Barriers to GeneXpert utilization for tuberculosis detection at a regional referral hospital in Malawi: a qualitative study.

INTRODUCTION

GeneXpert is the recommended diagnostic test for HIV-associated tuberculosis (TB). However, GeneXpert utilization is suboptimal in many countries. We explored the utilization of GeneXpert in an urban, regional referral hospital in northern Malawi using qualitative methods.

METHODS

in this cross-sectional qualitative study, a purposive sample of eight key informants from the TB clinic and laboratory was selected from outpatient and inpatient wards. An interview guide was used to conduct in-depth interviews to explore barriers to GeneXpert utilization. Interview data were analyzed using thematic analysis.

RESULTS

barriers to GeneXpert utilization appeared in three main themes: healthcare providers, institutions and operational-related factors. Healthcare provider factors included inadequate knowledge and training on differences in eligibility criteria for testing and GeneXpert algorithms by clinicians and laboratory technicians and poor interdepartmental communication. Institutional factors included staff shortages, heavy workloads and financial constraints. Operational factors included technical factors, e.g. power interruptions, GeneXpert module failures and poor sample quality and the restrictiveness of the algorithm.

CONCLUSION

the study identified multiple factors that lead to GeneXpert underutilization. GeneXpert-specific training is required to address many of the provider-related barriers to utilization. This study highlighted the importance of assessing context-specific barriers to inform interventions to improve GeneXpert utilization.