From Home Visits to Diagnosis, Household Contacts’ Preferences for Tuberculosis Screening and Testing in the Eastern Cape, South Africa
1
Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
2
McGill International TB Research Centre, McGill University, Montreal, Canada
3
School of Global Health, York University, Toronto, Canada
4
Brody School of Medicine, East Carolina University, Greenville, United States
5
Department of Psychiatry, University of Pennsylvania, Philadelphia, United States
6
TB-HIV Pathogenesis Unit, CAPRISA MRC, Durban, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A641
ABSTRACT
BACKGROUND:
South Africa continues to face delays with TB diagnosis¹'². Household contacts (HHCs) are understood to be at high TB risk and a key interest group for the rollout of Targeted Universal Testing for TB (TUTT)³⁻⁶. We explored preferences and acceptability toward household contact investigations (HCIs) via home visits to inform TUTT implementation practices.
METHODS:
Between July 2024 and March 2025, HHCs referred for TB testing⁷ in Buffalo City Metropolitan, Eastern Cape, South Africa were interviewed about their TB contact investigation experiences, perceptions, and testing preferences. Responses were analyzed via thematic coding and mapped against the constructs of Sekhon’s acceptability framework⁸.
RESULTS:
Among 31 interviewed HHCs receiving HCI home visits (58% female; median age 53; 39% presented to healthcare facilities for TB testing), HHCs valued the personalized attention, including concern, follow-up, and advice by members of the HCI team (high affective attitude and ethicality). However, many had limited understanding of HCI relevance, TB infection versus disease, ongoing exposure risks, and often sought testing only when prompted by others or by symptoms (low coherence). Home visits were viewed as opportunities for enhanced household support for members living with TB and easier participation in HCIs, particularly among older individuals frequently screened for the first time despite regular health system contact (low burden and opportunity costs, high affective attitude and ethicality). For those who attended facilities, testing was considered acceptable and achievable, reflecting high self-efficacy, though some preferred alternative specimen collection due to long test result wait times, logistical barriers, and test accuracy concerns (higher burden and low perceived effectiveness).
DISCUSSION:
An acceptability framework deepened understanding of HHCs’ healthcare-seeking decisions, while HCIs was perceived as critical entry points for TB screening and care. Expanding home-based, mobile, and alternative specimen collection could further improve engagement and timely progression through the care cascade⁹⁻¹⁴.
South Africa continues to face delays with TB diagnosis¹'². Household contacts (HHCs) are understood to be at high TB risk and a key interest group for the rollout of Targeted Universal Testing for TB (TUTT)³⁻⁶. We explored preferences and acceptability toward household contact investigations (HCIs) via home visits to inform TUTT implementation practices.
METHODS:
Between July 2024 and March 2025, HHCs referred for TB testing⁷ in Buffalo City Metropolitan, Eastern Cape, South Africa were interviewed about their TB contact investigation experiences, perceptions, and testing preferences. Responses were analyzed via thematic coding and mapped against the constructs of Sekhon’s acceptability framework⁸.
RESULTS:
Among 31 interviewed HHCs receiving HCI home visits (58% female; median age 53; 39% presented to healthcare facilities for TB testing), HHCs valued the personalized attention, including concern, follow-up, and advice by members of the HCI team (high affective attitude and ethicality). However, many had limited understanding of HCI relevance, TB infection versus disease, ongoing exposure risks, and often sought testing only when prompted by others or by symptoms (low coherence). Home visits were viewed as opportunities for enhanced household support for members living with TB and easier participation in HCIs, particularly among older individuals frequently screened for the first time despite regular health system contact (low burden and opportunity costs, high affective attitude and ethicality). For those who attended facilities, testing was considered acceptable and achievable, reflecting high self-efficacy, though some preferred alternative specimen collection due to long test result wait times, logistical barriers, and test accuracy concerns (higher burden and low perceived effectiveness).
DISCUSSION:
An acceptability framework deepened understanding of HHCs’ healthcare-seeking decisions, while HCIs was perceived as critical entry points for TB screening and care. Expanding home-based, mobile, and alternative specimen collection could further improve engagement and timely progression through the care cascade⁹⁻¹⁴.
| eISSN: | 2654-1459 |
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