Journal of Epidemiology and Global Health

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Volume 2, Issue 1, March 2012, Pages 39 - 50

Why are inaccurate tuberculosis serological tests widely used in the Indian private healthcare sector? A root-cause analysis

Authors
Szymon Jarosławskia, Madhukar Paib, *, madhukar.pai@mcgill.ca
aInstitute of Bioinformatics and Applied Biotechnology, Bangalore, India
bMcGill University, Montreal, Canada
*Corresponding author. Address: Department of Epidemiology and Biostatistics, McGill University, 1020 Pine Ave. W, Montreal, QC, Canada H3A 1A2. Tel.: +1 514 398 5422; fax: +1 514 398 4503.
Corresponding Author
Received 14 October 2011, Revised 24 November 2011, Accepted 9 December 2011, Available Online 1 February 2012.
DOI
10.1016/j.jegh.2011.12.001How to use a DOI?
Keywords
Tuberculosis; Serological tests; Root-cause analysis; India; Private medical sector; Diagnosis
Abstract

Serological tests for tuberculosis are inaccurate and WHO has recommended against their use. Although not used by the Revised National TB Control Programme (RNTCP), serodiagnostics are widely used in the private sector in India. A root-cause analysis was undertaken to determine why serological tests are so popular, and seven root causes were identified that can be grouped into three categories: technical/medical, economic, and regulatory. Technical/medical: RNTCP’s current low budget does not allow scale-up of the newer, WHO-endorsed technologies. Thus, under the RNTCP, most patients have access to only smear microscopy, a test that is insensitive and underused in the private sector. Because there is no accurate, validated, point-of-care test for TB, serological tests meet a perceived need among doctors and patients. Economic: While imported molecular or liquid culture tests are too expensive, there are no affordable Indian versions on the market, leaving serological tests as the main alternative. Although serological tests are inaccurate, various players along the value chain profit from their use, and this sustains a market for these tests. Regulatory: TB tests are poorly regulated and a large number of serological kits are on the market. Private healthcare in general is poorly regulated, and doctors in the private sector are outside the scope of RNTCP and do not necessarily follow standard guidelines. A clear understanding of these realities should facilitate market-based strategies that can help replace serological tests with accurate, validated tools.

Copyright
© 2012 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd.
Open Access
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

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<Previous Article In Issue
Next Article In Issue>
Journal
Journal of Epidemiology and Global Health
Volume-Issue
2 - 1
Pages
39 - 50
Publication Date
2012/02/01
ISSN (Online)
2210-6014
ISSN (Print)
2210-6006
DOI
10.1016/j.jegh.2011.12.001How to use a DOI?
Copyright
© 2012 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd.
Open Access
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Cite this article

risenwbib
TY  - JOUR
AU  - Szymon Jarosławski
AU  - Madhukar Pai
PY  - 2012
DA  - 2012/02/01
TI  - Why are inaccurate tuberculosis serological tests widely used in the Indian private healthcare sector? A root-cause analysis
JO  - Journal of Epidemiology and Global Health
SP  - 39
EP  - 50
VL  - 2
IS  - 1
SN  - 2210-6014
UR  - https://doi.org/10.1016/j.jegh.2011.12.001
DO  - 10.1016/j.jegh.2011.12.001
ID  - Jarosławski2012
ER  -