Cargando…

Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting

BACKGROUND: Early access to diagnosis is crucial for effective management of any disease including tuberculosis (TB). We investigated the barriers and opportunities to maximise uptake and utilisation of molecular diagnostics in routine healthcare settings. METHODS: Using the implementation of WHO ap...

Descripción completa

Detalles Bibliográficos
Autores principales: Ntinginya, Nyanda Elias, Kuchaka, Davis, Orina, Fred, Mwebaza, Ivan, Liyoyo, Alphonce, Miheso, Barbara, Aturinde, Augustus, Njeleka, Fred, Kiula, Kiula, Msoka, Elizabeth F, Meme, Helen, Sanga, Erica, Mwanyonga, Simeon, Olomi, Willyhelmina, Minja, Linda, Joloba, Moses, Mmbaga, Blandina T, Amukoye, Evans, Gillespie, Stephen Henry, Sabiiti, Wilber
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8386239/
https://www.ncbi.nlm.nih.gov/pubmed/34429298
http://dx.doi.org/10.1136/bmjgh-2021-005357
_version_ 1783742221942521856
author Ntinginya, Nyanda Elias
Kuchaka, Davis
Orina, Fred
Mwebaza, Ivan
Liyoyo, Alphonce
Miheso, Barbara
Aturinde, Augustus
Njeleka, Fred
Kiula, Kiula
Msoka, Elizabeth F
Meme, Helen
Sanga, Erica
Mwanyonga, Simeon
Olomi, Willyhelmina
Minja, Linda
Joloba, Moses
Mmbaga, Blandina T
Amukoye, Evans
Gillespie, Stephen Henry
Sabiiti, Wilber
author_facet Ntinginya, Nyanda Elias
Kuchaka, Davis
Orina, Fred
Mwebaza, Ivan
Liyoyo, Alphonce
Miheso, Barbara
Aturinde, Augustus
Njeleka, Fred
Kiula, Kiula
Msoka, Elizabeth F
Meme, Helen
Sanga, Erica
Mwanyonga, Simeon
Olomi, Willyhelmina
Minja, Linda
Joloba, Moses
Mmbaga, Blandina T
Amukoye, Evans
Gillespie, Stephen Henry
Sabiiti, Wilber
author_sort Ntinginya, Nyanda Elias
collection PubMed
description BACKGROUND: Early access to diagnosis is crucial for effective management of any disease including tuberculosis (TB). We investigated the barriers and opportunities to maximise uptake and utilisation of molecular diagnostics in routine healthcare settings. METHODS: Using the implementation of WHO approved TB diagnostics, Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) and Line Probe Assay (LPA) as a benchmark, we evaluated the barriers and how they could be unlocked to maximise uptake and utilisation of molecular diagnostics. RESULTS: Health officers representing 190 districts/counties participated in the survey across Kenya, Tanzania and Uganda. The survey findings were corroborated by 145 healthcare facility (HCF) audits and 11 policy-maker engagement workshops. Xpert MTB/RIF coverage was 66%, falling behind microscopy and clinical diagnosis by 33% and 1%, respectively. Stratified by HCF type, Xpert MTB/RIF implementation was 56%, 96% and 95% at district, regional and national referral hospital levels. LPA coverage was 4%, 3% below culture across the three countries. Out of 111 HCFs with Xpert MTB/RIF, 37 (33%) used 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 was available at level five HCFs. Underutilisation of Xpert MTB/RIF and LPA was mainly attributed to inadequate—utilities, 26% and human resource, 22%. Underfinancing was the main reason underlying failure to acquire molecular diagnostics. Second to underfinancing was lack of awareness with 33% healthcare administrators and 49% practitioners were unaware of LPA as TB diagnostic. Creation of a national health tax and decentralising its management was proposed by policy-makers as a booster of domestic financing needed to increase access to diagnostics. CONCLUSION: Our findings suggest higher uptake and utilisation of molecular diagnostics at tertiary level HCFs contrary to the WHO recommendation. Country-led solutions are crucial for unlocking barriers to increase access to diagnostics.
format Online
Article
Text
id pubmed-8386239
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-83862392021-09-09 Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting Ntinginya, Nyanda Elias Kuchaka, Davis Orina, Fred Mwebaza, Ivan Liyoyo, Alphonce Miheso, Barbara Aturinde, Augustus Njeleka, Fred Kiula, Kiula Msoka, Elizabeth F Meme, Helen Sanga, Erica Mwanyonga, Simeon Olomi, Willyhelmina Minja, Linda Joloba, Moses Mmbaga, Blandina T Amukoye, Evans Gillespie, Stephen Henry Sabiiti, Wilber BMJ Glob Health Original Research BACKGROUND: Early access to diagnosis is crucial for effective management of any disease including tuberculosis (TB). We investigated the barriers and opportunities to