Readiness to implement on-site molecular testing for tuberculosis in community health centers in Uganda
Abstract Background 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 treatme...
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| Format: | Article |
| Language: | English |
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BMC
2022-02-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-022-00260-y |
| _version_ | 1818500911532605440 |
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| author | Talemwa Nalugwa Margaret Handley Priya Shete Christopher Ojok Mariam Nantale Tania Reza Achilles Katamba Adithya Cattamanchi Sara Ackerman |
| author_facet | Talemwa Nalugwa Margaret Handley Priya Shete Christopher Ojok Mariam Nantale Tania Reza Achilles Katamba Adithya Cattamanchi Sara Ackerman |
| author_sort | Talemwa Nalugwa |
| collection | DOAJ |
| description | Abstract Background 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. |
| first_indexed | 2024-12-10T20:49:04Z |
| format | Article |
| id | doaj.art-57b38981fc1049e28a7e95df43d554e7 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-10T20:49:04Z |
| publishDate | 2022-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-57b38981fc1049e28a7e95df43d554e72022-12-22T01:34:09ZengBMCImplementation Science Communications2662-22112022-02-01311910.1186/s43058-022-00260-yReadiness to implement on-site molecular testing for tuberculosis in community health centers in UgandaTalemwa Nalugwa0Margaret Handley1Priya Shete2Christopher Ojok3Mariam Nantale4Tania Reza5Achilles Katamba6Adithya Cattamanchi7Sara Ackerman8Department of Medicine, School of Medicine, Makerere University College of Health SciencesDepartment of Epidemiology and Biostatistics, University of California San FranciscoCenter for Tuberculosis, University of California San FranciscoDepartment of Medicine, School of Medicine, Makerere University College of Health SciencesDepartment of Medicine, School of Medicine, Makerere University College of Health SciencesCenter for Tuberculosis, University of California San FranciscoDepartment of Medicine, School of Medicine, Makerere University College of Health SciencesCenter for Vulnerable Populations, University of California San FranciscoDepartment of Social and Behavioral Sciences, University of California San FranciscoAbstract Background 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.https://doi.org/10.1186/s43058-022-00260-yTuberculosisOnsite molecular testingGeneXpertXpert MTB/RIFHealth systemsUganda |
| spellingShingle | Talemwa Nalugwa Margaret Handley Priya Shete Christopher Ojok Mariam Nantale Tania Reza Achilles Katamba Adithya Cattamanchi Sara Ackerman Readiness to implement on-site molecular testing for tuberculosis in community health centers in Uganda Implementation Science Communications Tuberculosis Onsite molecular testing GeneXpert Xpert MTB/RIF Health systems Uganda |
| title | Readiness to implement on-site molecular testing for tuberculosis in community health centers in Uganda |
| title_full | Readiness to implement on-site molecular testing for tuberculosis in community health centers in Uganda |
| title_fullStr | Readiness to implement on-site molecular testing for tuberculosis in community health centers in Uganda |
| title_full_unstemmed | Readiness to implement on-site molecular testing for tuberculosis in community health centers in Uganda |
| title_short | Readiness to implement on-site molecular testing for tuberculosis in community health centers in Uganda |
| title_sort | readiness to implement on site molecular testing for tuberculosis in community health centers in uganda |
| topic | Tuberculosis Onsite molecular testing GeneXpert Xpert MTB/RIF Health systems Uganda |
| url | https://doi.org/10.1186/s43058-022-00260-y |
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