Uptake and rollout of the World Health Organization-endorsed technologies for Tuberculosis diagnosis in Africa: A systematic review of international evidence 2007-2021

The World Health Organization (WHO) has endorsed a range of diagnostic technologies for tuberculosis (TB) over the years, and at least one new endorsement is issued every year. However, little is documented about the uptake status in the WHO African Region (WHO/FR). We assessed the status of uptake of the WHO-endorsed TB diagnostics through a systematic review.

Methods

We conducted a systematic review of the peer-reviewed literature in French or English using PubMed, Google Scholar, and Embase for TB diagnostics endorsed by WHO between January 2007 and December 2017. We considered an extra period until December 2021 for the uptake and roll-out of the recently endorsed technologies and considered publications from the 47 countries in the WHO/AFR. We considered uptake as the use of the test in the country at any level and roll-out of the test as it is being used in the settings in which WHO endorsed for it. A summary number of articles was kept using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagrams (PRISMA) and the study protocol was registered with ISRCTN database. We used qualitative synthesis and quantitative data analysis by STATA version 14.0.

Results

We recorded 3,399 articles searched in peer-reviewed databases, then we eliminated 1683 duplicates and finally kept 1,716 articles for screening and 92 articles qualified for analysis. For the uptake, out of 47 countries, the majority of articles were for Xpert MTB/RIF (XPERT) test 22 (47%), followed by Line Probe Assay (LPA), 10 (21%), and the Mycobacteria Growth Indicator Tube (MGIT) 9 (19%). For the rollout, 11 (24%) countries and 16 (36%) had publications on Lipoarabinomannan (LAM) and XPERT test use respectively. The median years (Interquartile Range: IQR) for uptake were 6 (3.2 - 7.9), 5 (2.5 - 6.5), and 2.5 (3.2 - 7.9) for MGIT, XPERT, and LPA respectively, and lower for other tests. For the rollout, the median years for MGIT, LPA, and XPERT were 7 (3 – 7), 6 (1.6 - 9.4), and 5 (4 - 7) respectively, and lower for other tests.

Conclusion

Our study shows that the uptake and rollout of TB diagnostic technologies upon the endorsement by WHO among WHO AFR countries is slow. Future studies are needed to document the key factors affecting rapid uptake and rollout. Strategies to document a rapid guide to inform rapid uptake and roll-out as well as best practices are highly recommended.