Implementation of the Xpert MTB/RIF assay for TB in Mongolia: a qualitative exploration of barriers and enablers
Abstract
Objective
The aim of our study was
to identify barriers and enablers to implementation of the Xpert
MTB/RIF test within Mongolia’s National Tuberculosis
Program.
Methods
Twenty-four semi-structured
interviews were conducted between June and September 2015 with
laboratory staff and tuberculosis physicians in Mongolia’s
capital Ulaanbaatar and regional towns where Xpert MTB/RIF
testing had been implemented. Interviews were recorded,
transcribed, translated and analysed thematically using NVIVO
qualitative analysis software.
Results
Eight laboratory staff (five
from the National Tuberculosis Reference Laboratory in
Ulaanbaatar and three from provincial laboratories) and sixteen
tuberculosis physicians (five from the Mongolian National Center
for Communicable Diseases in Ulaanbaatar, four from district
tuberculosis clinics in Ulaanbaatar and seven from provincial
tuberculosis clinics) were interviewed. Major barriers to Xpert
MTB/RIF implementation identified were: lack of awareness of
program guidelines; inadequate staffing arrangements; problems
with cartridge supply management; lack of local repair options
for the Xpert machines; lack of regular formal training; paper
based system; delayed treatment initiation due to consensus
meeting and poor sample quality. Enablers to Xpert MTB/RIF
implementation included availability of guidelines in the local
language; provision of extra laboratory staff, shift working
arrangements and additional modules; capacity for
troubleshooting internally; access to experts; opportunities for
peer learning; common understanding of diagnostic algorithms and
decentralised testing.
Conclusion
Our study identified a
number of barriers and enablers to implementation of Xpert
MTB/RIF in the Mongolian National Tuberculosis Program. Lessons
learned from this study can help to facilitate implementation of
Xpert MTB/RIF in other Mongolian locations as well as other
low-and middle-income countries.
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Source:
PeerJ
