Community-based active-case finding for tuberculosis: navigating a complex minefield
Abstract Community-based active case finding (ACF) for tuberculosis (TB) involves an offer of screening to populations at risk of TB, oftentimes with additional health promotion, community engagement and health service strengthening. Recently updated World Health Organization TB screening guidelines...
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Global and Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s44263-024-00042-9 |
| _version_ | 1797272751871885312 |
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| author | Peter MacPherson Kwame Shanaube Mphatso D. Phiri Hannah M. Rickman Katherine C. Horton Helena R. A. Feasey Elizabeth L. Corbett Rachael M. Burke Molebogeng X. Rangaka |
| author_facet | Peter MacPherson Kwame Shanaube Mphatso D. Phiri Hannah M. Rickman Katherine C. Horton Helena R. A. Feasey Elizabeth L. Corbett Rachael M. Burke Molebogeng X. Rangaka |
| author_sort | Peter MacPherson |
| collection | DOAJ |
| description | Abstract Community-based active case finding (ACF) for tuberculosis (TB) involves an offer of screening to populations at risk of TB, oftentimes with additional health promotion, community engagement and health service strengthening. Recently updated World Health Organization TB screening guidelines conditionally recommend expanded offer of ACF for communities where the prevalence of undiagnosed pulmonary TB is greater than 0.5% among adults, or with other structural risk factors for TB. Subclinical TB is thought to be a major contributor to TB transmission, and ACF, particularly with chest X-ray screening, could lead to earlier diagnosis. However, the evidence base for the population-level impact of ACF is mixed, with effectiveness likely highly dependent on the screening approach used, the intensity with which ACF is delivered, and the success of community- and health-system participation. With recent changes in TB epidemiology due to the effective scale-up of treatment for HIV in Africa, the impacts of the COVID-19 pandemic, and the importance of subclinical TB, researchers and public health practitioners planning to implement ACF programmes must carefully and repeatedly consider the potential population and individual benefits and harms from these programmes. Here we synthesise evidence and experience from implementing ACF programmes to provide practical guidance, focusing on the selection of populations, screening algorithms, selecting outcomes, and monitoring and evaluation. With careful planning and substantial investment, community-based ACF for TB can be an impactful approach to accelerating progress towards elimination of TB in high-burden countries. However, ACF cannot and should not be a substitute for equitable access to responsive, affordable, accessible primary care services for all. |
| first_indexed | 2024-03-07T14:33:50Z |
| format | Article |
| id | doaj.art-4618da6b3ebc470cbab20a58aad0ae1a |
| institution | Directory Open Access Journal |
| issn | 2731-913X |
| language | English |
| last_indexed | 2024-03-07T14:33:50Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Global and Public Health |
| spelling | doaj.art-4618da6b3ebc470cbab20a58aad0ae1a2024-03-05T20:46:01ZengBMCBMC Global and Public Health2731-913X2024-02-012111410.1186/s44263-024-00042-9Community-based active-case finding for tuberculosis: navigating a complex minefieldPeter MacPherson0Kwame Shanaube1Mphatso D. Phiri2Hannah M. Rickman3Katherine C. Horton4Helena R. A. Feasey5Elizabeth L. Corbett6Rachael M. Burke7Molebogeng X. Rangaka8School of Health and Wellbeing, University of GlasgowZAMBART, University of ZambiaMalawi-Liverpool-Wellcome ProgrammeClinical Research Department, London School of Hygiene & Tropical MedicineDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical MedicineClinical Research Department, London School of Hygiene & Tropical MedicineClinical Research Department, London School of Hygiene & Tropical MedicineClinical Research Department, London School of Hygiene & Tropical MedicineCIDRI-Africa, University of Cape TownAbstract Community-based active case finding (ACF) for tuberculosis (TB) involves an offer of screening to populations at risk of TB, oftentimes with additional health promotion, community engagement and health service strengthening. Recently updated World Health Organization TB screening guidelines conditionally recommend expanded offer of ACF for communities where the prevalence of undiagnosed pulmonary TB is greater than 0.5% among adults, or with other structural risk factors for TB. Subclinical TB is thought to be a major contributor to TB transmission, and ACF, particularly with chest X-ray screening, could lead to earlier diagnosis. However, the evidence base for the population-level impact of ACF is mixed, with effectiveness likely highly dependent on the screening approach used, the intensity with which ACF is delivered, and the success of community- and health-system participation. With recent changes in TB epidemiology due to the effective scale-up of treatment for HIV in Africa, the impacts of the COVID-19 pandemic, and the importance of subclinical TB, researchers and public health practitioners planning to implement ACF programmes must carefully and repeatedly consider the potential population and individual benefits and harms from these programmes. Here we synthesise evidence and experience from implementing ACF programmes to provide practical guidance, focusing on the selection of populations, screening algorithms, selecting outcomes, and monitoring and evaluation. With careful planning and substantial investment, community-based ACF for TB can be an impactful approach to accelerating progress towards elimination of TB in high-burden countries. However, ACF cannot and should not be a substitute for equitable access to responsive, affordable, accessible primary care services for all.https://doi.org/10.1186/s44263-024-00042-9TuberculosisScreeningCommunityPublic healthHIV |
| spellingShingle | Peter MacPherson Kwame Shanaube Mphatso D. Phiri Hannah M. Rickman Katherine C. Horton Helena R. A. Feasey Elizabeth L. Corbett Rachael M. Burke Molebogeng X. Rangaka Community-based active-case finding for tuberculosis: navigating a complex minefield BMC Global and Public Health Tuberculosis Screening Community Public health HIV |
| title | Community-based active-case finding for tuberculosis: navigating a complex minefield |
| title_full | Community-based active-case finding for tuberculosis: navigating a complex minefield |
| title_fullStr | Community-based active-case finding for tuberculosis: navigating a complex minefield |
| title_full_unstemmed | Community-based active-case finding for tuberculosis: navigating a complex minefield |
| title_short | Community-based active-case finding for tuberculosis: navigating a complex minefield |
| title_sort | community based active case finding for tuberculosis navigating a complex minefield |
| topic | Tuberculosis Screening Community Public health HIV |
| url | https://doi.org/10.1186/s44263-024-00042-9 |
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