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Ethical challenges in community-based tuberculosis screening and surveillance.
Sameer Rastogi1, Nupur Giri2, Swapnil Bhanudas Kadam3
1School of Pharmacy, Noida International University, Uttar Pradesh, 203201, India.
The Indian Journal of Tuberculosis
|June 26, 2026
Summary
Community tuberculosis (TB) screening faces ethical challenges, primarily concerning privacy and informed consent. Addressing these issues is vital for effective disease surveillance and elimination strategies.
Area of Science:
- Public Health
- Bioethics
- Epidemiology
Background:
- Community-based screening and surveillance are essential for global tuberculosis (TB) elimination.
- However, the ethical dimensions of these programs remain underexplored.
Purpose of the Study:
- To systematically evaluate ethical issues in community-based TB screening and surveillance programs.
- To assess stakeholder perceptions of ethical adequacy and identify factors influencing ethical incidents.
Main Methods:
- A mixed-methods approach was employed, combining quantitative data on ethical occurrences with qualitative stakeholder views.
- A cross-sectional study involved 2847 screened individuals, 156 healthcare workers, and 42 administrators across 18 TB screening programs over 18 months.
Main Results:
- A total of 847 ethical cases were reported (29.7 per 100 screenings), with privacy/confidentiality (34.2%) and informed consent (24.8%) being most frequent.
- Digital surveillance programs showed higher privacy-related incidents (42.3% vs. 26.4%, p=0.001).
- Stakeholder ethical adequacy scores averaged 3.21±0.87, with community members scoring lower (2.89±0.94) than healthcare workers (3.54±0.72, p<0.001).
Conclusions:
- Ethical challenges in community TB programs are significant and require structured interventions.
- Program design, technology implementation, and policymaking are critical considerations for infectious disease surveillance.
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