Countrywide roll-out of Xpert® MTB/RIF in Swaziland: the first three years of implementation
Xpert MTB/RIF assay is a rapid test for mycobacterium tuberculosis (MTB) and rifampin resistance (RIF)
Abstract
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.
This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)
Citation
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. doi: 10.5588/pha.15.0001.
Links
Countrywide roll-out of Xpert® MTB/RIF in Swaziland: the first three years of implementation