Active case finding for TB must be paired with effective follow-up care, Cochrane review finds


Door-to-door tuberculosis (TB) screening and contact tracing can improve diagnosis rates, but must be paired with effective follow-up care to be successful, a new Cochrane review has found.

Active case finding (ACF) seeks to improve diagnosis rates in people living in communities who may not otherwise present to health facilities, helping them access treatment and reduce onward transmission.

Despite being a key strategy of most TB strategies globally, there is often little consideration of how these programmes are experienced by communities. This is essential in designing appropriate and effective services.

Published ahead of World TB Day (24 March), a new review published by Cochrane Infectious Diseases, based at Liverpool School of Tropical Medicine, looked at studies of community experiences towards ACF programmes for TB in any endemic low- or middle-income country. This was a qualitative evidence synthesis that looked at the evidence from 45 studies. 

Senior author and Cochrane Infectious Diseases Editor, Professor Sandy Oliver,  said, “The power of qualitative syntheses like these is in their ability to capture rich information from various contexts to develop a deep understanding of how policies play out in the real world – how services deliver them, how communities receive them or avoid them, what might make them work a little better, and why”.

The review authors found that ACF improves access to diagnosis for many, but does little for those in financial need to continue care. People may also experience stigma in relation to screening.

It was also shown that ACF can create expectations for follow-up care that health systems may not be able to meet, as well as health workers finding it difficult to implement.

This Cochrane Review will help to better understand policy in action and the perceived benefit relative to the harm of ACF.

Lead author Melissa Taylor said: “Active case finding brings diagnosis to many of those who may otherwise not have received it. However, our review demonstrates it is essential that active case finding is linked to well-resourced follow up services and wider health system strengthening.”

Community views on active case finding for tuberculosis in low‐ and middle‐income countries: a qualitative evidence synthesis

Taylor M, Medley N, van Wyk SS, Oliver S. Community views on active case finding for tuberculosis in low‐ and middle‐income countries: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014756. DOI: 10.1002/14651858.CD014756.pub2

Thursday, March 21, 2024