Cascade of TB care in Indigenous populations in South America: a scoping review

Indigenous populations in South America bear a disproportionately high burden of TB. We conducted a scoping review to map the literature on the TB care cascade, associated barriers, and TB-related knowledge and awareness among Indigenous groups in South American countries.We searched Medline, Embase, LILACS, and SciELO from inception to 11 December 2024. Two investigators screened papers to identify studies reporting concepts relevant to access to the TB care cascade.We identified 42 studies addressing components of the care cascade. Five studies reported the uptake of confirmatory TB testing among people with TB-suggestive symptoms. Fourteen studies reported on treatment initiation, and 23 on completion, with 17 studies reporting completion rates below 90%. Twelve qualitative studies were identified. Studies reported that cultural understandings posed challenges to TB care. While adherence to the biomedical model was described, traditional health understandings were also reported to influence health-seeking behaviours. Studies also highlighted substantial logistical and social barriers to accessing appropriate care among Indigenous populations.Significant evidence gaps were identified in the early stages of the cascade, particularly related to TB screening and diagnostic testing. Further research is needed to explore and evaluate interventions designed to address these gaps..