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Review
. 2024 Feb 8;2(1):9.
doi: 10.1186/s44263-024-00042-9.

Community-based active-case finding for tuberculosis: navigating a complex minefield

Peter MacPherson  1   2 , Kwame Shanaube  3 , Mphatso D Phiri  4   5 , Hannah M Rickman  6   4 , Katherine C Horton  7 , Helena R A Feasey  6 , Elizabeth L Corbett  6 , Rachael M Burke  6 , Molebogeng X Rangaka  8   9
Affiliations
Review

Community-based active-case finding for tuberculosis: navigating a complex minefield

Peter MacPherson et al. BMC Glob Public Health. .

Erratum in

Abstract

Community-based active case finding (ACF) for tuberculosis (TB) involves an offer of screening to populations at risk of TB, oftentimes with additional health promotion, community engagement and health service strengthening. Recently updated World Health Organization TB screening guidelines conditionally recommend expanded offer of ACF for communities where the prevalence of undiagnosed pulmonary TB is greater than 0.5% among adults, or with other structural risk factors for TB. Subclinical TB is thought to be a major contributor to TB transmission, and ACF, particularly with chest X-ray screening, could lead to earlier diagnosis. However, the evidence base for the population-level impact of ACF is mixed, with effectiveness likely highly dependent on the screening approach used, the intensity with which ACF is delivered, and the success of community- and health-system participation. With recent changes in TB epidemiology due to the effective scale-up of treatment for HIV in Africa, the impacts of the COVID-19 pandemic, and the importance of subclinical TB, researchers and public health practitioners planning to implement ACF programmes must carefully and repeatedly consider the potential population and individual benefits and harms from these programmes. Here we synthesise evidence and experience from implementing ACF programmes to provide practical guidance, focusing on the selection of populations, screening algorithms, selecting outcomes, and monitoring and evaluation. With careful planning and substantial investment, community-based ACF for TB can be an impactful approach to accelerating progress towards elimination of TB in high-burden countries. However, ACF cannot and should not be a substitute for equitable access to responsive, affordable, accessible primary care services for all.

Keywords: Community; HIV; Public health; Screening; Tuberculosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Public health needs assessment for planning, monitoring, and adapting community-based active case-finding programmes. ACF active case finding, CNR case notification rates
Fig. 2
Fig. 2
Interpretation of trends in tuberculosis case notification rates following implementation of active case-finding programmes. Note: The figure is illustrative, but based on data from Blantyre, Malawi, analysed by Burke et al. [38]. ACF active case finding
See this image and copyright information in PMC

References

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