Decoding Diagnostic Testing Landscape for Acute Febrile Illnesses in India
Diagnostic testing for specific illnesses, in Indian context, either cost too much, are inaccessible or simply do not exist. A global non- profit organization focused on accelerating access to diagnostics in low- and middle- income countries was keen to understand the current testing landscape for a set of febrile illnesses in India. This would help them align their development priorities and access initiatives in integrated fever management.
We analysed secondary data on the burden of specific set of febrile illnesses and government initiatives around the same. Once we analysed the secondary data, we conducted 200 in-depth interviews across 3 states with various stakeholders ranging from lab technicians to consulting physicians in different practice settings like PHCs, CHCs, district hospitals, private hospitals, clinics and laboratories. The objective was to get a deeper understanding on availability of diagnostic tests, and of these tests which are conducted for select set of febrile illnesses and underlying reasons for HCPs to prefer one test over other.
The study and subsequent analysis helped us define the diagnostic landscape of relevant illnesses in public and private settings; awareness and knowledge, decision- makers in different practices, current usage, drivers and barriers. We also identified challenges around access for these tests. The same was categorized across awareness, availability and attitude of decision makers to use best available tests and recommended approach for the same.
The findings and recommendations will be used to align internal efforts towards priority areas for improving access to febrile illness diagnostics in India. The findings were categorized in the following themes:
There are challenges with awareness of pathogens and appropriate diagnostic protocols which lead to suboptimal outcomes.
Stakeholders: While the top of the pyramid, consulting physicians and tropical diseases specialists are aware of the illnesses, the same cannot be said about primary care providers like general physicians, health workers, technicians.
Pathogen specific: Diseases like dengue and typhoid are well known but there is lesser awareness of scrub typhus and leptospirosis which form substantial febrile illness burden.
Practice Setting: There is strong awareness of all the illnesses at higher levels of care like district hospitals and private tertiary care centres but as one moves down the delivery chain, the awareness reduces, in both public and private settings.
Geography: Low awareness of leptospirosis and melioidosis was witnessed across all regions.
The nature of diagnosing fevers is empirical and so attitude of doctors plays a crucial role.
Underdiagnosis: Due to lack of rigor for fever diagnosis, doctors would miss identifying the illness accurately and begin the treatment without undertaking proper diagnostics. This was observed more in public and private settings.
Overdiagnosis: Private practitioners incentivized by lab or bound by hospital protocols would typically order a battery of tests without considering relevance.
Accurate diagnosis was provided by doctors who would diagnose based on clinical findings and then validate them with limited relevant tests.
Decisions are also based on the availability of tests.
Access: Lower levels of healthcare delivery systems, especially public, do not have the necessary infrastructure and human resources to conduct diagnosis of fevers in proximity so all the cases get referred to a referral centre, like district hospital.
Affordability: There are hardly any rapid tests available for illnesses other than dengue and typhoid. The lack of availability increases cost to patients. Hence doctors are forced to diagnose using basic investigations like CBC.
Acceptability: The private diagnostics market is largely unorganized with poor quality standards, which leads to questionable outcomes through diagnostics. Moreover, the quality of consumables and reagents tend to get influenced by more aggressive sales tactics by vendors.