Readiness to implement on-site molecular testing for tuberculosis in community health centers in Uganda
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Implementation Science Communications
Abstract
Newer molecular testing platforms are now available for deployment at lower-level community health
centers. There are limited data on facility- and health worker-level factors that would promote successful adoption
of such platforms for rapid tuberculosis (TB) testing and treatment initiation. Our study aimed to assess readiness to
implement onsite molecular testing at community health centers in Uganda, a high TB burden country in sub-Saharan
Africa.
Methods: To understand implementation readiness, we conducted a qualitative assessment guided by the Consolidated
Framework for Implementation Research (CFIR) at 6 community health centers in central and eastern Uganda
between February and April 2018. We conducted 23 in-depth, semi-structured interviews with health workers
involved in TB care at each health center to assess TB-related work practices and readiness to adopt onsite molecular
testing using the GeneXpert Edge platform. Interviews were transcribed verbatim and coded for thematic analysis.
Results: Participants (N=23) included 6 nurses/nursing assistants, 6 clinicians, 6 laboratory directors/technicians, 1
medical officer, 2 health center directors, and 2 other health workers involved in TB care. Health workers described
general enthusiasm that on-site molecular testing could lead to greater efficiencies in TB diagnosis and treatment,
including faster turn- around time for TB test results, lack of need for trained laboratory technicians to interpret results,
and reduced need to transport sputum specimens to higher level facilities. However, health workers also expressed
concerns about implementation feasibility. These included uncertainty about TB infection risk, safety risks from
disposal of hazardous waste, a lack of local capacity to provide timely troubleshooting and maintenance services,
and concerns about the security of GeneXpert devices and accessories. Health workers also expressed the need for
backup batteries to support testing or charging when wall power is unstable.
Conclusion: Our study generated a nuanced understanding of modifiable contextual barriers and led to direct revisions
of implementation strategies for onsite molecular testing. The findings highlight that novel diagnostics should
be implemented along with health system co-interventions that address contextual barriers to their effective uptake.
Pre-implementation assessment of stakeholder perspectives, collaborative work processes, and institutional contexts
is essential when introducing innovative technology in complex health care settings.
Description
Keywords
Tuberculosis, Onsite molecular testing, GeneXpert, Xpert MTB/RIF, Health systems
Citation
Nalugwa, T., Handley, M., Shete, P., Ojok, C., Nantale, M., Reza, T., ... & Ackerman, S. (2022). Readiness to implement on-site molecular testing for tuberculosis in community health centers in Uganda. Implementation Science Communications, 3(1), 1-9. https://doi.org/10.1186/s43058-022-00260-y