Abstract
Active case-finding (ACF), also referred to as community-based tuberculosis screening, is a component of the World Health Organization's End TB Strategy. ACF has potential benefits but also harms, which need to be carefully assessed when developing and implementing ACF policies. While empirical evidence on the benefits of ACF is still weak, evidence on the harms is even weaker. This study aimed to explore experts' views on the benefits and harms of ACF for people with presumptive TB and communities. This was an exploratory study. Semi-structured interviews were conducted with a purposive sample of 39 experts from international, non-governmental/non-profit organizations, funders, government institutions, international societies, think tanks, universities and research institutions worldwide. Framework analysis was applied. Findings elaborated perceived benefits of ACF, including reaching vulnerable populations, reducing patient costs, helping raise awareness for tuberculosis among individuals and engaging communities, and reducing tuberculosis transmission. Perceived harms included increasing stigma and discrimination, causing false-positive diagnoses, as well as triggering other unintended consequences related to screening for tuberculosis patients, such as deportation of migrants once confirmed to have tuberculosis. Most of the perceived benefits of ACF could be linked to its objective of finding and treating persons with tuberculosis early (theme 1), while ACF was also perceived as a "double-edged sword" and could cause harms, if inappropriately designed and implemented (theme 2). The analysis underlined the importance of considering the benefits and harms of ACF throughout the screening pathway. The study provides new insights into the perceived benefits and harms of ACF from the perspectives of experts in the field. This study highlights gaps in the evidence base surrounding ACF and can stimulate further research, debate and analysis regarding the benefits and harms of ACF to inform contextual optimization of design and implementation of ACF strategies.
Highlights
Tuberculosis (TB) remains the world’s leading infectious disease killer, even though it is curable and preventable [1]
Perceived harms included increasing stigma and discrimination, causing false-positive diagnoses, as well as triggering other unintended consequences related to screening for tuberculosis patients, such as deportation of migrants once confirmed to have tuberculosis
Most of the perceived benefits of Active case-finding (ACF) could be linked to its objective of finding and treating persons with tuberculosis early
Summary
Tuberculosis (TB) remains the world’s leading infectious disease killer, even though it is curable and preventable [1]. -called “passive case-finding” has previously been the principal approach to TB case-finding [2]. It relies on people with signs and symptoms of TB seeking care. This approach is inadequate to ensure early diagnosis and treatment of all people with TB [3] and several reviews have shown that a large pool of TB patients remains undetected despite efforts to improve passive case-finding [4,5,6,7,8]. This study aimed to explore experts’ views on the benefits and harms of ACF for people with presumptive TB and communities
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