{
  "abstract": "Introduction Fewer than 50% of people with tuberculosis receive a molecular WHO-recommended rapid diagnostic test (mWRD). We performed a mixed-methods systematic review to categorise barriers and enablers that affect mWRD use and impact and evaluate mWRD implementation strategies. Parts of this review informed the WHO standard: Universal Access to Tuberculosis Diagnostics.Methods We searched multiple databases without language restrictions until 29 July 2022. We included studies that used qualitative, quantitative or mixed methods study designs. Four reviewers independently screened studies and extracted data. We categorised studies as thick or thin depending on whether authors analysed findings beyond a descriptive list of barriers or enablers and demonstrated insights into participants’ perspectives. We appraised study quality by adapting the Standards for Reporting Implementation Studies statement. We synthesised data using a thematic approach and used GRADE-CERQual to assess confidence in the findings.Results We identified 54 high-thickness studies from 18 countries, including public and private healthcare settings. Implementation strategies included engaging patients, training and supporting clinicians, building infrastructure and interactive assistance. Examples included remote outreach programmes, community testing, longitudinal clinician engagement, auxiliary workers, multicomponent strategies, performance feedback, improving health information management to strengthen care linkage and diagnostic network improvement. We had high or moderate confidence in our findings.Conclusion Innovative and contextually relevant implementation strategies are needed for tuberculosis programmes to realise the benefits of improved accuracy and diagnostic expediency that mWRDs offer. Multicomponent strategies that centre equity and longitudinal health worker training across the diagnostic cascade must be prioritised.",
  "authors": [
    {
      "affiliations": [
        "Harvard Medical School, Boston, Massachusetts, USA",
        "Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Ruvandhi R Nathavitharana"
    },
    {
      "affiliations": [
        "Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Abarna Pearl"
    },
    {
      "affiliations": [
        "Harvard School of Public Health, Boston, Massachusetts, USA"
      ],
      "name": "Matthew O’Bryan"
    },
    {
      "affiliations": [
        "Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"
      ],
      "name": "Matthew Edwards"
    },
    {
      "affiliations": [
        "Primary Care Health Sciences, Oxford University, Oxford, UK"
      ],
      "name": "Helene-Mari van der Westhuizen"
    },
    {
      "affiliations": [
        "Technion’s American Medical School, Haifa, Israel"
      ],
      "name": "Bruna Voldman"
    },
    {
      "affiliations": [
        "Tulane University, New Orleans, Louisiana, USA"
      ],
      "name": "Advaith Subramanian"
    },
    {
      "affiliations": [
        "Tulane University, New Orleans, Louisiana, USA"
      ],
      "name": "Naveed Delrooz"
    },
    {
      "affiliations": [
        "George Mason University, Fairfax, Virginia, USA"
      ],
      "name": "Omolayo Anjorin"
    },
    {
      "affiliations": [
        "Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Amanda Biewer"
    },
    {
      "affiliations": [
        "World Health Organization, Geneva, Switzerland"
      ],
      "name": "Carl-Michael Nathanson"
    },
    {
      "affiliations": [
        "Maastricht University, Maastricht, The Netherlands"
      ],
      "name": "Nora Engel"
    },
    {
      "affiliations": [
        "World Health Organization, Geneva, Switzerland",
        "University of the Witwatersrand Johannesburg, Johannesburg, South Africa"
      ],
      "name": "Nazir Ismail"
    },
    {
      "affiliations": [
        "Tulane University, New Orleans, Louisiana, USA"
      ],
      "name": "Andrew McDowell"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK"
      ],
      "name": "Karen Steingart"
    }
  ],
  "title": "Implementation strategies to increase the uptake and impact of molecular WHO-recommended rapid diagnostic tests: evidence from a mixed-methods systematic review",
  "uid": "3e7da36e-fbef-5062-9fbe-964e4df12fc4"
}