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. 2021 Mar 11;16(3):e0247568. doi: 10.1371/journal.pone.0247568. eCollection 2021.
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.
主动病例发现（ACF），也称为基于社区的结核病筛查，是世界卫生组织终结结核病战略的组成部分。ACF 具有潜在的益处，但也有危害，在制定和实施 ACF 政策时需要仔细评估。虽然关于 ACF 益处的经验证据仍然薄弱，但关于危害的证据甚至更薄弱。本研究旨在探讨专家对疑似结核病患者和社区进行 ACF 的益处和危害的看法。
这是一项探索性研究。对来自全球国际、非政府/非营利组织、资助者、政府机构、国际协会、智库、大学和研究机构的 39 名专家进行了半结构式访谈。采用框架分析法进行分析。
研究结果详细阐述了 ACF 的益处，包括接触弱势群体、降低患者成本、帮助提高个人对结核病的认识并使社区参与、减少结核病传播。感知到的危害包括增加污名化和歧视、导致假阳性诊断，以及引发与结核病患者筛查相关的其他意外后果，例如一旦确诊患有结核病，移民被驱逐出境。ACF 的大多数益处都可以与其早期发现和治疗结核病患者的目标联系起来（主题 1），而 ACF 也被认为是一把“双刃剑”，如果设计和实施不当，可能会造成危害（主题 2）。分析强调了在整个筛查过程中考虑 ACF 的益处和危害的重要性。该研究从该领域的专家的角度提供了对 ACF 的益处和危害的新见解。
本研究强调了围绕 ACF 的证据基础存在差距，并可以激发更多关于 ACF 的益处和危害的研究、辩论和分析，为优化 ACF 策略的设计和实施提供信息。
