Implementation of the Xpert MTB/RIF assay for tuberculosis in Mongolia: A qualitative exploration of barriers and enablers

Nicole L. Rendell, Solongo Bekhbat, Gantungalag Ganbaatar, Munkhjargal Dorjravdan, Madhukar Pai, Claudia C. Dobler

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Objective. The aim of our study was to identify barriers and enablers to implementation of the Xpert MTB/RIF test within Mongolia's National Tuberculosis Program. Methods. Twenty-four semi-structured interviews were conducted between June and September 2015 with laboratory staffand tuberculosis physicians in Mongolia's capital Ulaanbaatar and regional towns where Xpert MTB/RIF testing had been implemented. Interviews were recorded, transcribed, translated and analysed thematically using NVIVO qualitative analysis software. Results. Eight laboratory staff(five from the National Tuberculosis Reference Labo- ratory in Ulaanbaatar and three from provincial laboratories) and sixteen tuberculosis physicians (five from the Mongolian National Center for Communicable Diseases in Ulaanbaatar, four from district tuberculosis clinics in Ulaanbaatar and seven from provincial tuberculosis clinics) were interviewed. Major barriers to Xpert MTB/RIF implementation identified were: lack of awareness of program guidelines; inadequate staffing arrangements; problems with cartridge supply management; lack of local repair options for the Xpert machines; lack of regular formal training; paper based system; delayed treatment initiation due to consensus meeting and poor sample quality. Enablers to Xpert MTB/RIF implementation included availability of guidelines in the local language; provision of extra laboratory staff, shift working arrangements and additional modules; capacity for troubleshooting internally; access to experts; opportunities for peer learning; common understanding of diagnostic algorithms and decentralised testing. Conclusion. Our study identified a number of barriers and enablers to implementation of Xpert MTB/RIF in the Mongolian National Tuberculosis Program. Lessons learned from this study can help to facilitate implementation of Xpert MTB/RIF in other Mongolian locations as well as other low-and middle-income countries.

Original languageEnglish
Article numbere3567
JournalPEERJ
Volume2017
Issue number7
DOIs
Publication statusPublished - 1 Jan 2017
Externally publishedYes

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Mongolia
tuberculosis
Assays
Tuberculosis
assays
physicians
interviews
Testing
Guidelines
Interviews
Physicians
Repair
testing
peers
qualitative analysis
Availability
towns
infectious diseases
Communicable Diseases
Consensus

Cite this

Rendell, Nicole L. ; Bekhbat, Solongo ; Ganbaatar, Gantungalag ; Dorjravdan, Munkhjargal ; Pai, Madhukar ; Dobler, Claudia C. / Implementation of the Xpert MTB/RIF assay for tuberculosis in Mongolia : A qualitative exploration of barriers and enablers. In: PEERJ. 2017 ; Vol. 2017, No. 7.
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abstract = "Objective. The aim of our study was to identify barriers and enablers to implementation of the Xpert MTB/RIF test within Mongolia's National Tuberculosis Program. Methods. Twenty-four semi-structured interviews were conducted between June and September 2015 with laboratory staffand tuberculosis physicians in Mongolia's capital Ulaanbaatar and regional towns where Xpert MTB/RIF testing had been implemented. Interviews were recorded, transcribed, translated and analysed thematically using NVIVO qualitative analysis software. Results. Eight laboratory staff(five from the National Tuberculosis Reference Labo- ratory in Ulaanbaatar and three from provincial laboratories) and sixteen tuberculosis physicians (five from the Mongolian National Center for Communicable Diseases in Ulaanbaatar, four from district tuberculosis clinics in Ulaanbaatar and seven from provincial tuberculosis clinics) were interviewed. Major barriers to Xpert MTB/RIF implementation identified were: lack of awareness of program guidelines; inadequate staffing arrangements; problems with cartridge supply management; lack of local repair options for the Xpert machines; lack of regular formal training; paper based system; delayed treatment initiation due to consensus meeting and poor sample quality. Enablers to Xpert MTB/RIF implementation included availability of guidelines in the local language; provision of extra laboratory staff, shift working arrangements and additional modules; capacity for troubleshooting internally; access to experts; opportunities for peer learning; common understanding of diagnostic algorithms and decentralised testing. Conclusion. Our study identified a number of barriers and enablers to implementation of Xpert MTB/RIF in the Mongolian National Tuberculosis Program. Lessons learned from this study can help to facilitate implementation of Xpert MTB/RIF in other Mongolian locations as well as other low-and middle-income countries.",
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Implementation of the Xpert MTB/RIF assay for tuberculosis in Mongolia : A qualitative exploration of barriers and enablers. / Rendell, Nicole L.; Bekhbat, Solongo; Ganbaatar, Gantungalag; Dorjravdan, Munkhjargal; Pai, Madhukar; Dobler, Claudia C.

