Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka, 1212, Bangladesh.
National Tuberculosis Control Programme (NTP), Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MOH&FW), Dhaka, Bangladesh.
BMC Health Serv Res. 2023 Jul 29;23(1):810. doi: 10.1186/s12913-023-09737-5.
One of the contributors to tuberculosis (TB) burden among vulnerable populations, such as sexual minority people, is the delay in case finding and notification. Given their socially excluded, hard-to-reach nature, community-led approaches need to be introduced to facilitate their screening of TB symptoms and their subsequent referral to TB healthcare providers. This article aimed to explore the existing challenges surrounding TB screening and referral, and the implementation facilitators and barriers of the proposed community-based TB screening model for sexual minority people in Dhaka, Bangladesh.
This study followed the quasi-experimental design using mixed methods (i.e., qualitative and quantitative) approach. The study participants who were also a part of the community-led TB screening model included sexual minority people enrolled in HIV prevention interventions. In addition to quantitative inquiry, in-depth interviews were conducted on sexual minority people, focus group discussions were also conducted on them and HIV prevention service providers, and key-informant interviews were conducted on service providers, programmatic experts and TB researchers. Data were analyzed using content, contextual and thematic approaches.
The 'Six Steps in Quality Intervention Development' framework was used to guide the development of the community-based TB screening model. In Step 1 (identifying the problem), findings revealed low rates of TB screening among sexual minority people enrolled in the HIV prevention intervention. In Step 2 (identifying contextual factors for change), various individual, and programmatic factors were identified, which included low knowledge, low-risk perception, prioritization of HIV services over TB, and stigma and discrimination towards these populations. In Step 3 (deciding change mechanism), community-based screening approaches were applied, thus leading to Step 4 (delivery of change mechanism) which designed a community-based approach leveraging the peer educators of the HIV intervention. Step 5 (testing intervention) identified some barriers and ways forward for refining the intervention, such as home-based screening and use of social media. Step 6 (collecting evidence of effectiveness) revealed that the main strength was its ability to engage peer educators.
This study indicates that a community-based peer-led TB screening approach could enhance TB screening, presumptive TB case finding and referral among these populations. Therefore, this study recommends that this approach should be incorporated to complement the existing TB program.
弱势群体（如性少数群体）结核病（TB）负担的一个促成因素是发现和通知病例的延迟。鉴于他们社会排斥、难以接触的性质，需要引入社区主导的方法，以方便他们筛查结核病症状，并随后将其转介到结核病保健提供者。本文旨在探讨围绕结核病筛查和转介的现有挑战，以及在孟加拉国达卡为性少数群体提出的基于社区的结核病筛查模式的实施促进因素和障碍。
本研究采用准实验设计，采用混合方法（即定性和定量）方法。参与社区主导的结核病筛查模式的研究参与者包括参加艾滋病毒预防干预措施的性少数群体。除了定量调查外，还对性少数群体进行了深入访谈，对他们和艾滋病毒预防服务提供者进行了焦点小组讨论，并对服务提供者、方案专家和结核病研究人员进行了关键人物访谈。使用内容、背景和主题方法分析数据。
使用“六步优质干预措施制定框架”指导社区主导的结核病筛查模式的制定。在步骤 1（确定问题）中，研究结果显示，参加艾滋病毒预防干预措施的性少数群体中结核病筛查率较低。在步骤 2（确定变化的背景因素）中，确定了各种个人和方案因素，包括知识水平低、风险认知低、对 HIV 服务的重视高于 TB、对这些人群的污名化和歧视。在步骤 3（决定变化机制）中，采用了基于社区的筛查方法，从而导致步骤 4（实施变化机制），该机制设计了一种基于社区的方法，利用艾滋病毒干预的同伴教育者。步骤 5（测试干预措施）确定了一些改进干预措施的障碍和前进方向，例如上门筛查和使用社交媒体。步骤 6（收集有效性证据）表明，该干预措施的主要优势是其能够吸引同伴教育者。
本研究表明，基于社区的同伴主导的结核病筛查方法可以提高这些人群的结核病筛查、疑似结核病病例发现和转介。因此，本研究建议将这种方法纳入补充现有的结核病方案。
