TY - JOUR T1 - Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2021-005357 VL - 6 IS - 8 SP - e005357 AU - Nyanda Elias Ntinginya AU - Davis Kuchaka AU - Fred Orina AU - Ivan Mwebaza AU - Alphonce Liyoyo AU - Barbara Miheso AU - Augustus Aturinde AU - Fred Njeleka AU - Kiula Kiula AU - Elizabeth F Msoka AU - Helen Meme AU - Erica Sanga AU - Simeon Mwanyonga AU - Willyhelmina Olomi AU - Linda Minja AU - Moses Joloba AU - Blandina T Mmbaga AU - Evans Amukoye AU - Stephen Henry Gillespie AU - Wilber Sabiiti Y1 - 2021/08/01 UR - http://gh.bmj.com/content/6/8/e005357.abstract N2 - Background Early access to diagnosis is crucial for effective management of any disease including tuberculosis (TB). We investigated the barriers and opportunities to maximise uptake and utilisation of molecular diagnostics in routine healthcare settings.Methods Using the implementation of WHO approved TB diagnostics, Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) and Line Probe Assay (LPA) as a benchmark, we evaluated the barriers and how they could be unlocked to maximise uptake and utilisation of molecular diagnostics.Results Health officers representing 190 districts/counties participated in the survey across Kenya, Tanzania and Uganda. The survey findings were corroborated by 145 healthcare facility (HCF) audits and 11 policy-maker engagement workshops. Xpert MTB/RIF coverage was 66%, falling behind microscopy and clinical diagnosis by 33% and 1%, respectively. Stratified by HCF type, Xpert MTB/RIF implementation was 56%, 96% and 95% at district, regional and national referral hospital levels. LPA coverage was 4%, 3% below culture across the three countries. Out of 111 HCFs with Xpert MTB/RIF, 37 (33%) used it to full capacity, performing ≥8 tests per day of which 51% of these were level five (zonal consultant and national referral) HCFs. Likewise, 75% of LPA was available at level five HCFs. Underutilisation of Xpert MTB/RIF and LPA was mainly attributed to inadequate—utilities, 26% and human resource, 22%. Underfinancing was the main reason underlying failure to acquire molecular diagnostics. Second to underfinancing was lack of awareness with 33% healthcare administrators and 49% practitioners were unaware of LPA as TB diagnostic. Creation of a national health tax and decentralising its management was proposed by policy-makers as a booster of domestic financing needed to increase access to diagnostics.Conclusion Our findings suggest higher uptake and utilisation of molecular diagnostics at tertiary level HCFs contrary to the WHO recommendation. Country-led solutions are crucial for unlocking barriers to increase access to diagnostics.Data are available on reasonable request. Data available at School of Medicine Division of Infection and Global Health, WS, ws31@st-andrews.ac.uk. Requests will be reviewed by the ethics Committee to assess their compliance to confidentiality and limits of consent given by study participants. ER -