Operational performance of GeneXpert for tuberculosis diagnosis in West Java province, Indonesia: a public health evaluation.

BACKGROUND

GeneXpert is instrumental in tuberculosis diagnosis. Operational challenges are widely reported, but comprehensive evaluations of its operational performance are rare.

METHODS

We conducted a health facility survey in 40 community health centres with GeneXpert machines in West Java, Indonesia, and interviewed nurses, laboratory technicians, and program officers. We developed indicators and data collection tools using the World Health Organization GeneXpert implementation manual and Consolidated Framework for Implementation Research.

RESULTS

GeneXpert has been implemented across the system with variable success. Several indicators were scored relatively low, which included facilities with Xpert-trained nurses (42%), samples referred from private providers (2%), samples transported in ≤ 1 day (61%), facilities with annual test volumes ≥ 3000 (16%), error rates ≤ 3% (46%), no result rates ≤ 1% (66%), absence of cartridge stockouts (72%) or machine module failure (37%), and annual machine calibration (58%). Barriers spanned multiple domains and layers. At Community Health Centres (CHCs), these included understaffing, geographical constraints, and digital infrastructure. Good communication shared at the stakeholders level and pre-assessments prior to GeneXpert deployment were identified as facilitators to GeneXpert utilisation.

CONCLUSION

The Indonesian TB program has made significant progress in GeneXpert implementation. However, improving GeneXpert utilisation requires multisectoral solutions and underscores the need to address real-world constraints in the design and implementation of new TB diagnostics.