The implementation of Xpert MTB/RIF assay for diagnosis of tuberculosis in Nepal: A mixed-methods analysis
| العنوان: | The implementation of Xpert MTB/RIF assay for diagnosis of tuberculosis in Nepal: A mixed-methods analysis |
|---|---|
| المؤلفون: | Stephen M. Graham, Sushil Baral, Trisasi Lestari, Shyam Prakash Dumre, Bandana Bhatta, Sharat Chandra Verma, Basant Joshi, Adi Utarini, Gokarna Ghimire |
| المصدر: | PLoS ONE PLoS ONE, Vol 13, Iss 8, p e0201731 (2018) |
| بيانات النشر: | Public Library of Science, 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | Bacterial Diseases, Physiology, lcsh:Medicine, Mixed methods analysis, Smear microscopy, Geographical Locations, 0302 clinical medicine, Medicine and Health Sciences, 030212 general & internal medicine, lcsh:Science, Microscopy, Multidisciplinary, biology, Kappa score, Hospitals, Body Fluids, Actinobacteria, Infectious Diseases, Tuberculosis Diagnosis and Management, medicine.symptom, Anatomy, Research Article, medicine.medical_specialty, Tuberculosis, Asia, Test failure, 030231 tropical medicine, Early detection, Mycobacterium tuberculosis, 03 medical and health sciences, Nepal, Diagnostic Medicine, medicine, Humans, Tuberculosis, Pulmonary, Bacteria, business.industry, lcsh:R, Sputum, Organisms, Biology and Life Sciences, biology.organism_classification, medicine.disease, Tropical Diseases, Health Care, Mucus, Early Diagnosis, Health Care Facilities, Emergency medicine, People and Places, lcsh:Q, business, Mycobacterium Tuberculosis |
| الوصف: | Background Tuberculosis (TB) is a major public health problem in low and middle-income countries. Early detection and enrolment of TB cases is a challenge for National TB Programs. Objective To understand the performance and feasibility for scale-up of Xpert MTB/RIF assay for the TB diagnosis in Nepal. Design Implementation research employed mixed-method sequential explanatory design. The results of Xpert MTB/RIF assay were analysed in 26 TB diagnostic centres where Xpert machines had been installed before 2015. In-depth interviews and focus group discussions were conducted with stakeholders, purposively selected to represent experiences in centres that were functioning well, poorly or not functioning. Results During a one-year period in 2015/16, 23,075 Xpert MTB/RIF assays were performed in 21 diagnostic centres with 22,288 people also tested by sputum microscopy. Among these, 77% had concordant (positive or negative) results, demonstrating fair agreement (Kappa score, 0.3) between test results. Test failure and positivity rates in diagnostic centres ranged from 2.6% to 13.4% and 6.5% to 49%, respectively. The number of cartridges per positive result varied from 2.3 to 10.2. Xpert assay was positive in 3314 (15% of all cases) sputum smear microscopy negative cases. Of 4280 bacteriologically confirmed cases by Xpert assay, 355 (8%) were rifampicin resistant. Xpert machines were no longer functioning regularly throughout the year in 5 diagnostic centres. The main barriers for effective implementation of Xpert in Nepal were the lack of: timely supply of cartridges; replacement of damaged modules; maintenance of Xpert machines; and stock verification for timely procurement of cartridges. Inadequate laboratory infrastructure for maintaining functional Xpert equipment further challenges implementation and scale-up. Conclusion The implementation of Xpert MTB/RIF assay has increased case-finding of TB and MDR-TB in Nepal. However, there is a need to improve laboratory performance and strengthen laboratory infrastructure for optimal utilisation and scale-up of Xpert. |
| اللغة: | English |
| تدمد: | 1932-6203 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::756abd2c570ea3a57d9723624a34255d http://europepmc.org/articles/PMC6086427 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....756abd2c570ea3a57d9723624a34255d |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19326203 |
|---|