In: PEERJ, Vol. 2017, No. 7, e3567, 01.01.2017.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Implementation of the Xpert MTB/RIF assay for tuberculosis in Mongolia

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AU - Rendell, Nicole L.

AU - Bekhbat, Solongo

AU - Ganbaatar, Gantungalag

AU - Dorjravdan, Munkhjargal

AU - Pai, Madhukar

AU - Dobler, Claudia C.

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N2 - Objective. The aim of our study was to identify barriers and enablers to implementation of the Xpert MTB/RIF test within Mongolia's National Tuberculosis Program. Methods. Twenty-four semi-structured interviews were conducted between June and September 2015 with laboratory staffand tuberculosis physicians in Mongolia's capital Ulaanbaatar and regional towns where Xpert MTB/RIF testing had been implemented. Interviews were recorded, transcribed, translated and analysed thematically using NVIVO qualitative analysis software. Results. Eight laboratory staff(five from the National Tuberculosis Reference Labo- ratory in Ulaanbaatar and three from provincial laboratories) and sixteen tuberculosis physicians (five from the Mongolian National Center for Communicable Diseases in Ulaanbaatar, four from district tuberculosis clinics in Ulaanbaatar and seven from provincial tuberculosis clinics) were interviewed. Major barriers to Xpert MTB/RIF implementation identified were: lack of awareness of program guidelines; inadequate staffing arrangements; problems with cartridge supply management; lack of local repair options for the Xpert machines; lack of regular formal training; paper based system; delayed treatment initiation due to consensus meeting and poor sample quality. Enablers to Xpert MTB/RIF implementation included availability of guidelines in the local language; provision of extra laboratory staff, shift working arrangements and additional modules; capacity for troubleshooting internally; access to experts; opportunities for peer learning; common understanding of diagnostic algorithms and decentralised testing. Conclusion. Our study identified a number of barriers and enablers to implementation of Xpert MTB/RIF in the Mongolian National Tuberculosis Program. Lessons learned from this study can help to facilitate implementation of Xpert MTB/RIF in other Mongolian locations as well as other low-and middle-income countries.

AB - Objective. The aim of our study was to identify barriers and enablers to implementation of the Xpert MTB/RIF test within Mongolia's National Tuberculosis Program. Methods. Twenty-four semi-structured interviews were conducted between June and September 2015 with laboratory staffand tuberculosis physicians in Mongolia's capital Ulaanbaatar and regional towns where Xpert MTB/RIF testing had been implemented. Interviews were recorded, transcribed, translated and analysed thematically using NVIVO qualitative analysis software. Results. Eight laboratory staff(five from the National Tuberculosis Reference Labo- ratory in Ulaanbaatar and three from provincial laboratories) and sixteen tuberculosis physicians (five from the Mongolian National Center for Communicable Diseases in Ulaanbaatar, four from district tuberculosis clinics in Ulaanbaatar and seven from provincial tuberculosis clinics) were interviewed. Major barriers to Xpert MTB/RIF implementation identified were: lack of awareness of program guidelines; inadequate staffing arrangements; problems with cartridge supply management; lack of local repair options for the Xpert machines; lack of regular formal training; paper based system; delayed treatment initiation due to consensus meeting and poor sample quality. Enablers to Xpert MTB/RIF implementation included availability of guidelines in the local language; provision of extra laboratory staff, shift working arrangements and additional modules; capacity for troubleshooting internally; access to experts; opportunities for peer learning; common understanding of diagnostic algorithms and decentralised testing. Conclusion. Our study identified a number of barriers and enablers to implementation of Xpert MTB/RIF in the Mongolian National Tuberculosis Program. Lessons learned from this study can help to facilitate implementation of Xpert MTB/RIF in other Mongolian locations as well as other low-and middle-income countries.

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