ workload permit

Diagnostic devices cannot overcome health system challenges (equipment, infrastructure) that undermine testing at doorstep

Glucometer readings (as part of pilot program)

ANM, at camp, anganwadi center or doorstep

Haemoglobin using Haemoglobinometer.

ASHA & ANM, same as above

Sputum and malaria smear sample

ASHA &ANM, same as above

HIV rapid and HIV Coombs’

HIV mobile testing van

Clinic (public sector)

Malaria smear; HbsAG card (hepatitis), dengue NS1 card; dengue IgG/IgM; VDRL card (syphilis); glucometer; urine pregnancy, HIV rapid or Coombs; urine sugar (Benedict’s); AFB sputum for TB (in selected clinics)

Lab technician, done in in-house lab, if no lab facilities then referred to public sector taluk or district hospital

For morning samples results by afternoon, doctor seen same day unless test kits/reagents/doctor unavailable, or tests out-sourced

Setting with shorter TATs, but exclusive lab-based testing in context of manpower and equipment shortages leads to delays

Malaria antigen

Referred to public sector taluk or district hospital or private lab

Patient’s initiative required to get tested, collect results and return to PHC for treatment

Clinic (private sector)

Glucometer, urine pregnancy

Private provider

Immediate results

Arrangements with private labs nearby ensure POC continuum; other rapid tests not trusted/too costly

Peripheral lab (private sector)

Rapid tests: Widal (typhoid), malaria rapid test (rare), HBsAG, dengue NS1, VDRL (syphilis), glucometer, urine pregnancy dipstick, HIV rapid, HB card, urine sugar (Benedict’s). Others: malaria smears, Mantoux, renal and lipid function, x-rays, scans, urine routine, blood grouping, CBC, blood pressure

Lab technician; done in in-house lab or nearby peripheral lab.

Same day results

Arrangements with private providers nearby ensure POC continuum using older, slower but cheaper methods

Hormone tests

Outsourced to larger chains of private labs in Bangalore/Mumbai

2 days for tests, results given on 3rd day.

Hospital (in wards)

Blood sugar with glucometer; urine sugar with dipstick or Benedict’s solution; haemoglobin by blotting paper method, BTCT (Bleeding Time Clotting Time), HIV Tridot, ECG

Staff nurse at in-patient bedside in ward, intensive care unit, emergency or labour ward

Treatment begins at bedside once doctor has seen results

POC continuum ensured for limited tests done in wards

Hospital (in labs)

Rapid tests for HIV, malaria, dengue, HBsAG, VDRL (syphilis), Widal, urine pregnancy, chest x-ray, renal and liver function tests, complete blood count (CBC), ESR (for TB).

Lab technician in in-house laboratory for outpatient department patients

Out-patients collect results from labs, see doctor in afternoon/evening if available; admitted patients: attenders carry samples to labs, nurses collect results if workload permits

Majority of testing is lab-based, high volumes, manpower shortage and different testing/consultation location across hospital campus compound delays

For TB: AFB sputum, ELISA (tertiary private only)

Lab technician in TB program lab outpatient department block; ELISA outsourced for private secondary care

Patients collect results from separate labs for TB/HIV testing, return results to doctor in afternoon if available