Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

Biermann, Olivia; Lönnroth, Knut; Caws, Maxine; Viney, Kerri

doi:10.1136/bmjopen-2019-031284

Cited by 41 publications

(44 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One root cause is the potentially limited availability of radiography equipment and radiologists. Even if high-quality radiography services are available, their facility-based nature and dependency on opening hours, travel time and associated costs further hinder the integration and use of CXR screening for TB in programmatic settings [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam

Nguyen

Codlin²,

Vo³

et al. 2020

TropicalMed

Self Cite

View full text Add to dashboard Cite

Across Asia, a large proportion of people with tuberculosis (TB) do not report symptoms, have mild symptoms or only experience symptoms for a short duration. These individuals may not seek care at health facilities or may be missed by symptom screening, resulting in sustained TB transmission in the community. We evaluated the yields of TB from 114 days of community-based, mobile chest X-ray (CXR) screening. The yields at each step of the TB screening cascade were tabulated and we compared cohorts of participants who reported having a prolonged cough and those reporting no cough or one of short duration. We estimated the marginal yields of TB using different diagnostic algorithms and calculated the relative diagnostic costs and cost per case for each algorithm. A total of 34,529 participants were screened by CXR, detecting 256 people with Xpert-positive TB. Only 50% of those diagnosed with TB were detected among participants reporting a prolonged cough. The study’s screening algorithm detected almost 4 times as much TB as the National TB Program’s standard diagnostic algorithm. Community-based, mobile chest X-ray screening can be a high yielding strategy which is able to identify people with TB who would likely otherwise have been missed by existing health services.

show abstract

Section: Introductionmentioning

confidence: 99%

An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam

Nguyen

Codlin²,

Vo³

et al. 2020

TropicalMed

Self Cite

View full text Add to dashboard Cite

show abstract

“…Many of the described factors influencing ACF policy implementation align with the available evidence in the field. Firstly, ACF policy implementation has been widely studied, as documented by a scoping review [ 17 ] and more recent studies [ 24 , 25 ]. In line with our study, a major barrier for ACF implementation is the lack of human and financial resources [ 26 – 30 ].…”

Section: Discussionmentioning

confidence: 99%

Active case-finding policy development, implementation and scale-up in high-burden countries: A mixed-methods survey with National Tuberculosis Programme managers and document review

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background The World Health Organization (WHO) stresses the importance of active case-finding (ACF) for early detection of tuberculosis (TB), especially in the 30 high-burden countries that account for almost 90% of cases globally. Objective To describe the attitudes of National TB Programme (NTP) managers related to ACF policy development, implementation and scale-up in the 30 high-burden countries, and to review national TB strategic plans. Methods This was a mixed-methods study with an embedded design: A cross-sectional survey with NTP managers yielded quantitative and qualitative data. A review of national TB strategic plans complemented the results. All data were analyzed in parallel and merged in the interpretation of the findings. Results 23 of the 30 NTP managers (77%) participated in the survey and 22 (73%) national TB strategic plans were reviewed. NTP managers considered managers in districts and regions key stakeholders for both ACF policy development and implementation. Different types of evidence were used to inform ACF policy, while there was a particular demand for local evidence. The NSPs reflected the NTP managers’ unanimous agreement on the need for ACF scale-up, but not all included explicit aims and targets related to ACF. The NTP managers recognized that ACF may decrease health systems costs in the long-term, while acknowledging the risk for increased health system costs in the short-term. About 90% of the NTP managers declared that financial and human resources were currently lacking, while they also elaborated on strategies to overcome resource constraints. Conclusion NTP managers stated that ACF should be scaled up but reported resource constraints. Strategies to increase resources exist but may not yet have been fully implemented, e.g. generating local evidence including from operational research for advocacy. Managers in districts and regions were identified as key stakeholders whose involvement could help improve ACF policy development, implementation and scale-up.

show abstract

“…While the available evidence in this area often focuses on ACF policy implementation, 51 this study fills important knowledge gaps by identifying factors influencing ACF policy development and characterising evidence use in ACF policy development and implementation, from the perspective of experts in the field. Moreover, this study offers an increased understanding of donor organisations' influence on ACF policy processes.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

‘Power plays plus push’: experts’ insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study

et al. 2020

Self Cite

View full text Add to dashboard Cite

ObjectiveTo explore experts’ views on factors influencing national and global active case-finding (ACF) policy development and implementation, and the use of evidence in these processes.DesignThis is an exploratory study based on semistructured expert interviews. Framework analysis was applied.ParticipantsThe study involved a purposive sample of 39 experts from international, non-governmental and non-profit organisations, funders, government institutions, international societies, think tanks, universities and research institutions worldwide.ResultsThis study highlighted the perceived need among experts for different types of evidence for ACF policy development and implementation, and for stakeholder engagement including researchers and policymakers to foster evidence use. Interviewees stressed the influence of government, donor and non-governmental stakeholders in ACF policy development. Such key stakeholders also influence ACF policy implementation, in addition to available systems and processes in a given health system, and implementers’ motivation and incentives. According to the interviewees, the World Health Organization (WHO) guidelines for systematic screening face the innate challenge of providing guidance to countries across the broad area of ACF in terms of target groups, settings and screening algorithms. The guidelines could be improved by focusing on what should be done rather than what can be done in ACF, and by providing howto examples. Leadership, integration into health systems and long-term financing are key for ACF to be sustainable.ConclusionsWe provide new insights into ACF policy processes globally, particularly regarding facilitators for and barriers to ACF policy development, evidence need and use, and donor organisations’ influence. According to expert participants, national and global ACF policy development and implementation can be improved by broadening stakeholder engagement. Meanwhile, using diverse evidence to inform ACF policy development and implementation could mitigate the ‘power plays plus push’ that might otherwise disrupt and mislead these policy processes.

show abstract

Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

Cited by 41 publications

References 74 publications

An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam

An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam

Active case-finding policy development, implementation and scale-up in high-burden countries: A mixed-methods survey with National Tuberculosis Programme managers and document review

‘Power plays plus push’: experts’ insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study

Contact Info

Product

Resources

About