Abstract
Current evidence indicates that the impact of GeneXpert for diagnosing TB in low- and middle-income countries (LMICs) has not demonstrated equivalent outcomes when compared to Xpert evaluations in upper-middle-income countries. Challenges associated with implementation are possible contributing factors preventing this innovative diagnostic technology from achieving more significant public health outcomes. This review aimed to assess the use of implementation science frameworks when reporting the enablers and barriers for the implementation of GeneXpert for diagnosing TB in LMICs. We conducted a qualitative systematic review of the peer-reviewed literature using PubMed, Medline, and Scopus. Eligible articles were those published between January 2010 and March 2020 that identified enablers and barriers to GeneXpert implementation, as well as the implementation approach delivered in an LMIC. Eleven studies were included in the review. Implementation barriers were found to be relatively consistent across studies and included patient-level factors, human resources, material resources, service implementation, service coordination, and technical operations. Few studies (n=5) identified enabling factors in the implementation of Xpert for TB testing. Identified enablers included strategies such as active case finding, expanding diagnostic algorithms, and daily transport of samples. The public health impact of Xpert TB testing interventions was commonly influenced by implementation barriers (n=4). Of the 11 studies, only 3 reported against an implementation framework. This review identified a commonality in implementation barriers and enablers that influenced the overall public health impact of GeneXpert. With greater transparency of these barriers and enablers, program planners can promote a more collaborative approach and adapt interventions. It is recommended that program planners use implementation science frameworks when conducting research and publishing. This will build an evidence base focused on implementation and thereby support programs to address implementation barriers and include enabling factors in program design.
Highlights
Current evidence indicates that the impact of GeneXpert for diagnosing TB in low- and middle-income countries (LMICs) has not demonstrated equivalent outcomes when compared to Xpert evaluations in upper-middle-income countries
An estimated 10 million people were affected by TB globally in 2019, with the total number of deaths reaching 1.2 million people,[1] down from 1.5 million people in 2018.2 TB is prevalent in all countries, the distribution shows a significant burden in lowand middle-income countries (LMICs)
It has been estimated that up to one-third of global TB cases and more than threequarters of multidrug-resistant TB (MDR-TB) cases are undetected,[3] equating to upward of 3.3 million people globally living with active TB who are unaware of their status and remain undiagnosed.[5]
Summary
Current evidence indicates that the impact of GeneXpert for diagnosing TB in low- and middle-income countries (LMICs) has not demonstrated equivalent outcomes when compared to Xpert evaluations in upper-middle-income countries. This review aimed to assess the use of implementation science frameworks when reporting the enablers and barriers for the implementation of GeneXpert for diagnosing TB in LMICs. Methods: We conducted a qualitative systematic review of the peer-reviewed literature using PubMed, Medline, and Scopus. Methods: We conducted a qualitative systematic review of the peer-reviewed literature using PubMed, Medline, and Scopus Eligible articles were those published between January 2010 and March 2020 that identified enablers and barriers to GeneXpert implementation, as well as the implementation approach delivered in an LMIC. Conclusion: This review identified a commonality in implementation barriers and enablers that influenced the overall public health impact of GeneXpert. It is recommended that program planners use implementation science frameworks when conducting research and publishing This will build an evidence base focused on implementation and thereby support programs to address implementation barriers and include enabling factors in program design. It has been estimated that up to one-third of global TB cases and more than threequarters of MDR-TB cases are undetected,[3] equating to upward of 3.3 million people globally living with active TB who are unaware of their status and remain undiagnosed.[5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
