Epidemiology of TB screening among adults aged 18-64 years in South Africa in 2020

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The study aims to investigate the epidemiology of TB screening among people aged 18-64 years in South Africa. Methods This is a cross-sectional study with a study population of 132 adults in 6 provinces in South Africa. Data was collected through an online questionnaire. Outcome variable was self-reported TB screening within the past year. Descriptive statistics, multivariate logistic regression analysis were performed to determine prevalence and factors associated with TB screening, p-value <0.05 considered statistically significant. Results A third 37(38%) participants reported to have been screened for TB. Factors such as gender (AOR 1.54; p=0.490), participants in the age group 26-45 (AOR 7.80; p=0.010), Ever been tested for TB (AOR 23.17; p=0.000), and TB testing yearly (AOR 21.69; p=0.000) were positively associated with TB screening. Participants that had information on TB (AOR 0.20, p=0.031), and those who seek healthcare services (AOR 0.28, p=0.035) were significantly less likely to report TB screening. Conclusion Only a quarter of adults aged 18-64 in South Africa had been screened for TB, with significant associations observed for age, gender, previous TB screening, and recent TB testing. The structural barriers and the need for comprehensive, person-centered screening strategies to meet the WHO's 90% target are needed. The study recommends understanding the low utilization of health services, capacity building for healthcare providers, increasing awareness of TB symptoms, and conducting research on comprehensive TB screening approaches. Epidemiology Tuberculosis screening adults South Africa INTRODUCTION TB globally Tuberculosis (TB) has remained a global health emergency, despite being preventable and curable ( 1 ). Before the advent of the coronavirus (COVID-19) pandemic, TB was the leading cause of death from a singular infectious agent, ranking above HIV/AIDS ( 1 , 2 ). In 2020 the global TB incidence rate was 127/100 000 population, and 9.9 million people were reported to have been ill with TB the same year ( 3 ). The African region suffer the greatest burden of TB ( 1 ) which account for 28% of all the cases globally ( 4 ) Low- and middle-income countries accounted for more than 95% of all TB deaths( 4 ). In 2022 the region had about 2.5 million individuals with TB, equating to one person every second ( 1 ). From 2015 to 2022, the region saw a 23% reduction in new TB cases, exceeding the initial End TB Strategy target of 20% by 2020 ( 1 , 3 ). However, while the reduction in TB deaths is commendable, it still falls short of the 2025 End TB Strategy target of a 75% reduction. Similarly, the 23% decline in TB incidence mises the mark of the 50% reduction target for 2025. This highlights the need for continued and intensified efforts to meet these ambitious goals( 1 ). Challenges such as delayed diagnosis, limited access to new tools and technologies, and the ongoing threat of multi-drug-resistant TB require continued vigilance and sustained efforts within the region. South Africa is one of the countries that carry high burden of TB accounts for 3% of cases globally ( 5 ). The high rates of TB have been fuelled from the early 1990s by the HIV epidemic that negatively impacted TB control in the country ( 1 , 6 ). Although South Africa has a well-established TB control program ( 3 ). The identified factors driving TB morbidity and mortality in South Africa are poverty, socio-economic inequalities, delayed or limited access to screening, overcrowding and occupational risks ( 3 , 7 ). HIV infection increases the likelihood of reactivation of latent tuberculous infection (LTBI) and the pace of disease progression. Of all demographic groups, young women face the highest risk of HIV. The disproportionate vulnerability of female-headed households to poverty, sex-based violence and HIV puts women at further risk for TB ( 8 ),which is a current problem in South Africa due to its high HIV prevalence. The recent South African TB Prevalence Survey found that TB was particularly under-detected among people without HIV and suggested this is a group that needs more