{
  "abstract": "Background Timely and appropriate diagnosis and treatment are key to ending tuberculosis (TB). Incorporating users’ preferences when implementing decentralised strategies for diagnosis may facilitate scale-up and impact. This qualitative study embedded within a cluster randomised controlled trial explored the values and preferences of multiple stakeholders regarding a TB diagnostic strategy using the Truenat platform, mycobacterium tuberculosis (MTB) Plus and rifampicin Dx Assays in Mozambique and Tanzania.Methods We conducted semi-structured interviews with people with presumptive TB (n=35), professional users (laboratory technicians, nurses, clinicians, n=19) and national decision-makers (n=5). Direct observations of testing procedures and usability surveys (n=12) were also conducted. Thematic analysis was performed, informed by the Consolidated Framework for Implementation Research.Results Facilities varied in testing capacity, number of cases and time-to-results (from same-day to >2 weeks). Availability and supply of reagents and cartridges were described as an issue by healthcare providers and a potential cause for delayed results. The Truenat platform for detection of TB was considered easy to use (median SUS score 90/100) as well as acceptable and fit to the context where the evaluation was conducted. Truenat’s advantage was appreciated in facilities with limited prior testing capacity (eg, shipping samples, using microscopy), including short time-to-results, reduced need to return to provide more samples and fewer infrastructure needs (compared with GeneXpert). People with presumptive TB preferred the same-day results and rapid initiation of treatment enabled by Truenat testing. Some viewed waiting longer time (>1 day) for the results acceptable if it were to result in increased accuracy. Regarding the diagnostic process, participants valued the support and counselling from the healthcare workers.Conclusions The Truenat platform and TB assays were perceived as easy to use by health providers, and as acceptable and feasible across stakeholder groups. Its implementation in decentralised settings was considered a preferred alternative to off-site Xpert testing for TB in Mozambique and Tanzania.Trial registration number NCT04568954.",
  "authors": [
    {
      "affiliations": [
        "Department of Infectious Disease and Tropical Medicine, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany",
        "Partner Site Heidelberg, German Center for Infection Research (DZIF), Heidelberg, Germany"
      ],
      "name": "Maria del Mar Castro"
    },
    {
      "affiliations": [
        "Instituto Nacional de Saúde, Marracuene, Mozambique"
      ],
      "name": "Celso Khosa"
    },
    {
      "affiliations": [
        "Ifakara Health Institute, Ifakara, Tanzania"
      ],
      "name": "Grace Mhalu"
    },
    {
      "affiliations": [
        "Mbeya Medical Research Centre (MMRC), National Institute for Medical Research, Dar es Salaam, Tanzania"
      ],
      "name": "Lonze Ndelwa"
    },
    {
      "affiliations": [
        "Mbeya Medical Research Centre (MMRC), National Institute for Medical Research, Dar es Salaam, Tanzania"
      ],
      "name": "Simeon Mwanyonga"
    },
    {
      "affiliations": [
        "Ifakara Health Institute, Ifakara, Tanzania"
      ],
      "name": "Thresphory Zumba"
    },
    {
      "affiliations": [
        "Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique"
      ],
      "name": "Délio Elísio"
    },
    {
      "affiliations": [
        "Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique"
      ],
      "name": "Katia Magul"
    },
    {
      "affiliations": [
        "Instituto Nacional de Saúde, Marracuene, Mozambique"
      ],
      "name": "Yolanda Manganhe"
    },
    {
      "affiliations": [
        "Instituto Nacional de Saúde, Marracuene, Mozambique"
      ],
      "name": "Antonio Machiana"
    },
    {
      "affiliations": [
        "Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique"
      ],
      "name": "Marta Cossa"
    },
    {
      "affiliations": [
        "Mbeya Medical Research Centre (MMRC), National Institute for Medical Research, Dar es Salaam, Tanzania"
      ],
      "name": "Raphael Edom"
    },
    {
      "affiliations": [
        "Ifakara Health Institute, Ifakara, Tanzania"
      ],
      "name": "Jerry Hella"
    },
    {
      "affiliations": [
        "Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique",
        "University of Amsterdam, Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands"
      ],
      "name": "Dinis Nguenha"
    },
    {
      "affiliations": [
        "FIND, Geneva, Switzerland"
      ],
      "name": "Morten Ruhwald"
    },
    {
      "affiliations": [
        "FIND, Geneva, Switzerland"
      ],
      "name": "Vinzeigh Leukes"
    },
    {
      "affiliations": [
        "FIND, Geneva, Switzerland"
      ],
      "name": "Adam Penn-Nicholson"
    },
    {
      "affiliations": [
        "Institute of Infectious Diseases and Tropical Medicine,LMU University Hospital, LMU Munich, Munich, Germany"
      ],
      "name": "Katharina Kranzer"
    },
    {
      "affiliations": [
        "Department of Infectious Disease and Tropical Medicine, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany",
        "Partner Site Heidelberg, German Center for Infection Research (DZIF), Heidelberg, Germany"
      ],
      "name": "Claudia M Denkinger"
    },
    {
      "affiliations": [],
      "name": "TB-CAPT Consortium"
    }
  ],
  "title": "User perspectives on the Molbio Truenat platform and tuberculosis assays for decentralised testing in Mozambique and Tanzania",
  "uid": "96046981-ba61-534d-b5be-1d934d5f6c43"
}