Breaking Down Barriers to the Implementation of the GeneXpert Technique: Perception of Healthcare Providers

Abstract

Background:Tuberculosis control strategies globally aim to early detect and manage the disease. The GeneXpert assay has shown improved specificity and sensitivity over sputum smear microscopy. The assay shows comparable results to sputum culture and produces results in less than 2 hours making it a better diagnostic tool. We sought to identify barriers and challenges associated with the GeneXpert intervention in Ghana.

Methods: This cross-sectional study was done between January and February 2022 and involved an online questionnaire (Google sheet, 2006) shared through WhatsApp with healthcare workers engaged in tuberculosis work in Ghana. The data collected was checked for completeness, coded, and entered into SPSS version 26 (IBM 2019) for analysis. Other analyses were done using GraphPad Prism 8 (Microsoft, 2019). Associations between demographic indicators, work-related characteristics, and choice of responses were explored using logistic regression models and generalized linear models. All analyses were two-tailed with p-values less than 0.05 being considered statistically significant

Results: 294 health professionals participated in the study, the majority (51.4%) of whom were aged between 26-35 years and were mostly males (240/294). The majority of the respondents had attained their first degree (55.4%) with the rest having either certificates, diplomas, masters, or fellowships. Participants were mostly laboratory professionals (93.5%) who worked in either the district or municipal health facilities (37.8%). Most of them worked in public health facilities (> 2/3), while the rest worked under the Christian Health Association of Ghana (CHAG), private and quasi-government facilities. The majority of the participants strongly agreed that module failure, delay in maintenance support, inadequate supply of cartridges, lack of appropriate centrifuges for non-pulmonary sample processing, poorly maintained air conditioners, and faulty UPS were associated with the optimal operation of the GeneXpert machines.

Conclusion: GeneXpert is widely used in Ghana and has positively impacted TB case detection and management. Barriers such as faulty air conditioners, faulty UPS, module failure, inadequate cartridge supply, delay in maintenance support, and lack of equipment such as refrigerated centrifuge are affecting the effective implementation of the intervention. There is therefore an urgent need to tackle these barriers to forestall the failure of the intervention.