Challenges with scale-up of GeneXpert MTB/RIF® in Uganda: a health systems perspective.

BMC Health Services Research
Talemwa NalugwaAchilles Katamba

Abstract

Many high burden countries are scaling-up GeneXpert® MTB/RIF (Xpert) testing for tuberculosis (TB) using a hub-and-spoke model. However, the effect of scale up on reducing TB has been limited. We sought to characterize variation in implementation of referral-based Xpert TB testing across Uganda, and to identify health system factors that may enhance or prevent high-quality implementation of Xpert testing services. We conducted a cross-sectional study triangulating quantitative and qualitative data sources at 23 community health centers linked to one of 15 Xpert testing sites between November 2016 and May 2017 to assess health systems infrastructure for hub-and-spoke Xpert testing. Data sources included a standardized site assessment survey, routine TB notification data, and field notes from site visits. Challenges with Xpert implementation occurred at every step of the diagnostic evaluation process, leading to low overall uptake of testing. Of 2192 patients eligible for TB testing, only 574 (26%) who initiated testing were referred for Xpert testing. Of those, 54 (9.4%) were Xpert confirmed positive just under half initiated treatment within 14 days (n = 25, 46%). Gaps in required infrastructure at 23 community health centers t...Continue Reading

References

Sep 10, 2010·The New England Journal of Medicine·Peter M Small, Madhukar Pai
Jan 5, 2014·BMC Infectious Diseases·Jacob CreswellLucica Ditiu
Mar 1, 2013·Global Health, Science and Practice·Amy S PiatekYaDiul Mukadi
May 18, 2016·Open Forum Infectious Diseases·Colleen F HanrahanDavid Dowdy
May 21, 2016·Transactions of the Royal Society of Tropical Medicine and Hygiene·Kashmira S ChawlaMina C Hosseinipour
Jan 27, 2019·The Lancet Global Health·Gian Luca Di TannaJohn Z Metcalfe
Nov 14, 2019·Journal of Clinical Tuberculosis and Other Mycobacterial Diseases·Katherine FarrAdithya Cattamanchi

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Software Mentioned

Xpert
Stata
Research Electronic Data Capture ( REDCap
Excel
GeneXpert
REDCap

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