Taylor, M; Medley, N; van Wyk, SS; Oliver, S; (2024) Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews , 2024 (3) , Article CD014756. 10.1002/14651858.CD014756.pub2.

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Abstract

BACKGROUND: Active case finding (ACF) refers to the systematic identification of people with tuberculosis in communities and amongst populations who do not present to health facilities, through approaches such as door‐to‐door screening or contact tracing. ACF may improve access to tuberculosis diagnosis and treatment for the poor and for people remote from diagnostic and treatment facilities. As a result, ACF may also reduce onward transmission. However, there is a need to understand how these programmes are experienced by communities in order to design appropriate services. OBJECTIVES: To synthesize community views on tuberculosis active case finding (ACF) programmes in low‐ and middle‐income countries. SEARCH METHODS: We searched MEDLINE, Embase, and eight other databases up to 22 June 2023, together with reference checking, citation searching, and contact with study authors to identify additional studies. We did not include grey literature. SELECTION CRITERIA: This review synthesized qualitative research and mixed‐methods studies with separate qualitative data. Eligible studies explored community experiences, perceptions, or attitudes towards ACF programmes for tuberculosis in any endemic low‐ or middle‐income country, with no time restrictions. DATA COLLECTION AND ANALYSIS: Due to the large volume of studies identified, we chose to sample studies that had 'thick' description and that investigated key subgroups of children and refugees. We followed standard Cochrane methods for study description and appraisal of methodological limitations. We conducted thematic synthesis and developed codes inductively using ATLAS.ti software. We examined codes for underlying ideas, connections, and interpretations and, from this, generated analytical themes. We assessed the confidence in the findings using the GRADE‐CERQual approach, and produced a conceptual model to display how the different findings interact. MAIN RESULTS: We included 45 studies in this synthesis, and sampled 20. The studies covered a broad range of World Health Organization (WHO) regions (Africa, South‐East Asia, Eastern Mediterranean, and the Americas) and explored the views and experiences of community members, community health workers, and clinical staff in low‐ and middle‐income countries endemic for tuberculosis. The following five themes emerged.

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