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‘A double-edged sword’: Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities—A qualitative study based on expert interviews

BACKGROUND: 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 em...

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Autores principales: Biermann, Olivia, Klüppelberg, Raina, Lönnroth, Knut, Viney, Kerri, Caws, Maxine, Atkins, Salla
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951804/
https://www.ncbi.nlm.nih.gov/pubmed/33705422
http://dx.doi.org/10.1371/journal.pone.0247568
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author Biermann, Olivia
Klüppelberg, Raina
Lönnroth, Knut
Viney, Kerri
Caws, Maxine
Atkins, Salla
author_facet Biermann, Olivia
Klüppelberg, Raina
Lönnroth, Knut
Viney, Kerri
Caws, Maxine
Atkins, Salla
author_sort Biermann, Olivia
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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spelling pubmed-79518042021-03-22 ‘A double-edged sword’: Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities—A qualitative study based on expert interviews Biermann, Olivia Klüppelberg, Raina Lönnroth, Knut Viney, Kerri Caws, Maxine Atkins, Salla PLoS One Research Article BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. Public Library of Science 2021-03-11 /pmc/articles/PMC7951804/ /pubmed/33705422 http://dx.doi.org/10.1371/journal.pone.0247568 Text en © 2021 Biermann et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Biermann, Olivia
Klüppelberg, Raina
Lönnroth, Knut
Viney, Kerri
Caws, Maxine
Atkins, Salla
‘A double-edged sword’: Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities—A qualitative study based on expert interviews
title ‘A double-edged sword’: Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities—A qualitative study based on expert interviews
title_full ‘A double-edged sword’: Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities—A qualitative study based on expert interviews
title_fullStr ‘A double-edged sword’: Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities—A qualitative study based on expert interviews
title_full_unstemmed ‘A double-edged sword’: Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities—A qualitative study based on expert interviews
title_short ‘A double-edged sword’: Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities—A qualitative study based on expert interviews
title_sort ‘a double-edged sword’: perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities—a qualitative study based on expert interviews
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951804/
https://www.ncbi.nlm.nih.gov/pubmed/33705422
http://dx.doi.org/10.1371/journal.pone.0247568
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