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

Claire Jacqueline Calderwood, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Tenzin Kunor, We Are TB, Georgia, United States of America, Atlanta.
Mikaela Coleman, Institute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
Edson Marambire, The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
Uzma Khan, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada.
Rosa Herrera, Autonomous University of Durango, Mexicali Campus, Mexicali, Mexico.
Jeffry Acaba, APCASO, Bangkok, Thailand.
Zafar Hussain, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Diptendu Bhattacharya, Survivors Against TB, Delhi, India.
Leyla Larsson, Institute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
Jose Luis Paredes, Advocate Health - MidwestFollow
Laura Paramo, Institute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
Márcia Chiluvane, Instituto Nacional de Saúde (INS), Maputo, Mozambique.
Thu-Anh Nguyen, Sydney School of Public Health, University of Sydney, Sydney, Australia.
Hanh Nguyen Hong, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam.
Marc d'Elbée, University of Bordeaux, National Institute for Health and Medical Research, Research Institute for Sustainable Development, Bordeaux, France.
Eneyi Kpokiri, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Luan Nguyen Vo, Friends for International TB Relief, Ha Noi, Viet Nam.
Tom Wingfield, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Ben Marais, Sydney Infectious Diseases Institute, University of Sydney, Sydney, Australia.
Madhavi Bhargava, Department of Community Medicine, Yenepoya Medical College, Mangalore, India.
Sarah Bernays, Sydney Infectious Diseases Institute, University of Sydney, Sydney, Australia.
Katharina Kranzer, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

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.

Type

Article

PubMed ID

41770762

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