Table 1 Characteristics of included studies that reported data on interventions that included counselling at the time of diagnostic evaluation for active TB

 Ullah, et al. 2020 [21]

Pakistan Community pharmacies 3025 presumptive TB cases

Implementation study to assess the feasibility and yield of community pharmacy-based TB case detection.

Community pharmacies provided referral slips to patients with presumptive TB (based on symptoms or purchase of anti-TB medication). For patients who re-presented to the pharmacy but had not followed up on referral, pharmacy staff provided counselling.

1901 patients in receipt of a referral actually visited GP clinics (referral uptake = 63%) and 547 cases were diagnosed with TB, that is, a positive referral outcome of 18%.

Every fifth referral among presumptive cases presenting and counseled at pharmacies was diagnosed with TB at GP clinics.

Lack of incentives for pharmacists

60%

 Putra et al. 2018, [22]

Indonesia Public health center 365 patients with diabetes mellitus (DM) type II being evaluated for TB

Nested cross-sectional qualitative study with structured questionnaires to identify factors associated with participation in pulmonary TB screening.

This study was nested within a TB diabetes screening study for which participants received counselling delivered by HCPs for pulmonary TB screening using chest x-ray.

Multivariate analysis showed that patients who received good support from their HCP, in the form of counselling was associated with participation in pulmonary TB screening [adjusted prevalence ratio = 1.35, 95% CI (1.06–1.70)].

Despite counselling, patient knowledge and attitudes related to TB and diabetes as co-morbidities were poor, highlighting the importance of high quality counselling.

Training HCPs in the delivery of high quality counselling.

Need to engage family members during the counselling process.

60%

 Belgaumkar et al. 2018 [23]

India Tertiary referral hospital 80 adults with smear positive pulmonary TB, 49 child contacts, and 25 health care providers (HCPs)

Cross-sectional study using semi-structured questionnaires and health record review to evaluate screening and isoniazid preventive therapy (IPT) provision among child contacts.

This was a programmatic evaluation (rather than an intervention study) of contact tracing referral and IPT uptake. Per program guidelines, index patients should receive counselling regarding contact screening and IPT.

Index cases with no counselling by HCPs (p < 0.001, adjusted OR [OR] 19.7) were less likely to have their child contact screened.

56/80 (70%) index patients were not counseled about TB risk and screening in child contacts. 39/56 (70%) said they were willing for screening and preventive therapy for child contacts if recommended.

19/25 (76%) HCPs said they routinely recommended index patients to bring their child contacts for screening.

20/24 (86%) of index patients who received advice about TB screening adhered.

The majority of index patients were reluctant to bring child contacts for screening as they did not have power to decide (i.e. were not the parent) (94%) and they did not think that the child would get TB (60%)

60%

 Kumar et al. 2013 [24]

United Kingdom TB clinics 1 index patient, 15 contacts

Case study describing a TB outbreak within a UK family where proven widespread transmission occurred but initial contact tracing yield was low.

Close contacts who screened negative for both LTBI and active TB were advised to be aware of symptoms and signs of disease affecting themselves and others.

Re-screening of contacts (who had received initial counselling) after one contact with LTBI developed active TB disease identified TB disease in 6/19 and LTBI in 8/19.

Buy-in from both the medical team is needed, since the educational component of counselling can be time consuming.

20%

 Furin et al. 2020, [25]

South Africa Households 8 patients with drug-resistant TB and 8 supporters

Retrospective, Cross-sectional qualitative using in-depth interviews to describe the meaning of ‘people centred care’.

The semi-structured interview guide included questions about challenges with drug-resistant TB diagnosis and care, and sources of support during care.

Few patients had support before formal diagnosis and this was usually from family members/spouses (almost always females).

Nurses were identified as the focal points for person-centered care but needed further training to provide counselling.

Multiple care providers at different facilities. Co-ordination and communication between them sub-optimal.

100%

 Khan et al. 2006 [26]

Pakistan Out-patient clinics 170 current and former TB patients (112 public sector, 58 private sector)

Cross sectional study using questionnaires to assess knowledge, attitudes and misconception about TB.

Questionnaire asked whether patients had received counselling about preventing TB transmission.

81/170 (48%) patients reported receiving no counselling by their physicians about how to prevent the spread of infection.

Inadequate knowledge of and misconceptions about TB on the part of general practitioners.

TB-related stigma.

40%

 Kivihya-Ndugga, et al. 2007 [27]

Kenya Chest Clinic 1469 patients with presumptive TB

Nested cross sectional cohort study to evaluate completion of the TB diagnostic process after counselling and to identify factors that impact adherence to recommended diagnostic process.

During evaluation of patients with presumptive TB, trained nurses provided counselling with a focus on obtaining three quality sputum specimens for evaluation

95% of the patients with presumptive TB who received counselling from trained nurses provided 3 sputum samples. There was no comparison group but this is higher than reported in other published data.

Counselling took 0.5 h/per patient.

Lack of staff capacity to undertake counselling.

60%

 Bonsu et al. 2017, [28]

Ghana TB clinics 35 clinic staff

Qualitative study using in-depth interviews to highlight healthcare professionals’ perspectives on patient satisfaction.

The interview guide was unstructured but one of the major themes highlighted was counselling and education.

Respondents frequently mentioned the need for patient counselling/education as core to satisfying TB patients, with three specific components: provision of TB related knowledge including transmission prevention, helping patients to cope with the diagnosis including stigma, and to provide education on appropriate techniques for providing sputum.

