User perspectives on the Molbio Truenat platform and Tuberculosis assays for decentralized testing in Mozambique and Tanzania

BackgroundTimely and appropriate diagnosis and treatment are key to end tuberculosis (TB). Incorporating users preferences when implementing decentralized strategies for diagnosis may facilitate scale-up and impact. This qualitative study embedded within a cluster randomized controlled trial explored the values and preferences of multiple stakeholders regarding a TB diagnostic strategy using the Truenat platform, MTB Plus and RIF Dx Assays in Mozambique and Tanzania. MethodsWe conducted semi-structured interviews with people with presumptive TB (n=34), professional users (laboratory technicians, nurses, clinicians, n=19) and national decision makers (n=5). Direct observations of testing procedures and usability surveys were also conducted. Thematic analysis was performed, informed by the Consolidated Framework for Implementation Research. ResultsFacilities 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 workers, 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. Truenats advantage was appreciated in facilities with limited prior testing capacity (e.g., shipping samples, using microscopy), including short time-to-results, reduced need to return to provide more samples and fewer infrastructure needs (compared to GeneXpert). People with presumptive TB preferred the same-day results and rapid initiation of treatment enabled by Truenat testing. Some viewed waiting longer time (>1day) for the results acceptable if it were to result in increased accuracy. Regarding the diagnostic process, participants valued the support and counseling from the healthcare workers. ConclusionsThe Truenat platform and TB assays were perceived as easy to use by health providers, and their implementation in decentralized settings was viewed as an acceptable, feasible and preferred alternative to off-site Xpert testing for TB in Mozambique and Tanzania.