Bridging the “know-do” gap to improve active case finding for tuberculosis in India: A qualitative exploration into national tuberculosis elimination program staffs’ perspectives

• DOI: 10.1371/journal.pone.0309750
• Publication Date: 2024-11-04T18:22:55Z
• Authors: Hemant Deepak She...; Prabhadevi Ravich...; S. Kiran Pradeep; G. Kiruthika; Devika Shanmugasu...; Joshua Chadwick; Swati Iyer; Aniket Chowdhury; Dheeraj Tumu; Amar N. Shah; Bhavin Vadera; Venkatesh Roddawar; Sanjay K. Mattoo; Kiran Rade; Raghuram Rao; Manoj V. Murhekar
• Keywords: Thematic Analysis; Incentive program

Background In 2022, India’s national tuberculosis (TB) elimination program (NTEP) commissioned a level evaluation of active case finding (ACF) for TB to guide evidence-based strategic planning. As part this evaluation, based on secondary data analysis we observed that the quality ACF was suboptimal in 2021. Hence, study aimed understand enablers, barriers, and suggested solutions improve India from NTEP staff (provider) perspective. Methods This descriptive qualitative involving key informant interviews six districts eight states, conducted between February August 2023. We purposively selected state- district- sub-district-level managers implementers who were experienced vocal. The audio recorded transcribed verbatim by research interns investigators. Two investigators independently did manual thematic analysis, third investigator resolved inconsistencies. themes categories emerged collating together results coding process. Results A total 34 these, four repeat interviews. Adequate budgets including incentives, performance review mechanism, engagement all stakeholders, adopting community friendly approach, use rapid diagnostic tests digitalization perceived enablers. some states implemented general population (not restricted high-risk population) following directives at state level. There limited mechanisms ensure indicators met before disbursing incentives cross-verification aggregate care cascade numbers reported Ni-kshay (electronic information management system under NTEP). addition district having understanding concepts around (quality indicators, number needed screen yield), also inferred presence ‘know-do’ gap many activities ACF. capacity building improvement strategies. Conclusion existing guidance should be revised emphasize building, need carry out general) population, control-linked regular implementation monitoring activities. contribute towards better coverage improved translating into outcomes.