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Papers by Vijayashree Dr.

Research paper thumbnail of Evaluation of Results Based Financing Strategies for Tuberculosis care and Control in India Evaluation of Results Based Financing Strategies for Tuberculosis care and Control in India

Research paper thumbnail of Determinants of sputum conversion at two months of treatment under National Tuberculosis Programme, South India

In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free diagnosis and ... more In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free diagnosis and treatment for TB, based on the Directly Observed Treatment Short (DOTS) course strategy. Under RNTCP, sputum conversion rate (SCR), at the end of 2 months of treatment is an important operational indicator, which is ideally expected to be 90%.

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

Background: The core objective of any point-of-care (POC) testing program is to ensure that testi... more Background: The core objective of any point-of-care (POC) testing program is to ensure that testing will result in an actionable management decision (e.g. referral, confirmatory test, treatment), within the same clinical encounter (e.g. POC continuum). This can but does not have to involve rapid tests. Most studies on POC testing focus on one specific test and disease in a particular healthcare setting. This paper describes the actors, technologies and practices involved in diagnosing major diseases in five Indian settingsthe home, community, clinics, peripheral laboratories and hospitals. The aim was to understand how tests are used and fit into the health system and with what implications for the POC continuum. Methods: The paper reports on a qualitative study including 78 semi-structured interviews and 13 focus group discussions with doctors, nurses, patients, lab technicians, program officers and informal providers, conducted between January and June 2013 in rural and urban Karnataka, South India. Actors, diseases, tests and diagnostic processes were mapped for each of the five settings and analyzed with regard to whether and how POC continuums are being ensured. Results: Successful POC testing hardly occurs in any of the five settings. In hospitals and public clinics, most of the rapid tests are used in laboratories where either the single patient encounter advantage is not realized or the rapidity is compromised. Lab-based testing in a context of manpower and equipment shortages leads to delays. In smaller peripheral laboratories and private clinics with shorter turn-around-times, rapid tests are unavailable or too costly. Here providers find alternative measures to ensure the POC continuum. In the home setting, patients who can afford a test are not/do not feel empowered to use those devices. Conclusion: These results show that there is much diagnostic delay that deters the POC continuum. Existing rapid tests are currently not translated into treatment decisions rapidly or are not available where they could ensure shorter turn-around times, thus undermining their full potential. To ensure the success of POC testing programs, test developers, decision-makers and funders need to account for such ground realities and overcome barriers to POC testing programs.

Research paper thumbnail of Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases

Successful point-of-care testing, namely ensuring the completion of the test and treat cycle in t... more Successful point-of-care testing, namely ensuring the completion of the test and treat cycle in the same encounter, has immense potential to reduce diagnostic and treatment delays, and impact patient outcomes. However, having rapid tests is not enough, as many barriers may prevent their successful implementation in point-of-care testing programs. Qualitative research on diagnostic practices may help identify such barriers across different points of care in health systems.

Research paper thumbnail of Private practitioners' contributions to the Revised National Tuberculosis Control Programme in a South Indian district

Research paper thumbnail of Coping with tuberculosis and directly observed treatment: a qualitative study among patients from South India

Background: In India, the Revised National TB control programme (RNTCP) offers free diagnosis and... more Background: In India, the Revised National TB control programme (RNTCP) offers free diagnosis and treatment for tuberculosis (TB), based on the Directly Observed Treatment Short course (DOTS) strategy. We conducted a qualitative study to explore the experience and consequences of having TB on patients enrolled in DOTS and their caretakers in Tumkur district, located in a southern state of India, Karnataka.

Research paper thumbnail of Evaluation of Results Based Financing Strategies for Tuberculosis care and Control in India Evaluation of Results Based Financing Strategies for Tuberculosis care and Control in India

Research paper thumbnail of Determinants of sputum conversion at two months of treatment under National Tuberculosis Programme, South India

In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free diagnosis and ... more In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free diagnosis and treatment for TB, based on the Directly Observed Treatment Short (DOTS) course strategy. Under RNTCP, sputum conversion rate (SCR), at the end of 2 months of treatment is an important operational indicator, which is ideally expected to be 90%.

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

Background: The core objective of any point-of-care (POC) testing program is to ensure that testi... more Background: The core objective of any point-of-care (POC) testing program is to ensure that testing will result in an actionable management decision (e.g. referral, confirmatory test, treatment), within the same clinical encounter (e.g. POC continuum). This can but does not have to involve rapid tests. Most studies on POC testing focus on one specific test and disease in a particular healthcare setting. This paper describes the actors, technologies and practices involved in diagnosing major diseases in five Indian settingsthe home, community, clinics, peripheral laboratories and hospitals. The aim was to understand how tests are used and fit into the health system and with what implications for the POC continuum. Methods: The paper reports on a qualitative study including 78 semi-structured interviews and 13 focus group discussions with doctors, nurses, patients, lab technicians, program officers and informal providers, conducted between January and June 2013 in rural and urban Karnataka, South India. Actors, diseases, tests and diagnostic processes were mapped for each of the five settings and analyzed with regard to whether and how POC continuums are being ensured. Results: Successful POC testing hardly occurs in any of the five settings. In hospitals and public clinics, most of the rapid tests are used in laboratories where either the single patient encounter advantage is not realized or the rapidity is compromised. Lab-based testing in a context of manpower and equipment shortages leads to delays. In smaller peripheral laboratories and private clinics with shorter turn-around-times, rapid tests are unavailable or too costly. Here providers find alternative measures to ensure the POC continuum. In the home setting, patients who can afford a test are not/do not feel empowered to use those devices. Conclusion: These results show that there is much diagnostic delay that deters the POC continuum. Existing rapid tests are currently not translated into treatment decisions rapidly or are not available where they could ensure shorter turn-around times, thus undermining their full potential. To ensure the success of POC testing programs, test developers, decision-makers and funders need to account for such ground realities and overcome barriers to POC testing programs.

Research paper thumbnail of Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases

Successful point-of-care testing, namely ensuring the completion of the test and treat cycle in t... more Successful point-of-care testing, namely ensuring the completion of the test and treat cycle in the same encounter, has immense potential to reduce diagnostic and treatment delays, and impact patient outcomes. However, having rapid tests is not enough, as many barriers may prevent their successful implementation in point-of-care testing programs. Qualitative research on diagnostic practices may help identify such barriers across different points of care in health systems.

Research paper thumbnail of Private practitioners' contributions to the Revised National Tuberculosis Control Programme in a South Indian district

Research paper thumbnail of Coping with tuberculosis and directly observed treatment: a qualitative study among patients from South India

Background: In India, the Revised National TB control programme (RNTCP) offers free diagnosis and... more Background: In India, the Revised National TB control programme (RNTCP) offers free diagnosis and treatment for tuberculosis (TB), based on the Directly Observed Treatment Short course (DOTS) strategy. We conducted a qualitative study to explore the experience and consequences of having TB on patients enrolled in DOTS and their caretakers in Tumkur district, located in a southern state of India, Karnataka.