title: The role of technical assistance in expanding access to Xpert(®) MTB/RIF: experience in sub-Saharan Africa.
abstract: To improve tuberculosis (TB) diagnosis, many national TB programmes have committed to deploying Xpert(®) MTB/RIF. Implementation of this relatively new technology has suffered from a lack of comprehensive technical assistance, however, including the formulation of policies and plans to address operational issues. While providing technical assistance, we observed numerous operational challenges in the implementation and scale-up of Xpert in five sub-Saharan African countries: low coverage, poor laboratory infrastructure, limited access, poor linkages to treatment, inadequate data on outcomes, problems with specimen transport, diagnostic algorithms that are not aligned with updated World Health Organization recommendations on target patient groups and financing challenges. We recommend better country preparedness and training, laboratory information and quality systems, supply management and referral mechanisms.
authors.affiliation: Pharmaceutical & Health Technology Group (PHT) Laboratory Services, Management Sciences for Health (MSH), Pretoria, South Africa.
authors.forename: A N
authors.initials: AN
authors.lastname: Umubyeyi
authors.affiliation: National Tuberculosis Programme, Ghana Health Service, Accra, Ghana.
authors.forename: F
authors.initials: F
authors.lastname: Bonsu
authors.affiliation: TB CARE I, MSH, Accra, Ghana.
authors.forename: R
authors.initials: R
authors.lastname: Chimzizi
authors.affiliation: HEAL-TB, MSH, Addis Ababa, Ethiopia.
authors.forename: S
authors.initials: S
authors.lastname: Jemal
authors.affiliation: HEAL-TB, MSH, Addis Ababa, Ethiopia.
authors.forename: M
authors.initials: M
authors.lastname: Melese
authors.affiliation: Laboratory Services, MSH, Nairobi, Kenya.
authors.forename: E
authors.initials: E
authors.lastname: Ruttoh
authors.affiliation: PHT, MSH, Arlington, VA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Mundy
keywords: TB diagnostic technology; TB laboratory services; Xpert; implementation of innovations; technical assistance