title: Countrywide roll-out of Xpert(®) MTB/RIF in Swaziland: the first three years of implementation.
abstract: METHODS
  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.
  
  
  METHODS
  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%).
  
  
  CONCLUSIONS
  Countrywide roll-out of Xpert in Swaziland has been successful, although operational issues have been identified and need to be resolved.
authors.affiliation: National Tuberculosis Control Programme, Mbabane, Swaziland ; Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Sikhondze
authors.affiliation: National Tuberculosis Control Programme, Mbabane, Swaziland.
authors.forename: T
authors.initials: T
authors.lastname: Dlamini
authors.affiliation: National Tuberculosis Control Programme, Mbabane, Swaziland ; National TB Reference Laboratory, Mbabane, Swaziland.
authors.forename: D
authors.initials: D
authors.lastname: Khumalo
authors.affiliation: Swaziland Health Laboratory Services, Mbabane, Swaziland.
authors.forename: G
authors.initials: G
authors.lastname: Maphalala
authors.affiliation: Swaziland Health Laboratory Services, Mbabane, Swaziland.
authors.forename: S
authors.initials: S
authors.lastname: Dlamini
authors.affiliation: National TB Reference Laboratory, Mbabane, Swaziland ; University Research Co., Center for Human Services, Mbabane, Swaziland.
authors.forename: T
authors.initials: T
authors.lastname: Zikalala
authors.affiliation: Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Albert
authors.affiliation: Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Wambugu
authors.affiliation: Médecins Sans Frontières, Medical Department, Operational Research Centre, Brussels, MSF-Luxembourg, Luxembourg.
authors.forename: K
authors.initials: K
authors.lastname: Tayler-Smith
authors.affiliation: Médecins Sans Frontières, Medical Department, Operational Research Centre, Brussels, MSF-Luxembourg, Luxembourg.
authors.forename: E
authors.initials: E
authors.lastname: Ali
authors.affiliation: National Tuberculosis Programme, Cotonou, Bénin ; International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Ade
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
keywords: SORT IT; Swaziland; Xpert® MTB/RIF; operational research; tuberculosis