Perceptions of tuberculosis and home-based infection screening among families and providers in Madagascar: a qualitative study.

BACKGROUND

Madagascar is a country with a high tuberculosis (TB) burden, and the incidence of the disease has remained unchanged since 2013. TB detection largely relies on passive strategies, with little attention given to TB infections (TBIs), which are silent reservoirs that fuel future active TB cases.

METHOD: This qualitative study investigated how Malagasy communities perceive TB and an innovative approach for TBI screening and care. This approach was developed through the APRECIT operational research project in partnership with the National Tuberculosis Control Program (NTP). Semi-structured in-depth interviews were conducted between March and May 2023 with a sample of stakeholders and health workers (26 HWs) at the national, regional and community levels and focus groups with household contacts (46 HHCs) of TB patients.

RESULTS

The fight against TB remains challenging in Madagascar. Community knowledge of TB is limited, and the disease is perceived as shameful. Individuals with TB and their families face stigmatization within their own family and the community. At the provider level, HWs reported challenges in promptly detecting and treating TB people with TB due to structural constraints within the health system and barriers at the household (HH) level. The introduction of home-based screening for TBI was perceived as a way to interrupt disease progression and help reduce stigma. For HWs, this strategy helps to limit TB transmission. However, HWs expressed concerns about giving treatment to asymptomatic people and the replicability of the strategy at the national level.

CONCLUSION

Improving communication about TB and implementing a home-based screening strategy for HHCs to identify individuals at high risk of TB progression have the potential to improve TB control in Madagascar.