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What are the main challenges encountered during GeneXpert implementation in developing countries?
Thanks Ranjan for introducing this very important topic especially for someof us practising in LMICs . In Sub-Saharan Africa Lab workers still havethis phobia of Biohazard attributable to GeneXpert despite the contrary .Health workers need more education . There is also this challenge ofscaling implementation to many health facilities involved in management ofTB . In SSA , lots of facilities that provide TB cannot do GeneXpert test.They rely mainly on Symptomatology , Chest radiograph and occasionallysputum AAFB .
Dear Ranjan,There are many publications that summarize the challenges and lessons learnt from implementation and rollout of GeneXpert from as early as 2014 to the present. Unfortunately, many of the challenges remain, as the technology has not addressed important issues related to the various LMIC settings in which the instruments are being placed and programs are slow to develop the supportive systems necessary to optimize testing, improve instrument utilization, increase uptake, and demonstrate impact. I have attached a few articles that review implementation over several countries as well as 2 specific country examples (different settings) for you to review. Many of the challenges are common throughout the globe. As countries expand their networks and strive to use Xpert MTB/RIF as the initial diagnostic test, some of these challenges or barriers may become exponential if not addressed appropriately from the start. You can find many more articles online to answer your recent query.Best regards,Kathleen EnglandSr. TB Diagnostics Advisor
Dear RanjanAdditional to Kathleen comments, I would add that one missing component on the introduction of this relatively new technology such as Xpert has suffered from a lack of comprehensive technical assistance to prepare country and stakeholders. Please find attached a paper published last year for uses and reference.
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