'A double-edged sword': Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities-A qualitative study based on expert interviews.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
03
07
2020
accepted:
09
02
2021
entrez:
11
3
2021
pubmed:
12
3
2021
medline:
14
9
2021
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 33705422
doi: 10.1371/journal.pone.0247568
pii: PONE-D-20-20600
pmc: PMC7951804
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0247568Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
BMJ. 2016 Jun 28;353:i2016
pubmed: 27353417
Int J Tuberc Lung Dis. 2013 Oct;17(10):1248-56
pubmed: 24025375
Health Technol Assess. 2013 Mar;17(13):1-170, v-vi
pubmed: 23540978
PLoS One. 2020 Oct 28;15(10):e0240696
pubmed: 33112890
BMC Fam Pract. 2017 Mar 23;18(1):46
pubmed: 28330453
PLoS One. 2016 Sep 09;11(9):e0162796
pubmed: 27611908
Int J Epidemiol. 2011 Jun;40(3):712-8
pubmed: 21330344
Qual Health Res. 2016 Nov;26(13):1753-1760
pubmed: 26613970
Eur Respir J. 2013 Jan;41(1):140-56
pubmed: 22936710
PLoS One. 2008 May 07;3(5):e2100
pubmed: 18461123
PLoS One. 2017 Sep 5;12(9):e0183924
pubmed: 28873092
N Engl J Med. 2018 Jan 18;378(3):221-229
pubmed: 29342390
Bull World Health Organ. 2002;80(3):217-27
pubmed: 11984608
PLoS Med. 2010 Dec 21;7(12):e1000381
pubmed: 21203587
BMC Med Res Methodol. 2013 Sep 18;13:117
pubmed: 24047204
Infect Dis Poverty. 2019 Dec 3;8(1):99
pubmed: 31791412
Glob Health Action. 2018;11(1):1494897
pubmed: 30173603
Proc Natl Acad Sci U S A. 2012 Jun 12;109(24):9557-62
pubmed: 22645356
PLoS One. 2015 Mar 26;10(3):e0119822
pubmed: 25812013
PLoS One. 2019 Mar 13;14(3):e0213345
pubmed: 30865730
BMJ Open. 2019 Dec 11;9(12):e031284
pubmed: 31831535
N Engl J Med. 2019 Oct 3;381(14):1347-1357
pubmed: 31577876
Clin Infect Dis. 2020 Mar 17;70(7):1316-1325
pubmed: 31095677
BMC Public Health. 2012 Jun 21;12:469
pubmed: 22720878
PLoS Med. 2011 Jan 18;8(1):e1000391
pubmed: 21267059
Lancet Infect Dis. 2008 Jun;8(6):359-68
pubmed: 18450516
Acta Trop. 2018 Apr;180:26-32
pubmed: 29289558
JAMA Intern Med. 2017 Mar 1;177(3):407-419
pubmed: 28097303
BMJ. 2000 Jan 1;320(7226):50-2
pubmed: 10617534
Int J Tuberc Lung Dis. 2013 Apr;17(4):432-46
pubmed: 23485377
Health Technol Assess. 2000;4(5):1-120
pubmed: 10859208
BMC Public Health. 2008 Oct 02;8:346
pubmed: 18831751
BMC Infect Dis. 2014 Jan 02;14:2
pubmed: 24383553
Int J Mycobacteriol. 2016 Dec;5(4):374-378
pubmed: 27931676
PLoS One. 2014 Apr 10;9(4):e94465
pubmed: 24722399
Bull World Health Organ. 2010 Apr;88(4):273-80
pubmed: 20431791
Int J Qual Health Care. 2007 Dec;19(6):349-57
pubmed: 17872937
Lancet Glob Health. 2017 Jun;5(6):e565-e566
pubmed: 28495255
Int J Tuberc Lung Dis. 2010 Jun;14(6):720-6
pubmed: 20487610
Lancet Infect Dis. 2012 Nov;12(11):859-70
pubmed: 22914343
JAMA. 2018 Aug 7;320(5):485-498
pubmed: 30088015
Int J Tuberc Lung Dis. 2013 Mar;17(3):289-98
pubmed: 23407219
BMJ Open. 2020 Jun 3;10(6):e036285
pubmed: 32499270
Br J Cancer. 2013 Jun 11;108(11):2205-40
pubmed: 23744281
PLoS One. 2009;4(5):e5602
pubmed: 19440346
Prev Med. 2016 Oct;91:250-263
pubmed: 27527575
Aust Fam Physician. 2006 Jan-Feb;35(1-2):39-42
pubmed: 16489385
Lancet. 2010 Oct 9;376(9748):1244-53
pubmed: 20923715
Proc Natl Acad Sci U S A. 1998 Nov 10;95(23):13881-6
pubmed: 9811895
J Med Ethics. 1994 Mar;20(1):12-8
pubmed: 8035433