Countrywide roll-out of Xpert® MTB/RIF in Swaziland: The first three years of implementation

Setting: All 19 public health laboratories in Swaziland that had Xpert® MTB/RIF machines installed as part of a countrywide roll-out between June 2011 and June 2014. Objective: To evaluate the utilisation and functionality of Xpert from 2011 to mid-2014. Design: Descriptive study of Xpert implementation using routinely collected data. Results: Of 48 829 Xpert tests conducted, 93% were successful: 14% detected Mycobacterium tuberculosis and 12% showed rifampicin resistance. The most common cause of unsuccessful tests was an ‘Error’ result (62%). Similar findings were obtained in government-supported and partner-supported laboratories. Annual utilisation of Xpert improved from 51% of maximum capacity in 2011 and 2012 to 74% in 2013 and 2014. A monitoring and supervision exercise of all Xpert testing sites in 2014 showed a generally good performance, with over 50% of laboratories achieving a 80% score on most components. However, poor scores were obtained with equipment use and maintenance (6% achieving a score of 80%), internal audit (19% achieving a score of 80%) and process control (25% achieving a score of 80%). Conclusion: Countrywide roll-out of Xpert in Swaziland has been successful, although operational issues have been identified and need to be resolved.