The adoption of a new diagnostic technology for tuberculosis in two Brazilian cities from the perspective of patients and healthcare workers: a qualitative study

Abstract

BackgroundThis article presents the qualitative component linked to a larger study of implementation of the Xpert™ MTB/Rif technology in two Brazilian cities. Despite intrinsic advantages of new health technologies, its introduction can be disruptive to existing routines, and it is thus important to understand how these innovations are perceived by the different groups involved in its regular use.MethodsThis study was based on semi-structured interviews with patients, lab technicians, health care workers and managers involved with diagnosis and care of Tuberculosis (TB). The interviews had their content analyzed in order to abstract the different perspectives for the various actors.ResultsFor patients the changes were not perceived as significant, since their greatest concerns were related to treatment and the stigma associated with TB. The professionals in general welcomed the new technique, which dramatically decreases the workload, time and reliability of diagnosis, in their view. However, we noted difficulties with the concomitant implementation of new IT technology for recording and reporting test results, which negatively impacted the time necessary to get lab diagnosis to physicians.ConclusionsThrough this analysis we detected some bottlenecks in the surrounding environment, not necessarily linked to the technology itself but which could hamper considerably its advantages.

Peer Review #2 of "Implementation of the Xpert MTB/RIF assay for tuberculosis in Mongolia: a qualitative exploration of barriers and enablers (v0.1)"

“…A study undertaken in two Brazilian cities found that the implementation of concomitant IT technology to support Xpert MTB/RIF integration into organisational workflows, led to delays in physicians receiving laboratory results. 16 In that study, difficulties with the online system were thought to be a result of poor knowledge on how to use the equipment and networks effectively, low availability of online systems and available systems not interacting with each other leading to repeated input of data. 16 Given the limited availability and uptake of electronic databases and online systems within Mongolia's NTP, it is reasonable to assume that Mongolian NTP staff may have concerns about upscaling IT technology that echo the experience outlined in the Brazilian study.…”

“…16 In that study, difficulties with the online system were thought to be a result of poor knowledge on how to use the equipment and networks effectively, low availability of online systems and available systems not interacting with each other leading to repeated input of data. 16 Given the limited availability and uptake of electronic databases and online systems within Mongolia's NTP, it is reasonable to assume that Mongolian NTP staff may have concerns about upscaling IT technology that echo the experience outlined in the Brazilian study. 16 However, IT solutions enable more efficient record keeping internally and capacity for connectivity externally to pool surveillance data that can benefit TB control efforts within the region.…”

“…16 Given the limited availability and uptake of electronic databases and online systems within Mongolia's NTP, it is reasonable to assume that Mongolian NTP staff may have concerns about upscaling IT technology that echo the experience outlined in the Brazilian study. 16 However, IT solutions enable more efficient record keeping internally and capacity for connectivity externally to pool surveillance data that can benefit TB control efforts within the region. 23 Several studies have highlighted issues with sample quantity and quality for GeneXpert testing.…”

“…[7][8][9][10][11][12] Only few research studies, however, have investigated implementation issues from an organisational perspective, 5,[13][14][15][16][17] two of which included qualitative tools designed specifically for the study to gather information on user experiences and challenges related to Manuscript to be reviewed Xpert MTB/RIF implementation. 5,16 Some of the identified challenges associated with Xpert MTB/RIF implementation in low-and middle income countries include lack of standardised guidance, piecemeal implementation of training, quality assurance, planning processes and equipment servicing and maintenance, issues with continuous power supply and difficulties recording and reporting test results using new technology. 5,16,17 The aim of our study was to identify and understand system and context specific factors within Mongolia's National Tuberculosis Program (NTP) that are barriers or enablers to implementing the Xpert MTB/RIF test from the perspective of NTP staff.…”

“…5,16 Some of the identified challenges associated with Xpert MTB/RIF implementation in low-and middle income countries include lack of standardised guidance, piecemeal implementation of training, quality assurance, planning processes and equipment servicing and maintenance, issues with continuous power supply and difficulties recording and reporting test results using new technology. 5,16,17 The aim of our study was to identify and understand system and context specific factors within Mongolia's National Tuberculosis Program (NTP) that are barriers or enablers to implementing the Xpert MTB/RIF test from the perspective of NTP staff.…”