Setting: All 19 public health laboratories in Swaziland that had Xpert® MTB/RIF machines installed as part of a countrywide roll-out between June 2011 and June 2014.
Objective: To evaluate the utilisation and functionality of Xpert from 2011 to mid-2014.
Design: Descriptive study of Xpert implementation using routinely collected data.
Results: Of 48,829 Xpert tests conducted, 93% were successful: 14% detected Mycobacterium tuberculosis and 12% showed rifampicin resistance. The most common cause of unsuccessful tests was an ‘Error’ result (62%). Similar findings were obtained in government-supported and partner-supported laboratories. Annual utilisation of Xpert improved from 51% of maximum capacity in 2011 and 2012 to 74% in 2013 and 2014. A monitoring and supervision exercise of all Xpert testing sites in 2014 showed a generally good performance, with over 50% of laboratories achieving a ≥80% score on most components. However, poor scores were obtained with equipment use and maintenance (6% achieving a score of ≥80%), internal audit (19% achieving a score of ≥80%) and process control (25% achieving a score of ≥80%).
Conclusion: Countrywide roll-out of Xpert in Swaziland has been successful, although operational issues have been identified and need to be resolved.
Sikhondze, W.; Dlamini, T.; Khumalo, D.; Maphalala, G.; Dlamini, S.; Zikalala, T.; Albert, H.; Wambugu, J.; Tayler-Smith, K.; Ali, E.; Ade, S.; Harries, A.D. Countrywide roll-out of Xpert® MTB/RIF in Swaziland: the first three years of implementation. Public Health Action (2015) 5 (2) 140-146.