Predisposing, enabling, and need factors influencing rapid uptake of the world health organization-endorsed TB diagnostic technologies in Africa

Background Rapid tuberculosis (TB) diagnostics are essential for TB control. Factors influencing the uptake of these technologies in Africa are not well-documented for all technologies and are completely undocumented for some countries. We conducted a survey to collect the status and document Predisposing, Enabling, and Need (PEN) factors influencing uptake so that we understand the associated barriers and inform interventions to improve the uptake. Methods We designed, piloted, and distributed a survey questionnaire in January 2023 to the National TB Programme (NTP) and National TB Reference Laboratory (NTRL) managers as well as key partners of the Ministry of Health in the 47 Member States of the World Health Organization African Region (WHO/AFR). Responses were accepted until July 2023. We performed quantitative data analysis using STATA version 14.0. Results From the 47 eligible countries, 22 responses (47%) were received from the NTRL managers, 17 (36%) from Technical Assistants (TAs) for NTRL and NTP, and 8 (17%) from the NTP managers. Our findings showed that it took between two to nine years from the endorsement of a new technology to its full implementation, with the duration increasing with the complexity of the test. Laboratory preparedness, staff competence, and policy reform were the main predisposing factors; availability of funds was the primary enabling factor, whereas the emergence of MDR-TB was the key need factor. Good governance and political commitment aligned with the existence of the Directorate of Laboratory Services and the NTRL, were crucial facilitators driving the adoption, adaptation, and implementation. Conclusion Our findings demonstrated that the uptake of TB diagnostics in Africa is slow. Considering the laboratory preparedness, staff competence, policy reform, availability of funds, and the emergence of MDR-TB as the main PEN factors identified could help speed up the uptake and rapid implementation of any new technology.