W Sikhondze1, T Dlamini2, D Khumalo3, G Maphalala4, S Dlamini4, T Zikalala5, H Albert6, J Wambugu6, K Tayler-Smith7, E Ali7, S Ade8, A D Harries9. 1. National Tuberculosis Control Programme, Mbabane, Swaziland ; Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland. 2. National Tuberculosis Control Programme, Mbabane, Swaziland. 3. National Tuberculosis Control Programme, Mbabane, Swaziland ; National TB Reference Laboratory, Mbabane, Swaziland. 4. Swaziland Health Laboratory Services, Mbabane, Swaziland. 5. National TB Reference Laboratory, Mbabane, Swaziland ; University Research Co., Center for Human Services, Mbabane, Swaziland. 6. Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland. 7. Médecins Sans Frontières, Medical Department, Operational Research Centre, Brussels, MSF-Luxembourg, Luxembourg. 8. National Tuberculosis Programme, Cotonou, Bénin ; International Union Against Tuberculosis and Lung Disease, Paris, France. 9. International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, United Kingdom.
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.
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.
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