Abstract
BackgroundTuberculosis (TB) care cascade analyses show large gaps at early stages, including care-seeking and diagnostic evaluation, where promising interventions to decrease attrition are urgently needed. Person-centered care is prioritized in the World Health Organization’s End TB strategy; yet little is known about how it is delivered and can be optimized. Recommendations for counselling, a core component of person-centered care, are largely limited to its role in improving TB treatment adherence. The role of counselling to close key diagnostic gaps in the care cascade is poorly understood.MethodsWe conducted a scoping review to identify evidence on the use of counselling at TB diagnosis, for both people with presumptive TB and index patients to promote patient retention and contact tracing. Using search terms for TB, diagnosis and counselling, we systematically searched PubMed, EMBASE and Web of Science. Two independent reviewers screened all abstracts, full-texts, extracted data and conducted a quality assessment. We used thematic analysis to identify key themes.ResultsAfter screening 1785 articles, we extracted data from 15 studies and determined that the major themes best corresponded to the following gaps in the TB care cascade: care-seeking, pre-diagnosis, and pre-treatment. Studies were conducted across varied settings including pharmacies, primary health centres, and clinics, primarily in high TB incidence countries. No study directly evaluated the impact of counselling on outcomes such as treatment initiation or retention in care. Included studies suggested counselling may play an important role in improving the uptake of diagnostic testing and contact tracing. Barriers to counselling included time and personnel requirements. Stakeholder consultation emphasized the importance of high-quality counselling as a core tenet of TB care.ConclusionData on the impact of counselling to improve TB case detection are absent from the literature. The shift towards person-centred care for TB presents an opportunity to incorporate counselling during earlier stages of the TB care cascade; however, evidence-based approaches are needed. Implementation research is needed to operationalize and evaluate counselling to strengthen high-quality TB care delivery.
Highlights
Tuberculosis (TB) care cascade analyses show large gaps at early stages, including care-seeking and diagnostic evaluation, where promising interventions to decrease attrition are urgently needed
Phase 5: collation and summary of findings We explored the role of counselling at different diagnostic stages of the TB care cascade which patients may initiate through one of two pathways: patient-initiated and provider-initiated (Fig. 1)
The majority of studies (n = 13) focused on drug-sensitive TB (DS-TB), aside from two studies that focused on people with drug-resistant TB (DR-TB)
Summary
Tuberculosis (TB) care cascade analyses show large gaps at early stages, including care-seeking and diagnostic evaluation, where promising interventions to decrease attrition are urgently needed. Cascade of care analyses based on national program data from high burden countries show that TB care delivery is greatly impeded by three ‘gaps’ [6, 7]; (1) the care seeking gap – the period during which patients or their contacts may be infectious but have not been evaluated; (2) the pre-diagnostic gap – whereby patients have been tested but not yet diagnosed; and (3) the pre-treatment gap – patients have received a positive TB diagnosis but have not been registered for treatment. There is an urgent need to identify promising interventions that decrease patient attrition during early stages of the cascade [9]
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