Health service perceptions about implementation of a new TB diagnostic in Northern Russia: a qualitative study

Setting: Many tuberculosis services are implementing new diagnostics to accelerate treatment initiation for multidrug-resistant tuberculosis. Successful implementation and uptake are likely to depend on many factors. Objective: To describe the perceptions of the Arkhangelsk health services staff in Northern Russia on the process of introducing the line-probe assay and to determine what facilitates the process of uptake into practice. Design: Process evaluation; semi-structured, in-depth interviews with key informants from civil and penitentiary health services; content analysis. Results: A good working relationship between the civil and penitentiary sectors and a tradition of positive collaboration between doctors and managers were integral to success. Uptake and adaptation were facilitated by regular discussions between managers and implementers, flexibility in adapting routines and an iterative approach to improving procedures. It is beneficial to allow all types of health care workers affected by the diagnostic to learn about it and contribute to its integration. A multidisciplinary evaluation can detect problems elsewhere in the care pathway. Bringing about change in workplace mind-sets and attitudes takes time and management. Conclusion: People take time to observe the effects of innovations, assess relative advantages and become convinced, sometimes by different types of evidence. Multi-disciplinary opportunities for learning, reflecting on care pathways and adaptation should all be a part of introducing new diagnostics.