NDLI: Improving active case finding for tuberculosis in South Africa: informing innovative implementation approaches in the context of the Kharitode trial through formative research

Content Provider	Springer Nature : BioMed Central
Author	Kerrigan, Deanna West, Nora Tudor, Carrie Hanrahan, Colleen F. Lebina, Limakatso Msandiwa, Reginah Mmolawa, Lesego Martinson, Neil Dowdy, David
Abstract	Background Tuberculosis (TB) is the leading infectious killer worldwide, with approximately 1.8 million deaths in 2015. While effective treatment exists, implementation of active case finding (ACF) methods to identify persons with active TB in a timely and cost-effective manner continues to be a major challenge in resource-constrained settings. Limited qualitative work has been conducted to gain an in-depth understanding of implementation barriers. Methods Qualitative research was conducted to inform the development of three ACF strategies for TB to be evaluated as part of the Kharitode cluster-randomised trial being conducted in a rural province of South Africa. This included 25 semi-structured in-depth interviews among 8 TB patients, 7 of their household members and 10 clinic health workers, as well as 4 focus group discussions (2 rural and 2 main town locations) with 6–8 participants each (n = 27). Interviews and focus group discussions explored the context, advantages and limitations, as well as the implications of three ACF methods. Content analysis was utilised to document salient themes regarding their feasibility, acceptability and potential effectiveness. Results Study participants (TB patients and community members) reported difficulty identifying TB symptoms and seeking care in a timely fashion. In turn, all stakeholder groups felt that more proactive case finding strategies would be beneficial. Clinic-based strategies (including screening all patients regardless of visit purpose) were seen as the most acceptable method based on participants’ preference ranking of the ACF strategies. However, given the resource constraints experienced by the public healthcare system in South Africa, many participants doubted whether it would be the most effective strategy. Household outreach and incentive-based strategies were described as promising, but participants reported some concerns (e.g. stigma in case of household-based and ethical concerns in the case of incentives). Participants offered insights into how to optimise each strategy, tailoring implementation to community needs (low TB knowledge) and realities (financial constraints, transport, time off from work). Conclusions Findings suggest different methods of TB ACF are likely to engage different populations, highlighting the utility of a comprehensive approach. Trial registration Clinicaltrials.gov ( NCT02808507 ). Registered June 1, 2016. The participants in this formative study are not trial participants.
Related Links	https://health-policy-systems.biomedcentral.com/counter/pdf/10.1186/s12961-017-0206-8.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	14784505
DOI	10.1186/s12961-017-0206-8
Journal	Health Research Policy and Systems
Issue Number	1
Volume Number	15
Language	English
Publisher	BioMed Central
Publisher Date	2017-05-30
Access Restriction	Open
Subject Keyword	Health Administration R & D Technology Policy Medicine Public Health Health Services Research Health Policy Tuberculosis South Africa Active case finding Incentives Household Clinic R & D/Technology Policy Medicine/Public Health
Content Type	Text
Resource Type	Article
Subject	Health Policy
Journal Impact Factor	3.6/2023
5-Year Journal Impact Factor	4.3/2023

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
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4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
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