Active case-finding policy development, implementation and scale-up in high-burden countries: A mixed-methods survey...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Policy and Management

Background:

• The World Health Organization (WHO) emphasizes active case-finding (ACF) for early tuberculosis (TB) detection, particularly in 30 high-burden countries responsible for nearly 90% of global cases.
• Effective ACF strategies are critical for reducing TB transmission and mortality.

Purpose of the Study:

• To assess the perspectives of National TB Programme (NTP) managers regarding ACF policy development, implementation, and scale-up in high-burden countries.
• To review national TB strategic plans for alignment with ACF objectives.

Main Methods:

• A mixed-methods approach combining a cross-sectional survey of NTP managers with a review of national TB strategic plans.
• Quantitative and qualitative data from surveys and plan reviews were analyzed in parallel.

Main Results:

• 77% of NTP managers participated in the survey; 73% of national TB strategic plans were reviewed.
• NTP managers identified district and regional managers as key stakeholders for ACF policy and implementation.
• While NTP managers agreed on the need for ACF scale-up and recognized potential long-term cost savings, most reported current financial and human resource shortages. Strategies to address these constraints were identified.

Conclusions:

• NTP managers support scaling up ACF but highlight significant resource limitations.
• Implementing strategies like generating local evidence and involving sub-national managers is essential for successful ACF scale-up.
• Addressing resource constraints through operational research and advocacy is vital for advancing TB control efforts.