PT  - JOURNAL ARTICLE
AU  - Brown, Scott
AU  - Leavy, Justine E.
AU  - Jancey, Jonine
TI  - Implementation of GeneXpert for TB Testing in Low- and Middle-Income Countries: A Systematic Review
AID  - 10.9745/GHSP-D-21-00121
DP  - 2021 Sep 30
TA  - Global Health: Science and Practice
PG  - 698--710
VI  - 9
IP  - 3
4099  - http://www.ghspjournal.org/content/9/3/698.short
4100  - http://www.ghspjournal.org/content/9/3/698.full
SO  - GLOB HEALTH SCI PRACT2021 Sep 30; 9
AB  - Key MessagesIn low- and middle-income countries (LMICs) that have a higher burden of TB, the necessity for improved and rapid diagnostic testing, such as Xpert MTB/RIF that detects both TB and rifampicin resistance, has been limited by resource-related implementation challenges.Identifying and responding to the implementation-related barriers and enablers in Xpert testing programs across LMICs can help improve public health outcomes, which in this review were negatively impacted by barriers that were identified.We found that across the studies included in the review, an integrated and coordinated approach was required for implementing Xpert TB models of care into different health settings, but in LMICs, this approach can be associated with a lack of integration and coordination.When deciding on a particular implementation approach, the existing context of a health setting and the expertise and needs of key stakeholders (for example, clinicians, laboratories, and government) should be considered.Reporting of Xpert programs against an implementation science framework can increase learning across geographically diverse settings and thereby support improvement in program design.Introduction: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.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.Results: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.Conclusion: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.