Principles and priorities for integrated tuberculosis screening and care: A modified Delphi consensus exercise

Tuberculosis predominates in communities with multiple health and socioeconomic vulnerabilities. Tuberculosis diagnosis presents an opportunity for expanded health services to tuberculosis-affected households. We conducted a modified Delphi process to ascertain if and how expanded services should be offered to people with tuberculosis and their households. Purposively invited panellists were identified through professional networks and included researchers, service providers, policymakers and members of tuberculosis-affected communities. Panellists completed two online survey rounds. Round one sought to establish consensus on the perceived value of integration and capture diverse views on service integration priorities through free-text responses. Round two explored broad consensus statements (consensus defined as ≥75% agreement) developed from round one responses using Likert scales and country-specific priorities. Free-text responses were analysed using inductive thematic analysis. The percentage of panellists agreeing with each statement was calculated as a proportion of all responses, overall and by pre-specified subgroups of professional categories and WHO region. In round one, 223 panellists from 44 countries indicated strong support for expanded and better integrated services for people with tuberculosis (98% agreement), and their household contacts (84%). In round two, 324 people from 68 countries reached consensus on key motivations for service integration. These included improved tuberculosis treatment and other health outcomes among people with tuberculosis, and increased tuberculosis screening and preventive treatment uptake among contacts. Almost all (>99%) panellists agreed that people with tuberculosis should be routinely screened for relevant non-tuberculosis conditions, but only 69% thought this was appropriate among household contacts. There was consensus (93%) that population-wide tuberculosis screening should be integrated with other disease screening. Multiple, often context-specific, considerations for implementation were highlighted. Integrated tuberculosis screening and care is highly valued by global tuberculosis experts. This international consensus provides a strong mandate for research evaluating the feasibility and effectiveness of integrated tuberculosis service delivery and further policy and guideline development.