An exploration of organizational readiness for scaling up the use of Urine LAM tests in high TB burden districts and peripheral health facilities in Malawi

Zondetsa, John Maseko
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Background: The use of the Urine Lipoarabinomannan (LAM) test was endorsed by the World Health Organization in 2015 and it has been recommended for use in people Living With HIV. Malawi is in the process of scaling up the use of LAM urine tests in low Tuberculosis (TB) burden districts and peripheral health facilities. The scaling up of health interventions has received greater attention; however, there remains a lack of systematic exploration of organizational readiness that is deemed necessary for the scaling-up process. We aim to explore factors associated with organizational readiness for scaling up the LAM tests in high TB burden districts in Malawi Methods: A narrative (in-depth) qualitative study was conducted at the Ministry of Health (MoH) department of HIV and TB, and in seven high TB burden districts. The study used a purposive sampling technique to enroll participants and enrolled twenty-eight participants who were overseeing TB and HIVAIDS programs as aimed to concentrate on participants with the precise information on TB and HIV programs, and readiness scale-up LAM urine tests. Thematic data analysis for qualitative data was conducted using MAXQDA software Results: The study conducted Key Informants Interviews (KII) with participants who had a wide range of expertise in HIV and TB. Twenty-eight participants (comprising of twenty-four males and four female participants, four participants from implementing partners (Non-Governmental Organizations) and twenty-four civil servants, two participants working at the Department of HIV/AIDS(DHA) and National TB Control Program (NTP), five participants from health facilities, and four participants from central referral hospitals and seventeen from the district hospitals). The study demonstrated that the MoH has done quite a remarkable work in preparing for the scaling up of the LAM urine tests. There is various extent of organizational readiness ranging from facility to facility as some facilities have all the necessities for scaling up the LAM urine tests while some facilities are still lagging. The MoH through the DHA and NTP has taken remarkable steps in policy and guidelines formulation and dissemination, capacity building, routinizing the LAM tests in the point of care tests, and stakeholder engagement, and these have created a favorable environment for the readiness of the facilities and enable the scaling-up process to be smooth and well-coordinated. Conclusion: There are varying levels of organizational readiness for scaling up the use of LAM urine tests due to several factors including lack of or inadequate capacity building activities, lack of support from implementing partners, availability of LAM test kits, as well as dissemination of policies and guidelines. The MoH should consider addressing factors related to the graded differences in readiness for scaling up the LAM tests by conducting periodic supportive supervision and refresher training, systematically analyzing the health systems strengths and weaknesses that will strengthen the institutional capacity, strengthen the monitoring and evaluation system, as well as continuing constant collaboration with key stakeholders. Further research studies are essential to evaluate the coverage and effectiveness of strategies to scale up and sustain the use of LAM tests for TB diagnosis.
A research report submitted in partial fulfillment of the requirements for the degree of Master of Science in Epidemiology and Implementation Science to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, 2022