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Prerequisites for Xpert MTB/RIF Implementation

Medium 19 items · 30 min
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testuser Published 2 months ago
Health

This checklist summarizes practical steps countries should take before and during rollout of Xpert MTB/RIF testing. It’s written for public health program managers, lab coordinators, and clinicians responsible for implementing rapid TB diagnostics. Inspired by World Health Organization guidelines. Always consult a qualified healthcare professional.

Inspired by World Health Organization (WHO) guidelines. Always consult a qualified healthcare professional where applicable.

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  1. Review national TB burden and testing gaps — Check recent case data and lab coverage to justify Xpert rollout.
  2. Secure government commitment and budget — Obtain formal approval and line items for equipment, cartridges, and operations.
  3. Update national diagnostic policy to include Xpert — Define who gets tested and how Xpert fits with existing algorithms.
  4. Identify priority health facilities and laboratories for rollout — Map high-burden areas and referral networks to choose initial sites.
  5. Verify power supply, lab space, and biosafety needs — Confirm reliable electricity, bench space, and basic biosafety measures.
  6. Plan procurement for machines and consumables — Decide models, quantities, and procurement timelines for devices and cartridges.
  7. Order GeneXpert machines — Place orders with approved suppliers and track delivery timelines.
  8. Order cartridges and laboratory consumables — Forecast initial and buffer stock levels; include shipment lead time.
  9. Arrange maintenance, warranty, and service contracts — Set up local support, spare parts, and a plan for device downtime.
  10. Train laboratory technicians on Xpert operation — Provide hands-on training covering test running, troubleshooting, and QC.
  11. Set up sputum collection, transport, and specimen handling — Define sample containers, labeling, and transport timing/conditions.
  12. Start a quality assurance program and enroll in EQA — Implement internal controls, periodic proficiency testing, and audits.
  13. Integrate Xpert results into national reporting systems — Ensure electronic or paper reporting feeds into surveillance and patient records.
  14. Define testing algorithms and clinical guidelines — Specify indications, confirmatory testing, and links to treatment pathways.
  15. Create a forecasting plan for cartridges and supplies — Use consumption data and buffer stock rules to prevent stockouts.
  16. Implement waste management and cartridge disposal procedures — Set safe disposal protocols for used cartridges and infectious waste.
  17. Set indicators and monitor test volumes, positivity, and errors — Track key metrics regularly to evaluate performance and quality.
  18. Inform clinicians, community workers, and partners about rollout — Share eligibility criteria, expected turnaround times, and referral paths.
  19. Develop a long-term scale-up and sustainability plan — Plan financing, training refreshers, and phased expansion.
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