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dc.contributor.authorNtinginya, Nyanda Elias
dc.contributor.authorKuchaka, Davis
dc.contributor.authorOrina, Fred
dc.contributor.authorMwebaza, Ivan
dc.contributor.authorLiyoyo, Alphonce
dc.contributor.authorMiheso, Barbara
dc.contributor.authorAturinde, Augustus
dc.contributor.authorNjeleka, Fred
dc.contributor.authorKiula, Kiula
dc.contributor.authorMsoka, Elizabeth F
dc.contributor.authorMeme, Helen
dc.contributor.authorSanga, Erica
dc.contributor.authorMwanyonga, Simeon
dc.contributor.authorOlomi, Willyhelmina
dc.contributor.authorMinja, Linda
dc.contributor.authorJoloba, Moses
dc.contributor.authorMmbaga, Blandina Theophil
dc.contributor.authorAmukoye, Evans
dc.contributor.authorGillespie, Stephen Henry
dc.contributor.authorSabiiti, Wilber
dc.date.accessioned2021-08-25T08:30:08Z
dc.date.available2021-08-25T08:30:08Z
dc.date.issued2021-08-24
dc.identifier275152883
dc.identifier4923cf39-ea13-462a-a80e-9d0143c67ff4
dc.identifier85113745373
dc.identifier000688529300001
dc.identifier.citationNtinginya , N E , Kuchaka , D , Orina , F , Mwebaza , I , Liyoyo , A , Miheso , B , Aturinde , A , Njeleka , F , Kiula , K , Msoka , E F , Meme , H , Sanga , E , Mwanyonga , S , Olomi , W , Minja , L , Joloba , M , Mmbaga , B T , Amukoye , E , Gillespie , S H & Sabiiti , W 2021 , ' Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low- and middle- income country setting ' , BMJ Global Health , vol. 6 , no. 8 , e005357 . https://doi.org/10.1136/bmjgh-2021-005357en
dc.identifier.issn2059-7908
dc.identifier.otherORCID: /0000-0001-6537-7712/work/99116014
dc.identifier.otherORCID: /0000-0002-4742-2791/work/99116140
dc.identifier.urihttps://hdl.handle.net/10023/23830
dc.descriptionThe study was funded by the European and Developing Countries Clinical Trials Partnership (EDCTP), grant TWENDE-EDCTP-CSA-2014-283.en
dc.description.abstractBackground : Early access to diagnosis is crucial for effective management of any disease including tuberculosis (TB). We investigated the barriers and opportunities to maximise uptake and utilisation of molecular diagnostics in routine healthcare settings. Methods : Using the implementation of World Health Organisation approved TB diagnostics, Xpert MTB/RIF and Line Probe Assay (LPA) as a benchmark we evaluated the barriers and how they could be unlocked to maximise uptake and utilisation of molecular diagnostics. Results : Health officers representing 190 districts/counties participated in the survey across Kenya, Tanzania and Uganda. The survey findings were corroborated by 145 healthcare facility (HCF) audits and 11 policymaker engagement workshops. Xpert MTB/RIF coverage was 66%, falling behind microscopy and clinical diagnosis by 33% and 1% respectively. Stratified by HCF type, Xpert MTB/RIF implementation was 56%, 96% and 95% at district-, regional- and national referral- hospital levels. LPA coverage was 4%, 3% below culture across the three countries. Out of 111 HCFs with Xpert MTB/RIF, 37 (33%) utilised it to full capacity, performing ≥8 tests per day of which 51% of these were level five (zonal consultant and national referral) HCFs. Likewise, 75% of LPA was available at level five HCFs. Underutilisation of Xpert MTB/RIF and LPA was mainly attributed to inadequate- utilities, 26% and human resource, 22%. Underfinancing was the main reason underlying failure to acquire molecular diagnostics. Second to underfinancing was lack of awareness with 33% healthcare administrators and 49% practitioners were unaware of LPA as TB diagnostic. Creation of a health tax and decentralising its management was proposed by policymakers as a booster of domestic financing needed to increase access to diagnostics. Conclusion : Our findings suggest higher uptake and utilisation of molecular diagnostics at tertiary level HCFs contrary to the WHO recommendation. Country-led solutions are crucial for unlocking barriers to increase access to diagnostics.
dc.format.extent12
dc.format.extent1115230
dc.language.isoeng
dc.relation.ispartofBMJ Global Healthen
dc.subjectImplementaionen
dc.subjectMolecular diagnosticsen
dc.subjectTuberculosisen
dc.subjectMaximising uptake and utilisationen
dc.subjectPolicy and practiceen
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.subjectE-NDASen
dc.subjectSDG 3 - Good Health and Well-beingen
dc.subject.lccRA0421en
dc.titleUnlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low- and middle- income country settingen
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. Sir James Mackenzie Institute for Early Diagnosisen
dc.contributor.institutionUniversity of St Andrews. Centre for Biophotonicsen
dc.contributor.institutionUniversity of St Andrews. Infection and Global Health Divisionen
dc.contributor.institutionUniversity of St Andrews. Global Health Implementation Groupen
dc.contributor.institutionUniversity of St Andrews. Gillespie Groupen
dc.contributor.institutionUniversity of St Andrews. Biomedical Sciences Research Complexen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.identifier.doi10.1136/bmjgh-2021-005357
dc.description.statusPeer revieweden
dc.date.embargoedUntil2021-08-24
dc.identifier.urlhttps://gh.bmj.com/content/6/8/e005357.full#supplementary-materialsen


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