DOI : https://doi.org/10.56338/mppki.v9i10.10739

Community-based Tuberculosis Screening Strategies: A Systematic Review of Active Case Finding and Contact Investigation

Dewi Ariyani Wulandari (1), Mateus Sakundarno Adi (2), Martini (3), Daru Lestantyo (4)
(1) Doctoral Program of Public Health, Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia. Department of Public Health, School of Health Science Wira Husada, Yogyakarta, Special Region of Yogyakarta, Indonesia.
(2) Department of Epidemiology, Faculty of Public Health, Universitas Diponegoro, Semarang, Central Java, Indonesia
(3) Department of Epidemiology, Faculty of Public Health, Universitas Diponegoro, Semarang, Central Java, Indonesia
(4) Department of Occupational Safety and Health, Faculty of Public Health, Universitas Diponegoro, Semarang, Central Java, Indonesia
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Wulandari, D. A., Adi, M. S., Martini, & Lestantyo, D. (2026). Community-based Tuberculosis Screening Strategies: A Systematic Review of Active Case Finding and Contact Investigation . Media Publikasi Promosi Kesehatan Indonesia, 9(10), 1793–1803. https://doi.org/10.56338/mppki.v9i10.10739
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Introduction: Delays in tuberculosis (TB) diagnosis remain a persistent challenge to TB control across the care cascade in low- and middle-income countries (LMICs). Community-based active case finding (ACF) and contact investigation provide opportunities to expand diagnostic services beyond healthcare facilities. However, evidence of their effects at different stages of the TB care cascade varies considerably across studies. This systematic review aimed to assess the effects of community-based TB screening interventions at different stages of the care cascade in LMICs, with behavioural frameworks applied to interpret the findings after synthesis.


Methods: This systematic review followed the PRISMA 2020 guidelines and was registered in PROSPERO (CRD420261288243). We searched Scopus, PubMed, and ProQuest for studies published from January 2016 to March 2026. We included randomised controlled trials (RCTs) and quasi-experimental studies on community-based TB screening in low- and middle-income countries (LMICs). Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. The findings were summarised narratively according to TB care cascade outcomes and study design.


Results: The 13 included studies comprised seven randomised controlled trials (RCTs) and six quasi-experimental studies. The findings varied according to study design and stages of the TB care cascade. Although evidence directly evaluating outcomes at the early stages of the TB care cascade remained limited, a few studies reported improvements in screening participation and progression to diagnostic evaluation. Positive effects on TB case detection, notification, and population-level outcomes were also reported in several studies. However, studies with control groups showed varied findings; some reported favourable effects, while others found no statistically significant effects. Evidence on the initiation of tuberculosis preventive treatment (TPT) was limited and mainly came from studies involving children who were household contacts of TB patients.


Conclusion: Community-based TB screening may improve access to diagnosis and support TB case detection in some settings. However, the results vary by study design, population, intervention, and implementation context. Evidence on improved screening participation and completion of diagnostic evaluation remains limited. Therefore, the effects of community-based TB screening across the TB care cascade should be interpreted carefully based on the outcomes assessed at each stage.

