The following is a summary of “Facilitators and barriers to tuberculosis active case findings in low- and middle-income countries: a systematic review of qualitative research,” published in the August 2023 issue of Infectious Disease by Fenta et al.
Tuberculosis (TB) is a major public health problem in low- and middle-income countries (LMICs). Active case finding (ACF) is essential to ending the global TB epidemic by 2035. Researchers started a retrospective study to explore the factors that enable or hinder tuberculosis ACF in LMICs.
They conducted a systematic search using well-known databases, including PubMed, Google Scholar, SCOPUS, HINARI, and other reference databases. Relevant research on TB-ACF in LMICs was assessed for attributes using the Joanna Briggs Institute’s (JBI) Critical Appraisal Tool. The Statement of Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) was employed for protocol enhancement. Additionally, the reliability of the review findings was assessed using the Confidence of Evidence Review Quality (CERQual) approach.
The results showed 228 search results and 23 studies in the final review. Findings on TB-ACF revealed two main themes, barriers and facilitators in LMICs. These barriers were categorized into healthcare-related and non-healthcare-related. The obstacles to active TB detection included healthcare worker knowledge and skills in TB-ACF, geographical distance, and time constraints, the availability and workload of ACF healthcare workers, resource shortages like diagnostic equipment, reagents, and consumables at TB-ACF facilities, the stigma surrounding TB-ACF detection, poor TB-ACF training for HCPs, communication and language issues in TB-ACF, and low TB awareness. Stigma was the main patient-related obstacle to TB case detection in LMICs.
They concluded that surveillance, monitoring, training, integration, and funding were key to sustainable ACF in LMICs.