Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis

Abstract

Background Active case finding (ACF) refers to the systematic identification of people with tuberculosis in communities and amongst populations who do not present to health facilities, through approaches such as door‐to‐door screening or contact tracing. ACF may improve access to tuberculosis diagnosis and treatment for the poor and for people remote from diagnostic and treatment facilities. As a result, ACF may also reduce onward transmission. However, there is a need to understand how these programmes are experienced by communities in order to design appropriate services. Objectives To synthesize community views on tuberculosis active case finding (ACF) programmes in low‐ and middle‐income countries. Search methods We searched MEDLINE, Embase, and eight other databases up to 22 June 2023, together with reference checking, citation searching, and contact with study authors to identify additional studies. We did not include grey literature. Selection criteria This review synthesized qualitative research and mixed‐methods studies with separate qualitative data. Eligible studies explored community experiences, perceptions, or attitudes towards ACF programmes for tuberculosis in any endemic low‐ or middle‐income country, with no time restrictions. Data collection and analysis Due to the large volume of studies identified, we chose to sample studies that had 'thick' description and that investigated key subgroups of children and refugees. We followed standard Cochrane methods for study description and appraisal of methodological limitations. We conducted thematic synthesis and developed codes inductively using ATLAS.ti software. We examined codes for underlying ideas, connections, and interpretations and, from this, generated analytical themes. We assessed the confidence in the findings using the GRADE‐CERQual approach, and produced a conceptual model to display how the different findings interact. Main results We included 45 studies in this synthesis, and sampled 20. The studies covered a broad range of World Health Organization (WHO) regions (Africa, South‐East Asia, Eastern Mediterranean, and the Americas) and explored the views and experiences of community members, community health workers, and clinical staff in low‐ and middle‐income countries endemic for tuberculosis. The following five themes emerged. • ACF improves access to diagnosis for many, but does little to help communities on the edge. Tuberculosis ACF and contact tracing improve access to health services for people with worse health and fewer resources (High confidence). ACF helps to find this population, exposed to deprived living conditions, but is not sensitive to additional dimensions of their plight (High confidence) and out‐of‐pocket costs necessary to continue care (High confidence). Finally, migration and difficult geography further reduc...

Impact of active case finding for tuberculosis with mass chest X-ray screening in Glasgow, Scotland, 1950-1963: an epidemiological analysis of historical data

“…Critically important to achieving high population coverage of tuberculosis screening was a programme of mass community engagement and mobilisation, supported by more than 12,000 volunteers. A recent qualitative synthesis of the community views of participating in ACF programmes emphasises that local ownership and leadership, ongoing support for people screened, and health systems strengthening to support the increased healthcare demands generated by mass screening are important determinants of intervention success25 ; The Glasgow mass screening campaign exemplified these principles, and we argue that community and health systems support within contemporary ACF programmes are often insuYicient, and delivered in a "top-down" -rather than community-responsive -fashion, likely contributing to lower than anticipated participation and eYectiveness.The post-war period between 1948 and 1960 was a period of tremendous social change, and the 1957 Glasgow mass tuberculosis screening campaign needs to be contextualised alongside progressive improvements in living conditions, healthcare, and tuberculosis care and prevention. In Glasgow, "Slum clearances" commenced in the mid-1950s, particularly in wards in the centre and South of the city such as Camphill, Gorbals, Cowcaddens, and Govan, with new residential schemes established on the peripheries of the city.…”