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Public health
Original research
Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review
  1. Olivia Biermann1,
  2. Knut Lönnroth1,
  3. Maxine Caws2,3,
  4. Kerri Viney1,4
  1. 1Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
  3. 3Birat Nepal Medical Trust, Kathmandu, Lazimpat, Nepal
  4. 4Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
  1. Correspondence to Olivia Biermann; olivia.biermann{at}ki.se

Abstract

Objective To explore antecedents, components and influencing factors on active case-finding (ACF) policy development and implementation.

Design Scoping review, searching MEDLINE, Web of Science, the Cochrane Database of Systematic Reviews and the World Health Organization (WHO) Library from January 1968 to January 2018. We excluded studies focusing on latent tuberculosis (TB) infection, passive case-finding, childhood TB and studies about effectiveness, yield, accuracy and impact without descriptions of how this evidence has/could influence ACF policy or implementation. We included any type of study written in English, and conducted frequency and thematic analyses.

Results Seventy-three articles fulfilled our eligibility criteria. Most (67%) were published after 2010. The studies were conducted in all WHO regions, but primarily in Africa (22%), Europe (23%) and the Western-Pacific region (12%). Forty-one percent of the studies were classified as quantitative, followed by reviews (22%) and qualitative studies (12%). Most articles focused on ACF for tuberculosis contacts (25%) or migrants (32%). Fourteen percent of the articles described community-based screening of high-risk populations. Fifty-nine percent of studies reported influencing factors for ACF implementation; mostly linked to the health system (eg, resources) and the community/individual (eg, social determinants of health). Only two articles highlighted factors influencing ACF policy development (eg, politics). Six articles described WHO’s ACF-related recommendations as important antecedent for ACF. Key components of successful ACF implementation include health system capacity, mechanisms for integration, education and collaboration for ACF.

Conclusion We identified some main themes regarding the antecedents, components and influencing factors for ACF policy development and implementation. While we know much about facilitators and barriers for ACF policy implementation, we know less about how to strengthen those facilitators and how to overcome those barriers. A major knowledge gap remains when it comes to understanding which contextual factors influence ACF policy development. Research is required to understand, inform and improve ACF policy development and implementation.

  • tuberculosis
  • active case-finding
  • health policy
  • policy development
  • policy implementation
  • preventive medicine

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2019-031284

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    Footnotes

    • Twitter @olibiermann

    • Contributors OB, KL, MC and KV conceived the study. OB developed the search strategy together with a medical librarian from Karolinska Institutet. OB and KV screened titles and abstracts, and then full-text articles. OB extracted, charted, analysed and interpreted the data. KV verified the data extraction by charting data from a random sample of studies for comparison. OB wrote the first draft of the manuscript. KL, MC and KV were consulted at various stages of the scoping review to provide input on the search strategy, data extraction, charting, analysis and the interpretation of the results, and provided comments on the manuscript. All authors read and approved the final manuscript.

    • Funding This work was supported by the EU-Horizon 2020-funded IMPACT-TB project (grant 733174).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.