‘A double-edged sword’: Perceived benefits and harms of active case finding for people with presumptive tuberculosis and communities-A qualitative study based on expert interviews

The study showed the importance of considering the benefits and harms of ACF throughout the screening pathway, not just in the planning phase. On the one hand, the perceived benefits of ACF included reaching vulnerable populations, reducing patient costs, helping raise awareness for TB among individuals and engaging communities. On the other hand, the perceived harms of ACF comprised increasing stigma and discrimination, causing false-positive diagnoses, as well as triggering other unintended negative consequences like deportation of migrants once confirmed to have TB. Overall, most of the benefits of ACF were tied to its objective of finding and treating persons with TB early, while most of the perceived harms were said to be caused by inappropriate implementation of ACF. This study opened my eyes to the challenges in making judgements on the benefits and harms of screening, as they’re tricky to quantify (e.g. stigma) or compare (e.g. transmission versus false-positive results). These results may be relevant for planning and implementing ACF, but even COVID-19 screening – to avoid “screeningitis” that does more harm than good.

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