maximise uptake and utilisation of molecular diagnostics in routine healthcare settings. METHODS: Using the implementation of WHO approved TB diagnostics, Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) and Line Probe Assay (LPA) as a benchmark, we evaluated the barriers and how they could be unlocked to maximise uptake and utilisation of molecular diagnostics. RESULTS: Health officers representing 190 districts/counties participated in the survey across Kenya, Tanzania and Uganda. The survey findings were corroborated by 145 healthcare facility (HCF) audits and 11 policy-maker engagement workshops. Xpert MTB/RIF coverage was 66%, falling behind microscopy and clinical diagnosis by 33% and 1%, respectively. Stratified by HCF type, Xpert MTB/RIF implementation was 56%, 96% and 95% at district, regional and national referral hospital levels. LPA coverage was 4%, 3% below culture across the three countries. Out of 111 HCFs with Xpert MTB/RIF, 37 (33%) used 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 was available at level five HCFs. Underutilisation of Xpert MTB/RIF and LPA was mainly attributed to inadequate—utilities, 26% and human resource, 22%. Underfinancing was the main reason underlying failure to acquire molecular diagnostics. Second to underfinancing was lack of awareness with 33% healthcare administrators and 49% practitioners were unaware of LPA as TB diagnostic. Creation of a national health tax and decentralising its management was proposed by policy-makers as a booster of domestic financing needed to increase access to diagnostics. CONCLUSION: Our findings suggest higher uptake and utilisation of molecular diagnostics at tertiary level HCFs contrary to the WHO recommendation. Country-led solutions are crucial for unlocking barriers to increase access to diagnostics. BMJ Publishing Group 2021-08-24 /pmc/articles/PMC8386239/ /pubmed/34429298 http://dx.doi.org/10.1136/bmjgh-2021-005357 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Ntinginya, Nyanda Elias
Kuchaka, Davis
Orina, Fred
Mwebaza, Ivan
Liyoyo, Alphonce
Miheso, Barbara
Aturinde, Augustus
Njeleka, Fred
Kiula, Kiula
Msoka, Elizabeth F
Meme, Helen
Sanga, Erica
Mwanyonga, Simeon
Olomi, Willyhelmina
Minja, Linda
Joloba, Moses
Mmbaga, Blandina T
Amukoye, Evans
Gillespie, Stephen Henry
Sabiiti, Wilber
Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting
title Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting
title_full Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting
title_fullStr Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting
title_full_unstemmed Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting
title_short Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting
title_sort unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8386239/
https://www.ncbi.nlm.nih.gov/pubmed/34429298
http://dx.doi.org/10.1136/bmjgh-2021-005357
work_keys_str_mv AT ntinginyanyandaelias unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT kuchakadavis unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT orinafred unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT mwebazaivan unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT liyoyoalphonce unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT mihesobarbara unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT aturindeaugustus unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT njelekafred unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT kiulakiula unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT msokaelizabethf unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT memehelen unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT sangaerica unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT mwanyongasimeon unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT olomiwillyhelmina unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT minjalinda unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT jolobamoses unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT mmbagablandinat unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT amukoyeevans unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT gillespiestephenhenry unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting
AT sabiitiwilber unlockingthehealthsystembarrierstomaximisetheuptakeandutilisationofmoleculardiagnosticsinlowincomeandmiddleincomecountrysetting