Private providers and HIV testing in Pune, India: challenges and opportunities

Abstract

We explored HIV testing practices of private medical providers in an urban Indian setting in Pune, western India. 215 private practitioners (PPs) and 36 persons-in-charge of private laboratories were interviewed in separate surveys. 77% of PPs had prescribed HIV tests and 94% of laboratories had performed HIV tests, or collected samples for HIV testing. Among those providers who had prescribed/performed tests, practices which violated national policy guidelines were found to be common. 55% of PPs and 94% of laboratories had not prescribed/performed confirmatory HIV tests, 82% of PPs had conducted routine HIV screening tests, 53% of PPs and 47% of laboratories had never counselled patients before testing, and 39% of laboratories reported breaching confidentiality of test results. PPs’ knowledge about HIV tests was also inadequate, with 28% of PPs who had prescribed HIV tests being unable to name the tests they had advised. Prolific HIV testing in the private medical sector is accompanied by inappropriate practices and inadequate knowledge, reflecting deficiencies in the implementation of policy guidelines. The perspectives and needs of private providers, the major source of health care in India, need to be acknowledged. Supportive and regulatory mechanisms can be used to involve private providers in the delivery of better HIV testing services.

Acknowledgments

We would like to thank all those members of the Maharashtra Association of Anthropological Sciences (MAAS) for their work and encouragement on this project, particularly Dr Ram Gambhir, Prof RK Mutatkar and Dr Sudhakar Morankar. Deepali Deshmukh and Dr Yatin Dholakia had major roles in designing the instruments and in organizing the research. Our thanks to all the investigators, Priti Apte, Swanand Tilekar, Rajesh Mali, Nilangi Nanal, Maya Kakade, Sampada Deshmukh, Mahesh Punde, Anil Sharma, Babita Rajkumari, Devika Bhalerao, Jyoti Katikar, and the programmers, Santosh Deshmukh and Ashok Vir who worked on the project. Aruna Deshpande helped with the statistics. We are grateful to Peter Godfrey-Faussett, Dr AK Chakraborty and James Hargreaves for their comments on the draft. The project was funded by DFID and WHO SEARO.

Notes

1. The government of India officially recognizes medical qualifications for five systems of medicine including allopathy (western biomedicine), three indigenous systems (Ayurveda, Siddha, and Unani) and Homeopathy.

2. Medical facilities in India can been classified into three categories based on ownership (Bhat, 1996): public, private for-profit – henceforth referred to as ‘private’, and private not-for profit (including charities, voluntary programmes, missions, churches and trusts) referred to as ‘charitable’.

3. A private practitioner was defined, for purposes of the survey, as a physician who practices regularly in a clinic for profit for at least one day per week, whose practice is denoted by a visible display board, is consulted by adult out-patients and who works in an establishment with fewer than five practicing doctors. A private laboratory was defined, as a for-profit establishment offering diagnostic services, and denoted as a laboratory by a display board.