Olivia Biermann1, Raina Klüppelberg1, Knut Lönnroth1, Kerri Viney1,2, Maxine Caws3,4, Salla Atkins1,5. 1. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. 2. Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia. 3. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. 4. Birat Nepal Medical Trust, Lazimpat, Kathmandu, Nepal. 5. New Social Research and Global Health and Development, Faculty of Social Sciences, Tampere University, Tampere, Finland.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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 tuberculosispatients, 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. CONCLUSION: 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.
Authors: Pablo Alonso-Coello; Holger J Schünemann; Jenny Moberg; Romina Brignardello-Petersen; Elie A Akl; Marina Davoli; Shaun Treweek; Reem A Mustafa; Gabriel Rada; Sarah Rosenbaum; Angela Morelli; Gordon H Guyatt; Andrew D Oxman Journal: BMJ Date: 2016-06-28
Authors: Christian von Wagner; Gianluca Baio; Rosalind Raine; Julia Snowball; Stephen Morris; Wendy Atkin; Austin Obichere; Graham Handley; Richard F Logan; Sandra Rainbow; Stephen Smith; Stephen Halloran; Jane Wardle Journal: Int J Epidemiol Date: 2011-02-17 Impact factor: 7.196