  1. World Health Organization. Global tuberculosis report 2025. World Health Organization; 2025. Available from: https://iris.who.int/handle/10665/383364
  2. Ledesma JR, Ma J, Zhang M, Basting AVL, Chu HT, Vongpradith A, et al. Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Infectious Diseases. 2024;24(7):698–725. Available from: https://doi.org/10.1016/S1473-3099(24)00007-0
  3. Jiang W, Dong D, Febriani E, Adeyi O, Fuady A, Surendran S, et al. Policy gaps in addressing market failures and intervention misalignments in tuberculosis control: prospects for improvement in China, India, and Indonesia. The Lancet Regional Health - Western Pacific. 2024;46:101045. Available from: https://doi.org/10.1016/j.lanwpc.2024.101045
  4. Sathar F, Charalambous S, Velen K, Fielding K, Rachow A, Ivanova O, et al. Health-seeking behaviour and patient-related factors associated with the time to TB treatment initiation in four African countries: a cross-sectional survey. BMJ Public Health. 2024;2(2):e001002. Available from: https://doi.org/10.1136/bmjph-2024-001002
  5. Shah AP, Dave JD, Makwana MN, Rupani MP, Shah IA. A mixed-methods study on impact of active case finding on pulmonary tuberculosis treatment outcomes in India. Archives of Public Health. 2024;82(1):92. Available from: https://doi.org/10.1186/s13690-024-01326-0
  6. Nyasulu P, Phiri F, Sikwese S, Chirwa T, Singini I, Banda HT, et al. Factors Influencing Delayed Health Care Seeking Among Pulmonary Tuberculosis Suspects in Rural Communities in Ntcheu District, Malawi. Qual Health Res. 2016;26(9):1275–88. Available from: https://doi.org/10.1177/1049732315588083
  7. Craciun OM, Torres M del R, Llanes AB, Romay-Barja M. Tuberculosis Knowledge, Attitudes, and Practice in Middle- and Low-Income Countries: A Systematic Review. Journal of Tropical Medicine. 2023;2023(1):1014666. Available from: https://doi.org/10.1155/2023/1014666
  8. Dixit K, Biermann O, Rai B, Aryal TP, Mishra G, Teixeira de Siqueira-Filha N, et al. Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention. BMJ Open. 2021;11(10):e049900. Available from: https://doi.org/10.1136/bmjopen-2021-049900
  9. Santos JA, Leite A, Soares P, Duarte R, Nunes C. Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal. BMC Public Health. 2021;21(1):2178. Available from: https://doi.org/10.1186/s12889-021-12245-y
  10. Chukwu JN, Onah CK, Ossai EN, Nwafor CC, Alphonsus C, Ezeakile OE, et al. Improving TB Case Detection Through Active Case-Finding: Results of Multiple Intervention Strategies in Hard-to-Reach Riverine Areas of Southern Nigeria. GLOB HEALTH SCI PRACT. 2024;12(1):e2300164. Available from: https://doi.org/10.9745/GHSP-D-23-00164
  11. Putra IWGAE, Kurniasari NMD, Dewi NPEP, Suarjana IK, Duana IMK, Mulyawan IKH, et al. The Implementation of Early Detection in Tuberculosis Contact Investigation to Improve Case Finding. Journal of Epidemiology and Global Health. 2019;9(3):191–7. Available from: https://doi.org/10.2991/jegh.k.190808.001
  12. Ayabina DV, Gomes MGM, Nguyen NV, Vo L, Shreshta S, Thapa A, et al. The impact of active case finding on transmission dynamics of tuberculosis: A modelling study. PLOS ONE. 2021;16(11):e0257242. Available from: https://doi.org/10.1371/journal.pone.0257242
  13. Seid G, Alemu A, Diriba G, Zerihun B, Abebaw Y, Moga S, et al. Routine tuberculosis contact investigation yield and preventive treatment cascade in central Ethiopia. Heliyon. 2024;10(10):e30942. Available from: https://doi.org/10.1016/j.heliyon.2024.e30942
  14. Zellweger J-P. Is the EU model for contact investigation applicable to high TB burden settings? International Journal of Infectious Diseases. 2020;92:S55–9. Available from: https://doi.org/10.1016/j.ijid.2020.02.013
  15. Shaluhiyah Z, Handayani S, Sriatmi A, Agushybana F, Rimawati E. Understanding tuberculosis as a wicked problem: a qualitative study in coastal urban settlements of Semarang, Indonesia. Frontiers in Communication. 2025;10:1719819. Available from: https://doi.org/10.3389/fcomm.2025.1719819
