Evidence map›Paper›PMID 40967658›Full record

SynthesisBMJ global health2025

Implementation strategies to increase the uptake and impact of molecular WHO-recommended rapid diagnostic tests: evidence from a mixed-methods systematic review.

Ruvandhi R Nathavitharana, Abarna Pearl, Matthew O'Bryan, Matthew Edwards, Helene-Mari van der Westhuizen, Bruna Voldman, Advaith Subramanian, Naveed Delrooz, Omolayo Anjorin, Amanda Biewer and 5 more

Abstract readSystematic Review
In one paragraph

Synthesis in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Ruvandhi R NathavitharanaHarvard Medical School, Boston, Massachusetts, USA rnathavi@bidmc.harvard.edu.ORCID 0000-0002-3544-5021
Abarna Pearl *Harvard Medical School, Boston, Massachusetts, USA.
Matthew O'Bryan *Harvard School of Public Health, Boston, Massachusetts, USA.
Matthew EdwardsCase Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Helene-Mari van der WesthuizenPrimary Care Health Sciences, Oxford University, Oxford, UK.
Bruna VoldmanTechnion's American Medical School, Haifa, Israel.
Advaith SubramanianTulane University, New Orleans, Louisiana, USA.
Naveed DelroozTulane University, New Orleans, Louisiana, USA.
Omolayo AnjorinGeorge Mason University, Fairfax, Virginia, USA.
Amanda BiewerHarvard Medical School, Boston, Massachusetts, USA.
Carl-Michael NathansonWorld Health Organization, Geneva, Switzerland.
Nora EngelMaastricht University, Maastricht, The Netherlands.
Nazir Ismail *World Health Organization, Geneva, Switzerland.
Andrew McDowell *Tulane University, New Orleans, Louisiana, USA.
Karen Steingart *Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.

Funding

THWART-TB : Testing Health Workers At Risk to advance our understanding of TB infectionDP2AI176896 · NIAID · BETH ISRAEL DEACONESS MEDICAL CENTER · PI Ruvandhi Nathavitharana · 2023 to 2026
$1.6M
Optimizing Diagnostic Strategies for TB Transmission Control in Health-Care FacilitiesK23AI132648 · NIAID · BETH ISRAEL DEACONESS MEDICAL CENTER · PI NATHAVITHARANA, RUVANDHI · 2018 to 2022
$945k
NIAID NIH HHS DP2 AI176896NIAID NIH HHS K23 AI132648World Health Organization 001
6 · The paper itself

Abstract

introductionFewer than 50% of people with tuberculosis receive a molecular WHO-recommended rapid diagnostic test (mWRD). We performed a mixed-methods systematic review to categorise barriers and enablers that affect mWRD use and impact and evaluate mWRD implementation strategies. Parts of this review informed the WHO standard: Universal Access to Tuberculosis Diagnostics.

methodsWe searched multiple databases without language restrictions until 29 July 2022. We included studies that used qualitative, quantitative or mixed methods study designs. Four reviewers independently screened studies and extracted data. We categorised studies as thick or thin depending on whether authors analysed findings beyond a descriptive list of barriers or enablers and demonstrated insights into participants' perspectives. We appraised study quality by adapting the Standards for Reporting Implementation Studies statement. We synthesised data using a thematic approach and used GRADE-CERQual to assess confidence in the findings.

resultsWe identified 54 high-thickness studies from 18 countries, including public and private healthcare settings. Implementation strategies included engaging patients, training and supporting clinicians, building infrastructure and interactive assistance. Examples included remote outreach programmes, community testing, longitudinal clinician engagement, auxiliary workers, multicomponent strategies, performance feedback, improving health information management to strengthen care linkage and diagnostic network improvement. We had high or moderate confidence in our findings.

conclusionInnovative and contextually relevant implementation strategies are needed for tuberculosis programmes to realise the benefits of improved accuracy and diagnostic expediency that mWRDs offer. Multicomponent strategies that centre equity and longitudinal health worker training across the diagnostic cascade must be prioritised.

Indexed as

Diagnostic Tests, RoutineMolecular Diagnostic TechniquesTuberculosisHumansRapid Diagnostic TestsWorld Health OrganizationDiagnostics and toolsTuberculosis

Identifiers

PMID40967658
PMCPMC12458786

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.