Original Research

Implementing active surveillance for tuberculosis: The experiences of healthcare workers at four sites in two provinces in South Africa

Febisola I. Ajudua, Robert J. Mash
South African Family Practice | Vol 64, No 1 : Part 3| a5514 | DOI: https://doi.org/10.4102/safp.v64i1.5514 | © 2022 Febisola I. Ajudua, Robert J. Mash | This work is licensed under CC Attribution 4.0
Submitted: 21 February 2022 | Published: 26 July 2022

About the author(s)

Febisola I. Ajudua, Department of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Department of Family Medicine and Primary Care, Faculty of Health Sciences, Walter Sisulu University, Gqeberha, South Africa
Robert J. Mash, Department of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Abstract

Background: The high burden of tuberculosis (TB) in South Africa (SA) is associated with uncontrolled transmission in communities and delayed diagnosis of active cases. Active surveillance for TB is provided by community-based services (CBS). Research is required to understand key factors influencing TB screening services in the CBS. This study explored the implementation of active surveillance for TB where community-oriented primary care (COPC) had been successfully implemented to identify these factors.

Methods: This was a qualitative study of four established COPC sites across two provinces in SA where active surveillance for TB is implemented. Semi-structured interviews were conducted with purposively selected healthcare workers in the CBS and citizens in these communities. The recorded interviews were transcribed for data analysis using ATLAS.ti software.

Results: The factors influencing active surveillance for TB were directly related to the major players in the delivery of CBS. These factors interacted in a complex network influencing implementation of active surveillance for TB. Building effective relationships across stakeholder platforms by community health workers (CHWs) was directly influenced by the training, capacity building afforded these CHWs by the district health services; and acceptability of CBS. Each factor interplayed with others to influence active surveillance for TB.

Conclusion: Community health workers were central to the success of active surveillance for TB. The complex interactions of the social determinants of health and TB transmission in communities required CHWs to develop trusting relationships that responded to these issues that have impact on TB disease and linked clients to healthcare.


Keywords

tuberculosis; active case finding; community-oriented primary care; community health worker (CHW); community-based services; active surveillance

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