  16. Taylor M, Medley N, van Wyk SS, Oliver S. Community views on active case finding for tuberculosis in low‐ and middle‐income countries: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews. 2024;(3):CD014756. Available from: https://doi.org/10.1002/14651858.CD014756.pub2
  17. Godoy S, Parrón I, Millet J-P, Caylà JA, Follia N, Carol M, et al. Losses in the Care Cascade for Latent Tuberculosis Infection in the Tracing Contact Studies. Pathogens. 2023;12(12):1403. Available from: https://doi.org/10.3390/pathogens12121403
  18. Yeoh AST, Mahmood MI, Ganason M, Ang SH, Peng PWY, Min J, et al. The cascade of care for latent tuberculosis infection in Malaysia: a cohort analysis. BMC Infectious Diseases. 2026;26(1):685. Available from: https://doi.org/10.1186/s12879-026-12943-1
  19. Chakaya J, Khan M, Ntoumi F, Aklillu E, Fatima R, Mwaba P, et al. Global Tuberculosis Report 2020 – Reflections on the Global TB burden, treatment and prevention efforts. International Journal of Infectious Diseases. 2021;113:S7–12. Available from: https://doi.org/10.1016/j.ijid.2021.02.107
  20. de Vries SG, Cremers AL, Heuvelings CC, Greve PF, Visser BJ, Bélard S, et al. Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature. The Lancet Infectious Diseases. 2017;17(5):e128–43. Available from: https://doi.org/10.1016/S1473-3099(16)30531-X
  21. Fenta MD, Ogundijo OA, Warsame AAA, Belay AG. Facilitators and barriers to tuberculosis active case findings in low- and middle-income countries: a systematic review of qualitative research. BMC Infectious Diseases. 2023;23(1):515. Available from: https://doi.org/10.1186/s12879-023-08502-7
  22. Kongkamol C, Chintrakul A, Horsiritham K, Kiranantawat N, Nirattisaikul S, Sungsiri J, et al. The predictors of voluntary participation in pulmonary tuberculosis screening program: a study in a suburban community of southern Thailand. Frontiers in Public Health. 2024;12:1360986. Available from: https://doi.org/10.3389/fpubh.2024.1360986
  23. Lau LLH, Hung N, Dodd W, Lim K, Ferma JD, Cole DC. Social trust and health seeking behaviours: A longitudinal study of a community-based active tuberculosis case finding program in the Philippines. SSM - Population Health. 2020;12:100664. Available from: https://doi.org/10.1016/j.ssmph.2020.100664
  24. Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science. 2011;6(1):42. Available from: https://doi.org/10.1186/1748-5908-6-42
  25. Kay AW, Sandoval M, Mtetwa G, Mkhabela M, Ndlovu B, Devezin T, et al. Vikela Ekhaya: A Novel, Community-based, Tuberculosis Contact Management Program in a High Burden Setting. Clinical Infectious Diseases. 2022;74(9):1631–8. Available from: https://doi.org/10.1093/cid/ciab652
  26. Lukman M, Ibrahim K, Yani DI, Prista Sari S, Juniarti N. Strategies to Improve the Performance of Community Health Volunteers for Tuberculosis Care and Prevention: A Qualitative Study. International Journal of Community Based Nursing & Midwifery. 2019;7(4):270–8. Available from: https://doi.org/10.30476/ijcbnm.2019.81353.0
  27. Yassin MA, Datiko DG, Tulloch O, Markos P, Aschalew M, Shargie EB, et al. Innovative Community-Based Approaches Doubled Tuberculosis Case Notification and Improve Treatment Outcome in Southern Ethiopia. PLOS ONE. 2013;8(5):e63174. Available from: https://doi.org/10.1371/journal.pone.0063174
  28. van Wyk SS, Blose N, Kapanda-Phiri L, Claassens M, Young T. The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review. eClinicalMedicine. 2025;79:103010. Available from: https://doi.org/10.1016/j.eclinm.2024.103010
  29. MacPherson P, Shanaube K, Phiri MD, Rickman HM, Horton KC, Feasey HRA, et al. Community-based active-case finding for tuberculosis: navigating a complex minefield. BMC Global and Public Health. 2024;2(1):9. Available from: https://doi.org/10.1186/s44263-024-00042-9
  30. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Available from: https://doi.org/10.1136/bmj.n71
  31. Barker TH, Habibi N, Aromataris E, Stone JC, Leonardi-Bee J, Sears K, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies. JBI Evidence Synthesis. 2024;22(3):378–88. https://doi.org/10.11124/JBIES-23-00268
