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Maximising uptake and utilization of molecular diagnostics: lessons from implementation evaluation of tuberculosis diagnostics

Maximising uptake and utilization of molecular diagnostics: lessons from implementation evaluation of tuberculosis diagnostics

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dc.contributor.author N.E. Ntinginya
dc.contributor.author Orina F
dc.contributor.author Mwebaza I
dc.contributor.author Liyoyo A
dc.contributor.author Miheso B
dc.contributor.author Aturinde A
dc.contributor.author Njeleka F
dc.contributor.author Msoka Ef
dc.contributor.author Meme H
dc.contributor.author Sanga E
dc.contributor.author Kuchaka D
dc.contributor.author Mwanyonga S
dc.contributor.author Olomi W
dc.contributor.author Minja L
dc.contributor.author Joloba M
dc.contributor.author Mmbaga Bt
dc.contributor.author Amukoye E
dc.contributor.author Stephen H. Gillespie
dc.contributor.author Wilber Sabiiti
dc.date.accessioned 2021-01-11T13:51:40Z
dc.date.available 2021-01-11T13:51:40Z
dc.date.issued 2020
dc.identifier.uri https://combine.alvar.ug/handle/1/49414
dc.description.abstract Abstract; Background: Tuberculosis (TB), a treatable disease claims over a million lives every year. Accurate rapid diagnosis is crucial for early treatment initiation and prevention of severe disease. Despite over 10 years approval of molecular diagnostics for routine use, an estimated 3 million TB cases go undetected per year. We investigated the barriers and opportunities to maximise uptake and utilization of molecular diagnostics in routine healthcare settings. Methods: We deployed surveys, healthcare facility audits, focus group discussions, in-depth interviews, and policymaker dialogues to unravel factors affecting the uptake and utilization of TB molecular diagnostics in three East African countries. The benchmark was the World Health Organization approved Xpert MTB/RIF and Line Probe Assay (LPA) implemetation at district and regional hospital level respectively. Results: 190 district and county health officers participated in the survey. The survey findings were corroborated by 145 healthcare facility (HCF) audits and 11 policymaker engagement workshops. At 66% coverage, Xpert MTB/RIF fell behind microscopy and clinical diagnosis by 33% and 1% respectively across 190 districts/counties. Stratified by HCF type, Xpert MTB/RIF implementation was 56%, 96% and 95% at district-, regional- and national referral- hospital level. LPA coverage was 4%, 3% below culture across the three countries. Out of 111 HCFs with Xpert MTB/RIF, 37 (33%) utilized it to full capacity, performing ≥8 tests per day of which 51% of these were level five (zonal consultant and national referral) HCFs. Likewise, 75% of LPA test performance was at level five HCFs. Underutilization of Xpert MTB/RIF and LPA was mainly attributed to inadequate- human resource, 22% and utilities, 26% respectively. Absence of the diagnostic services was attributed to under financing. Lack of awareness was second to underfinancing as reason underlying absence of LPA service. Creation of a health tax and decentralising collection and management of this tax to district/county level was proposed by policymakers as means to boost domestic financing for uptake of health technologies. Conclusion Our findings show higher uptake and utilization of molecular and other diagnostics at tertiary- than primary-secondary- level HCFs. Innovative implementation models to ensure quality access at lower level HCFs are urgently needed.
dc.publisher Research Square
dc.title Maximising uptake and utilization of molecular diagnostics: lessons from implementation evaluation of tuberculosis diagnostics
dc.type Preprint
dc.identifier.doi 10.21203/rs.3.rs-106037/v1
dc.identifier.mag 3102925071
dc.identifier.lens 009-954-339-238-283
dc.subject.lens-fields Molecular diagnostics
dc.subject.lens-fields Systems engineering
dc.subject.lens-fields Tuberculosis diagnostics
dc.subject.lens-fields Implementation evaluation
dc.subject.lens-fields Computer science


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