Building on facilitators and overcoming barriers to implement active tuberculosis case-finding in Nepal
Based on interviews with community health workers and people with TB, we described the facilitators and barriers linked to the implementation of active case-finding within the IMPACT TB project (www.impacttbproject.org), and also described how those facilitators and barriers have been or could be addressed. We generated five main themes from the data: (1) active case-finding addressed social determinants of TB by providing timely access to free healthcare, (2) knowledge and awareness about TB among people with TB, communities and community health workers were the ‘oil’ in the active case-finding ‘machine’, (3) trust in community health workers was fundamental for implementing active case-finding, (4) community engagement and support had a powerful influence on active case-finding implementation and (5) improved working conditions and better collaboration with key stakeholders could further facilitate active case-finding.
Interestingly, the facilitators, barriers and “how-to” strategies for implementing active case-finding where very similar to what we had found in a separate study related to IMPACT TB in Vietnam which has not yet been published. Our results were also very much in line with other available evidence in the field. The nuances we found were mostly related to the social determinants of health in the given contexts, e.g., in Nepal, interviewees emphasized poverty and community support as important barriers/facilitators for active case-finding implementation.
We believe there are many possibilities for cross-learning, not only with regards to what the facilitators and barriers for active case-finding are, but in terms of strategies on how to address these factors.