Step 10.1 – Monitor implementation of the diagnostic test
If a new test is implemented, the use of the test should be monitored at the implementation phase and tracked later. For TB infection skin tests – use of materials, number of tests that are not read and number of tests that show positive reactions can be monitored. For IGRAs, the number of tests performed, number of indeterminate results and number with positive results are useful to follow.
The quantity and quality of testing and reporting must be monitored. Staff at sites with an unexpectedly low or high testing or indeterminate rates, or very high frequencies of positive or negative test results, may need additional training and sensitization.
Step 10.2 – Monitor and evaluate the impact of the diagnostic test
The impact of the test on the number of patients starting TPT should be closely followed. As discussed above, the success of a programme to scale up TPT depends on the optimization of all steps of the cascade of care. Impact analyses and in-depth interviews on the perspectives of health care personnel and patients after implementation can also inform policy-makers. Digital tools (described in Area 7 and 9) may be useful to monitor patient-important outcomes (e.g. how many patients complete TPT and any long-term decrease of TB incidence) as well as gaps identified across all previous steps of the cascade of care. The consumption of TPT regimens may be a good indicator of quality testing services.