Table 2 Recommendations for research studies: a) to quantify whether and how counselling is being delivered, b) to understand patient and HCP needs that could be fulfilled by counselling and c) to evaluate the impact of counselling on patient-important TB care outcomes

Operational or Implementation research

To quantify the extent to which diagnostic counselling is currently offered and evaluate delivery strategies, which could be incorporated as part of programmatic efforts.

Standardized patient studies that include indicators regarding diagnostic counselling (for patient support, explaining procedures, disclosure counselling etc.) that quantify whether, how and by whom counselling is being delivered as well as the quality of counselling.

Studies to test different approaches to the delivery of counselling, including assessment of by whom the counselling intervention should be implemented e.g. health workers (and type) versus peer navigators.

Pre-post studies using tools such as Knowledge, Attitudes, and Practices surveys to assess gaps in patient and health worker understanding and practice.

Qualitative studies

Interviews and/or focus groups with patients with TB, caregivers of people with TB and health workers to determine which topics should be addressed by counselling.

Evaluating the optimal approach to training HWs on counselling and interpersonal communication skills.

Use of explanatory frameworks to understand drivers of loss to follow up and potential roles for counselling including different types of behavioural change techniques.

Intervention studies

Rigorously designed and conducted studies to test the impact of diagnostic counselling with a comparator group.

Quasi-experimental or randomised controlled trials to evaluate the impact of diagnostic counselling on TB cascade of care outcomes.

Translating insights from counselling research conducted for other stigmatized illnesses (i.e. HIV, mental illness) to TB and developing integrated care models.