Review: missed tuberculosis cases in India: a systematic analysis of diagnostic, treatment, and reporting gaps
Abstract
BACKGROUND: India aims to eliminate tuberculosis (TB) by 2025. Despite ongoing efforts to transform TB care, numerous factors contribute to the persistence of missing cases in India. To gain insight into this issue, we performed a comprehensive review to identify the factors responsible for these missing cases, segregating them into patient- and provider-related factors, with reference to the layers of the onion model. METHODS: We conducted a comprehensive literature review using relevant search strings in the MEDLINE, Scopus, and Web of Science databases from 2000 to 2024. Given the heterogeneity of the included studies, a qualitative rather than quantitative data analysis approach was considered. For the quality evaluation of studies, we employed a modified version of the Critical Appraisal Skills Program (CASP) checklist. RESULTS: Of the 253 articles identified, 25 studies that met the criteria for “missing cases” were selected for analysis. Based on the objectives of this review, we identified patient-related factors contributing to missing cases, including geographical displacement due to migration or occupational reasons, alcoholism, illiteracy, personal commitments, side effects to Anti-Tubercular Treatment (ATT), depressive symptoms, perceived social stigma, reluctance to reveal prior treatment history, and no record keeping. Provider-related factors highlighted were inadequate communication and sputum sample collection, exhaustion of pharmaceutical supplies, patient…
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