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 |  |