  32. Barker TH, Stone JC, Sears K, Klugar M, Tufanaru C, Leonardi-Bee J, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evidence Synthesis. 2023;21(3):494–506. https://doi.org/10.11124/JBIES-22-00430
  33. Akwaowo C, Umoh V, Umoh I, Usoroh E, Motilewa O, Ekpin V, et al. Effectiveness of Providing Cash Incentives and Training To Community Health Workers on Active Case Finding for Tuberculosis In Nigeria: A Cluster-Randomized Control Trial. F1000Research. 2024;10:1154. Available from: https://doi.org/10.12688/f1000research.53822.2
  34. Shah L, Rojas Peña M, Mori O, Zamudio C, Kaufman JS, Otero L, et al. A pragmatic stepped-wedge cluster randomized trial to evaluate the effectiveness and cost-effectiveness of active case finding for household contacts within a routine tuberculosis program, San Juan de Lurigancho, Lima, Peru. International Journal of Infectious Diseases. 2020;100:95–103. Available from: https://doi.org/10.1016/j.ijid.2020.09.034
  35. Machavariani E, Cox SR, Nonyane BAS, Gvelesiani T, Martinson N, Dowdy DW, et al. A cluster-randomized trial of household vs incentive-based tuberculosis contact investigation in rural South Africa: implementation reach. PLOS Global Public Health. 2025;5(12):e0005580. Available from: https://doi.org/10.1371/journal.pgph.0005580
  36. Feasey HRA, Khundi M, Soko RN, Bottomley C, Chiume L, Burchett HED, et al. Impact of active case-finding for tuberculosis on case-notifications in Blantyre, Malawi: A community-based cluster-randomised trial (SCALE). PLOS Global Public Health. 2023;3(12):e0002683. Available from: https://doi.org/10.1371/journal.pgph.0002683
  37. Marks GB, Nguyen NV, Nguyen PTB, Nguyen T-A, Nguyen HB, Tran KH, et al. Community-wide Screening for Tuberculosis in a High-Prevalence Setting. New England Journal of Medicine. 2019;381(14):1347–57. Available from: https://doi.org/10.1056/NEJMoa1902129
  38. Kaswaswa K, MacPherson P, Kumwenda M, Mpunga J, Thindwa D, Nliwasa M, et al. Effect of patient-delivered household contact tracing and prevention for tuberculosis: A household cluster-randomised trial in Malawi. PLOS ONE. 2022;17(9):e0269219. Available from: https://doi.org/10.1371/journal.pone.0269219
  39. Davis JL, Turimumahoro P, Meyer AJ, Ayakaka I, Ochom E, Ggita J, et al. Home-based tuberculosis contact investigation in Uganda: a household randomised trial. ERJ Open Res. 2019;5(3):00112-2019. Available from: https://doi.org/10.1183/23120541.00112-2019
  40. Vo LNQ, Forse RJ, Codlin AJ, Vu TN, Le GT, Do GC, et al. A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam. BMC Public Health. 2020;20(1):934. Available from: https://doi.org/10.1186/s12889-020-09042-4
  41. Garg T, Bhardwaj M, Deo S. Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India. BMJ Open. 2020;10(10):e036625. Available from: https://doi.org/10.1136/bmjopen-2019-036625
  42. José B, Manhiça I, Jones J, Mutaquiha C, Zindoga P, Eduardo I, et al. Using community health workers for facility and community based TB case finding: An evaluation in central Mozambique. PLOS ONE. 2020;15(7):e0236262. Available from: https://doi.org/10.1371/journal.pone.0236262
  43. Morishita F, Eang MT, Nishikiori N, Yadav R-P. Increased Case Notification through Active Case Finding of Tuberculosis among Household and Neighbourhood Contacts in Cambodia. PLOS ONE. 2016;11(3):e0150405. Available from: https://doi.org/10.1371/journal.pone.0150405
  44. Sarwar G, Khan SM, Irfan SD, Khan MNM, Reza MdM, Rana AKMM, et al. Community based peer-led TB screening intervention: an innovative approach to increase TB knowledge, presumptive case identification, and referral among sexual minority people in urban Bangladesh. BMC Health Services Research. 2023;23(1):810. Available from: https://doi.org/10.1186/s12913-023-09737-5
  45. Codlin AJ, Monyrath C, Ky M, Gerstel L, Creswell J, Eang MT. Results from a roving, active case finding initiative to improve tuberculosis detection among older people in rural cambodia using the Xpert MTB/RIF assay and chest X-ray. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. 2018;13:22–7. Available from: https://doi.org/10.1016/j.jctube.2018.11.001

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