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

From: Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs

Setting Tests done By whom and where Completion of POC test and treat cycle Implications for POC continuum
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  
  1. Legend Table 2:
  2. AfB acid fast bacilli, ANM auxiliary nurse midwife, ASHA accredited social health activist, BTCT bleeding time clotting time, CBC complete blood count, CHW community health worker, ECG electrocardiogram, ELISA enzyme-linked immunosorbent assay, ESR erythrocyte sedimentation rate, HBsAG hepatitis B surface antigen, IgG/IgM immunoglobulin G/M, NS1 non-structural protein 1, PHC primary health centre, VDRL venereal disease research laboratory test