Evaluating Feasibility And Acceptability Of Tuberculosis Screening And Diagnostic Tests: A Multi-Country Qualitative Study Of The Start4All Project
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healthcareRecord type:
paper
Creator:
VibSaySyeKAM
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Background:Optimising tuberculosis (TB) diagnosis involves combining screening and confirmatory tests within diagnostic algorithms. Their impact depends on accuracy, feasibility, and acceptability. This study assessed stakeholder perspectives on TB diagnostic tests and algorithms across high TB burden settings.
Methods:A qualitative study was conducted across seven high TB burden countries within Start4All. Between October 2024 and June 2025, 38 key informants were interviewed and 18 focus groups conducted with healthcare providers and people affected by TB. Discussions covered C-reactive protein (CRP), lateral flow lipoarabinomannan (LF-LAM), computer-aided detection for chest X-ray (CAD-CXR), pooled molecular testing, and diagnostic algorithms. Data were analysed deductively using feasibility and acceptability frameworks.
Findings:Feasibility and acceptability were shaped by tests' roles within diagnostic pathways rather than individual characteristics. CRP and LF-LAM were simple and acceptable, with concerns about CRP's low specificity and LF-LAM's limited sensitivity; LF-LAM was most useful among people living with HIV. CAD-CXR enabled rapid, decentralised screening but required confirmatory testing and system investment. Pooled molecular testing was resource-efficient, with concerns about reduced sensitivity and workflow complexity. Multistep algorithms strengthened diagnostic confidence but became less feasible with increasing complexity, particularly in lower-level and community facilities. Across approaches, clinical coherence and trust underpinned acceptability, while infrastructure, workforce, and system organisation shaped feasibility.
Interpretation:Diagnostic tests should be complementary components of context-specific pathways rather than standalone technologies. Stakeholders valued combinations with clearly defined roles aligned with clinical reasoning and system capacity. Implementation requires adequate infrastructure, workforce, and coordinated service delivery. Funding: Funded by Unitaid (Grant 2022-50-START-4-ALL).
Methods:A qualitative study was conducted across seven high TB burden countries within Start4All. Between October 2024 and June 2025, 38 key informants were interviewed and 18 focus groups conducted with healthcare providers and people affected by TB. Discussions covered C-reactive protein (CRP), lateral flow lipoarabinomannan (LF-LAM), computer-aided detection for chest X-ray (CAD-CXR), pooled molecular testing, and diagnostic algorithms. Data were analysed deductively using feasibility and acceptability frameworks.
Findings:Feasibility and acceptability were shaped by tests' roles within diagnostic pathways rather than individual characteristics. CRP and LF-LAM were simple and acceptable, with concerns about CRP's low specificity and LF-LAM's limited sensitivity; LF-LAM was most useful among people living with HIV. CAD-CXR enabled rapid, decentralised screening but required confirmatory testing and system investment. Pooled molecular testing was resource-efficient, with concerns about reduced sensitivity and workflow complexity. Multistep algorithms strengthened diagnostic confidence but became less feasible with increasing complexity, particularly in lower-level and community facilities. Across approaches, clinical coherence and trust underpinned acceptability, while infrastructure, workforce, and system organisation shaped feasibility.
Interpretation:Diagnostic tests should be complementary components of context-specific pathways rather than standalone technologies. Stakeholders valued combinations with clearly defined roles aligned with clinical reasoning and system capacity. Implementation requires adequate infrastructure, workforce, and coordinated service delivery. Funding: Funded by Unitaid (Grant 2022-50-START-4-ALL).
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