期刊
JOURNAL OF EPIDEMIOLOGY AND GLOBAL HEALTH
卷 2, 期 1, 页码 39-50出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jegh.2011.12.001
关键词
Tuberculosis; Serological tests; Root-cause analysis; India; Private medical sector; Diagnosis
资金
- France Volontaires, Ivry sur Seine, France
- Canadian Institutes of Health Research (CIHR), European and Developing Countries Clinical Trials Partnership (EDCTP) (TB-NEAT grant)
- European Commission (EU-FP7
- TBSusgent grant)
- Grand Challenges Canada
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. (C) 2012 Ministry of Health, Saudi Arabia.
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