Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.
PLoS One. 2020 Oct 28;15(10):e0240696. doi: 10.1371/journal.pone.0240696. eCollection 2020.
The World Health Organization (WHO) stresses the importance of active case-finding (ACF) for early detection of tuberculosis (TB), especially in the 30 high-burden countries that account for almost 90% of cases globally.
To describe the attitudes of National TB Programme (NTP) managers related to ACF policy development, implementation and scale-up in the 30 high-burden countries, and to review national TB strategic plans.
This was a mixed-methods study with an embedded design: A cross-sectional survey with NTP managers yielded quantitative and qualitative data. A review of national TB strategic plans complemented the results. All data were analyzed in parallel and merged in the interpretation of the findings.
23 of the 30 NTP managers (77%) participated in the survey and 22 (73%) national TB strategic plans were reviewed. NTP managers considered managers in districts and regions key stakeholders for both ACF policy development and implementation. Different types of evidence were used to inform ACF policy, while there was a particular demand for local evidence. The NSPs reflected the NTP managers' unanimous agreement on the need for ACF scale-up, but not all included explicit aims and targets related to ACF. The NTP managers recognized that ACF may decrease health systems costs in the long-term, while acknowledging the risk for increased health system costs in the short-term. About 90% of the NTP managers declared that financial and human resources were currently lacking, while they also elaborated on strategies to overcome resource constraints.
NTP managers stated that ACF should be scaled up but reported resource constraints. Strategies to increase resources exist but may not yet have been fully implemented, e.g. generating local evidence including from operational research for advocacy. Managers in districts and regions were identified as key stakeholders whose involvement could help improve ACF policy development, implementation and scale-up.
世界卫生组织（WHO）强调了主动病例发现（ACF）在早期发现结核病（TB）方面的重要性，尤其是在占全球病例近 90%的 30 个高负担国家。
描述国家结核病规划（NTP）管理者在 30 个高负担国家中与 ACF 政策制定、实施和扩大相关的态度，并审查国家结核病战略计划。
这是一项混合方法研究，采用嵌入式设计：对 NTP 管理者进行横断面调查，获得定量和定性数据。对国家结核病战略计划的审查补充了结果。所有数据均并行分析，并在解释结果时合并。
23 名（77%）30 名 NTP 管理者参与了调查，22 名（73%）国家结核病战略计划得到了审查。NTP 管理者认为地区和区域的管理者是 ACF 政策制定和实施的关键利益相关者。不同类型的证据用于为 ACF 政策提供信息，而特别需要当地的证据。国家规划反映了 NTP 管理者对扩大 ACF 规模的一致共识，但并非所有规划都包含与 ACF 相关的明确目标。NTP 管理者认识到 ACF 可能会降低长期的卫生系统成本，同时承认短期增加卫生系统成本的风险。大约 90%的 NTP 管理者表示目前缺乏资金和人力资源，同时还详细说明了克服资源限制的策略。
NTP 管理者表示应该扩大 ACF 的规模，但报告了资源限制。增加资源的策略存在，但可能尚未得到充分实施，例如从包括业务研究在内的地方产生证据，以进行宣传。地区和区域的管理者被确定为关键利益相关者，他们的参与可以帮助改善 ACF 政策的制定、实施和扩大。
