Factors Associated With The Utilization Of Genexpert In The Diagnosis Of Drug Resistant Tuberculosis In The Greater Accra Region.

Abstract

Background There has been a gap in the diagnosis of drug resistant tuberculosis, hence a new rapid diagnostic test; the geneXpert was introduced by the World Health Organization in 2010. The objective of this study was to identify factors that affect the utilization of the geneXpert intervention in the Greater Accra Region. Methods This was a mixed methods study. A qualitative approach was used to provide empirical explanations for the findings of the quantitative component which was cross-sectional. Functional facilities administering geneXpert were enrolled into the study. Quantitative data on risk factors for drug-resistant tuberculosis and geneXpert testing were obtained from the tuberculosis registers on 386 cases of tuberculosis using a pre-tested data extraction tool. Ten health care workers were interviewed using a semi-structured in-depth interview guide. Quantitative and qualitative results were triangulated in line with study objectives. Results A total of 386 cases of tuberculosis were included in the study. Less than half of the total cases reviewed 89(23%) had a geneXpert test. The proportion of cases at risk of drug resistant tuberculosis who were tested with geneXpert was relatively low among the various risk categories. Risk factors for drug resistant tuberculosis had no influence on having a geneXpert test and cases of extra-pulmonary tuberculosis were less likely to have a geneXpert test compared to cases of pulmonary tuberculosis [AOR= 0.17 (95%CI = 0.06-0.51), p< 0.002]. In-depth interviews identified lack of skilled technicians to collect extra-pulmonary specimens, sputum collection in children, loss to follow up for testing, an inefficient test result communication system and cartridge supply management system, lack of refrigerators for temporary storage of specimen and equipment maintenance as factors affecting the utilization of geneXpert. Conclusion This study found the non-prioritization of patients at risk of drug resistant tuberculosis for geneXpert testing resulting from lack of adherence to standard guidelines a key factor affecting the utilization of geneXpert. Based on findings, making geneXpert guidelines available at health facilities as well as training of health workers on the guidelines is recommended to improve the uptake of geneXpert.