Long waiting times.

TB-related stigma.

70%

 Kirsch et al. 1999 [29]

United States Tertiary care center 630 presumptive TB cases

Implementation study to assess the feasibility and effectiveness of an emergency department (ED)-based TB screening and counselling program conducted in cooperation with the local public health department.

ED patients identified as being high-risk for having latent TB were counselled about TB and post-counselling assessment evaluated the patient’s understanding of purified protein derivative (PPD) testing and rates of follow up for PPD reading.

873 patients were counselled, 630 were eligible for screening, and 374 (59.4%) consented to purified protein derivative PPD testing. Of the 203 (54.1%) who returned, 32 (15.8%) were PPD-positive.

Initial counselling took an average of 28 min per patient. Enrollment with postcounselling testing, reeducation, and PPD placement took an additional 70 min.

Although it was not independently evaluated, counselling was highlighted as an important aspect of the study due to its influence over patients and their contacts with regard to seeking screening.

Training on counselling needed for program managers/all clinical staff.

High staff turnover.

Long waiting times.

Nurses unable to prescribe treatment.

50%

 Islam et al. 2015 [30]

Bangladesh DOTS Center, Chest Clinic and Tertiary care center 4974 referred cases, 234 TB patients from the referred cases and 30 healthcare providers

Quantitative study using structured questionnaires and record review to identify the gaps in the referral system, including the pre-treatment gap.

Patients were asked about ability to follow instructions given during counselling.

HCPs were interviewed regarding their knowledge about counselling and the process of referral.

Ability to follow instructions during counselling was significantly associated with identification of DOTS centres by patients who remained in the referral system.

Only 40% of health workers interviewed had the experience of referring TB patients to the DOTS centres through proper counselling.

Ensuring that patients can follow instructions provided during counselling.

Many patients are diagnosed by private providers who do not provide effective counselling.

70%

 McNally et al. 2019 [31]

Peru Healthcare centers or households 15 current or former MDR patients and 11 HCPs

Qualitative study using semi-structured interviews to examine patient perceptions, experiences and views on positive and negative factors that impact outcomes.

Counselling was not explicitly evaluated or mentioned but themes included patient knowledge and education.

Patients mention knowledge gaps and those with poor knowledge saw their education as the responsibility of HCPs.

HCPs acknowledged the importance of quality patient education and mentioned the importance of the method of delivery and source of the information.

An initial distrust of medical advice.

Inadequate clinical infrastructure.

TB-related stigma.

60%

 Mwansa-Kambafwile et al. 2020 [32]

South Africa Ward-based outreach teams and TB programming 9 program managers

Qualitative study using in-depth interviews to explore reasons for TB initial loss to follow up from the perspectives of TB and primary care program managers.

Interview guide included questions about TB related communication and reasons for loss to follow up.

Lack of counselling for TB (in comparison to HIV) mentioned as a reason for loss to follow up.

Staff reluctance to work in ‘TB room’.

Frequent staff rotations.

Staff shortages.

50%

 Colvin et al. 2019 [33]

The Philippines Health facilities 560 patients and 435 TB service providers

Cross-sectional quantitative study using questionnaire to identify and address gaps in the quality of TB services.

The study utilized a quality of TB services assessment that included questions about whether counselling was provided or received and included a series of items related to interpersonal counselling and communication (IPCC) skills were analyzed.

The analysis shows that providers consistently reported having covered basic TB information more often than patients reported receiving the information during counselling.

While 77% of providers reported that they discussed duration of TB treatment, only 33% of clients reported knowing how long treatment would last.

When clients reported lower levels of IPCC, their recall of key topics covered in counselling was lower.

Training of health care providers to improve communication and counselling skills

60%

 Mntlangula et al. 2017 [34]

South Africa Primary health center 87 nurses

Cross sectional quantitative study using self- administered questionnaires to assess the knowledge, attitude and beliefs of nurses about behavioral counselling for HIV and AIDS, sexually transmitted diseases and TB (HAST).

Counselling was the focus of the questionnaires, which were based on the Health Belief Model.

Although the majority of nurses were in favor of the counselling behavior for HAST, 54 (62%), (95% CI: 50.0, 71.0) believed that poverty stricken patients only need treatment since they cannot do anything to improve their health.

Some nurses had a negative attitude towards counselling behaviour for HAST, for example whether there was a benefit for patients with alcohol use disorders or for patients with good adherence.

Insufficient time to counsel patients properly and insufficient space.

Negative attitudes of HCPs regarding counselling may lead to counselling not being undertaken.

50%

 Ayakaka et al., 2017 [35]

Uganda Out-patient clinics and one general hospital 61 health care workers, 21 lay health workers (LHW), and 400 household contacts of newly diagnosed TB patients

Cross-sectional qualitative study using focus group discussions and interviews to identifying barriers to and facilitators of TB contact investigation in Kampala, Uganda.

Counselling was discussed as part of several themes that emerged from the data.

HCPs mentioned that tasks like TB education and counselling were often viewed as being of a low priority and thus ignored.

Patients mentioned that counselling provided by LHWs motivated them to initiate treatment promptly.

Insufficient personnel at TB unit.

Lack of dedicated space for TB care.

Fear of contracting TB among clinic staff.

TB-related stigma

Distrust of clinic-staff among contacts.

80%