Perceived usability, acceptability, and feasibility of stool-based qPCR TB diagnostics: perspectives from healthcare providers in Manhiça District, southern Mozambique

Abstract

Background

Stool-based qPCR TB diagnostics (S-qPCR TBD) are reported to contribute to increased rates of bacteriological confirmation in children and people living with HIV. However, there is still limited literature on the usability, acceptability, and feasibility of S-qPCR TBD in countries with high TB burden. This study aimed to assess healthcare providers’ perspectives on usability and perceived barriers and facilitators to the uptake of S-qPCR TBD.

Methods

This generic qualitative study was conducted across five health facilities and four communities within the Manhiça District (Mozambique). Twenty-one semi-structured interviews combined with direct observations were conducted with HPs from February 2022 to March 2023. The interviews were transcribed, coded using an Excel matrix, and analyzed using the Diffusion of Innovation theory and the socioecological framework.

Results

The findings suggest that HPs view S-qPCR TBD as easy to perform and beneficial for patients who struggle with sputum production. Intrapersonal factors, such as prior experiences with biological sampling procedures, traumatic experiences with invasive procedures, and understanding of clinical outcomes, are crucial factors positively influencing acceptability. Institutional factors, namely, the clarity of information about S-qPCR TBD, and community factors, such as collaboration between community leaders and health services to facilitate patient referral, were also identified as critical. Societal factors, such as the definition of national guidelines, also play a role. However, potential barriers were identified. These include intrapersonal factors like level of education, employment, distance to health facilities, lack of experience with Stool-based Procedures, and misconceptions about and fears of handling stools. Institutional challenges, such as a lack of clear explanation of the technique, as well as resources and training, delays in consumable replenishment, and machine breakdowns, could also hinder acceptance. Local beliefs about TB transmission also play a role as community-level factors.

Conclusions

While HPs consider S-qPCR TBD as beneficial and easy to perform, acceptability may be compromised by factors such as patients’ characteristics, health services challenges, lack of awareness about the S-qPCR TBD, and misconceptions about stool samples and TB. To promote acceptability, the study suggests disseminating information about TB and S-qPCR TBD, improving trust in health services, and fostering collaboration between the health sector and community actors.