Abstract

In northwest Tanzania, many artisanal small-scale miners (ASMs) and female sex workers (FSWs) live in informal communities surrounding mines where tuberculosis (TB) is highly prevalent. An active case finding (ACF) intervention to increase TB case notification was undertaken in two districts. Alongside this, a study was implemented to understand engagement with the intervention through: (1) quantitative questionnaires to 128 ASMs and FSWs, who either engaged or did not engage in the ACF intervention, to assess their views on TB; (2) qualitative interviews with 41 ASMs and FSWs, 36 community health workers (CHWs) and 30 community stakeholders. The mean perceived severity of TB score was higher in the engaged than in the non-engaged group (p = 0.01). Thematic analysis showed that health-seeking behaviour was similar across both groups but that individuals in the non-engaged group were more reluctant to give sputum samples, often because they did not understand the purpose. CHWs feared contracting TB on the job, and many noted that mining areas were difficult to access without transportation. Community stakeholders provided various recommendations to increase engagement. This study highlights reasons for engagement with a large-scale ACF intervention targeting key populations and presents insights from implementers and stakeholders on the implementation of the intervention.

Highlights

  • Drillers and stone crushers were significantly more likely to be in the engaged group than female sex workers (FSWs) (OR= 2.24; p = 0.05 and Odds ratios (OR) = 4.98; p = 0.003, respectively)

  • Participants earning more than 2000 Tanzanian shillings a day were significantly less likely to be in the engaged group than those earning less than 2000

  • Our study investigated the reasons for engagement and lack thereof in active case finding (ACF) interventions by artisanal small-scale miners (ASMs) and FSWs

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Summary

Introduction

Affecting over 10 million individuals every year, tuberculosis (TB) is one of the leading causes of death worldwide [1]. In 2019, there were 2.9 million individuals who were not reported to national TB programs (NTPs), referred to as the “missing millions” [1]. The United Republic of Tanzania, hereafter Tanzania, estimated that of the 137,000 individuals who fell ill with TB, 55,800 (41%) were not reported to the NTP [2]. Tanzania has a high burden of people living with both TB and human immunodeficiency virus (HIV), with an estimated 17% of the global 3.5 million individuals with TB/HIV living within its borders [1].

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