testing ( 6 ). In the 2021 Guidelines for Systematic Screening for Tuberculosis Disease, WHO recommended Systematic screening for TB disease in the general population and among people with risk factors, household and close contacts, inmates, PLHIV, people exposed to silica in workplaces in areas with a high TB prevalence ( 1 , 7 , 9 ). Emphasis made on screening of general population where the estimated prevalence of undiagnosed TB is above 0.5% (500 per 100,000) adults (10). The country has commitment itself in meeting the 90-90-90 WHO TB strategy through its National Strategic Plan for HIV, TB and STI 2023–2028 ( 7 ). The target aims to have at least 90% of the population screened for TB and placed on therapy; 90% of the vulnerable populations screened for TB and give access to appropriate therapy and achieved 90% of treatment success in all people diagnosed with TB ( 7 ). In 2021, the TB incidence in South Africa was 554 per 100 000 (328 000) among general population and 394 per 100 000 among people living with HIV (PLHIV). With a recorded mortality of 42 per 100 000 and 61 per 100 000 respectively ( 11 ). TB incidence still poses a threat within the country’s health system. The findings will inform policy and practice, guiding the optimization of the TB screening programs to better serve the broader community, ultimately reduce the burden of TB at population level, and thus contribute toward the WHO 90-90-90 TB targets ( 7 )Therefore, this study is a need to comprehensively investigate the epidemiology of TB screening among people aged 18–64 years. METHODS Study design and setting This was a Cross-Sectional study utilizing a Network-Based Digital Recruitment Technique( 12 ) in preparation for South Africa’s World TB Day Commemoration in Sedibeng District. This approach utilizes various digital platforms and the inherent social connections within these platforms, employing network-based sampling techniques where initial participants (seeds) recruit peers from their social networks, thereby creating a chain-referral system ( 12 , 13 ). Study population The study population comprised of132 adults aged 18–64 years. The inclusion criteria included Residing in Sedibeng District, willing to provide an informed consent. Pregnant women were excluded in the study. Data collection The data collection tool was developed by the SANAC Civil Society Forum Research Sector in close consultation with its members. A structured questionnaire was designed using Google Forms to assess various TB community interventions targeting engagement in TB screening and awareness, while also incorporating demographic characteristics and health-seeking behaviours. Key variables included:(Community TB awareness campaigns targeting men, deployment of mobile TB screening units in areas frequented by men, the role of community leaders as TB ambassadors, effectiveness of incentives for TB screening and distribution of Information, Education, and Communication (IEC) materials in male-dominated areas, partnerships with local sports teams to promote TB events, hosting TB screening events alongside other health services, conducting door-to-door outreach emphasizing the importance of TB screening, peer-to-peer outreach activities encouraging TB screening and community events centred around TB screening. The questionnaire was piloted among Civil Society Forum Research Sector and Men’s Sector leaders to ensure its relevance and clarity ( 14 ) Data Analysis Data were captured in Microsoft Excel and analysed using Stata software version 18. Participants were categorized by sex assigned at birth and age was categorized into three age groups: 18–25, 26–45 and 49&above. Educational levels were categorized into two groups: matric and below, and post-matric. The outcome variable was self-reported TB screening, determined by asking participants if they had been screened for TB in the past 12 months. Data were summarized using frequency distributions and descriptive statistics. Unadjusted logistic regression was employed to assess the association between TB screening and individual variables. Variables with a p-value < 0.20 were included in the multivariate logistic regression model. Results are presented as odds ratios (OR) with 95% confidence intervals (CI), providing a robust analysis of the factors influencing TB screening behaviours among the participants ( 15 ) . Results A total of 132 participants were included in the study. About a quarter of participants 37(28%) reported to have been screening for TB. 21(29.2%) males and 16(26.7%) were females screened. Less than half 12(33.3%) of participants aged 46 and above had screened. Of note, 9(100%) participants from the Northwest province had been screened. Only a quarter 22(25.2%) of those who utilize healthcare services had been screened for tuberculosis. Half of participants 12(50.0%) who visited healthcare facilities monthly reported being screened for tuberculosis. Over a third 23(85.2%) of those who visit healthcare facilities more than once a month were not screened for TB in the past year. Almost a third 13(72.2%) of participants who underwent TB testing annually were screened for the disease see table 1. Table 1 : study participants characteristics Variable Category TB screening No N=95(72%) Yes N=37(38%) N=132 Gender Male Female 51(70.8) 44(73.3) 21(29.2) 16(26.7) 72 60 Age group 18-25 26-35 46 & above 31(75.6) 40(72.7) 24(66.7) 10(24.4) 15(27.3) 12(33.3) 41 55 36 Marital status Complicated Divorced Married Single 0(0.0) 5(100.0) 38(82.6) 52(68.4) 5(100.0) 0(0.0) 8(17.4) 24(31.6) 5 5 46 76 Education Secondary Tertiary 60(75.0) 35(67.3) 20(25.0) 17(32.7) 80 52 Province Eastern Cape Gauteng KZN Limpopo Northwest Northern Cape 5 (55.6) 74(78.7) 6(60.0) 6(100.0) 0(0.0) 4(100.0) 4(44.4) 20(21.3) 4(40.0) 0(0.0) 9(100.0) 0(0.0) 9 94 10 6 9 4 Employment Unemployed Employed Other 62(73.8) 25(62.5) 8(100.0) 22(26.2) 15(40.5) 0(0.00) 84 40 8 Health access No Yes 0(0.0) 95(74.8) 5(100.0) 32(25.2) 5 127 Seek healthcare No Yes 35(70.0) 60(73.2) 15(30.0) 22(26.8) 50 82 Healthcare visits More than once monthly Once monthly Once in 3 months Once yearly Once in 6 months 23(85.2) 29(85.3) 12(50.0) 15(100.0) 16(50.0) 4(14.8) 5(14.7) 12(50.0) 0(0.0) 16(50.0) 27 34 24 15 32 Ever tested for TB No Yes 70(87.5) 25(48.1) 10(12.5) 27(51.9) 80 52 Test for TB yearly No Yes 90(78.9) 5(27.8) 24(21.0) 13(72.2) 114 18 Males had a higher likelihood of undergoing TB screening compared to females, though this association was not statistically significant (AOR: 1.54, 95% CI: 0.45-5.29, p=0.490). Age was a significant factor, with participants aged 46 and above being much more likely to undergo TB screening compared to those aged 17-25 (AOR: 7.80, 95% CI: 1.63-37.24, p=0.010). Those aged 26-45 also had a higher, though not statistically significant, likelihood of TB screening (AOR: 6.27, 95% CI: 0.89-44.15, p=0.065). Having information was associated with a significantly lower likelihood of undergoing TB screening (AOR: 0.20, 95% CI: 0.05-0.86, p=0.031). Seeking healthcare was significantly associated with a lower likelihood of TB screening (AOR: 0.28, 95% CI: 0.09-0.91, p=0.035). The frequency of healthcare visits was significant, with participants who visited healthcare facilities once in three months (AOR: 5.75, 95% CI: 1.52-21.73, p=0.010) and those who visited once yearly (AOR: 5.75, 95% CI: 1.62-20.43, p=0.007) having a significantly higher likelihood of TB screening compared to those who visited more than once monthly. Participants who had ever been tested for TB were significantly more likely to undergo TB screening (AOR: 23.17, 95% CI: 5.92-90.69, p<0.0001), and those who tested for TB yearly had a similarly high likelihood of undergoing TB screening (AOR: 21.69, 95% CI: 4.06-115.95, p<0.0001) (Table 2) Table 2 : Factors associated with TB screening in South Africa (N=132) Variables Levels Univariate regression Multivariate p-value C0R [95% CI] p-value AOR [95%CI] Gender Female Male 1 0.750 1 1.13[0.53-2.43] 1 0.490 1 1.54[0.45-5.29] Age group 18-25 26-45 46& above 0.750 0.388 1 0.65[0.24-1.74] 0.75[0.30-1.87] 1 0.065 0.010 1 6.27[0.89-44.15] 7.80[1.63-37.24] 1 Information No Yes 1 0.428 1 1.43[0.58-3.54] 1 0.031 1 0.20[0.05-0.86] Education Secondary Tertiary 1 0.337 1 1.46[.68- 3.14] Province Non-coastal Coastal 1 0.429 1 1.47[0.56-3.83] Seek healthcare No Yes 1 0.694 1 0.86[0.39-1.86] 1 0.035 1 0.28[0.09-0.91] Healthcare visits More than once monthly Once monthly Once in 3 months Once in 6 months 1 0.990 0.010 0.007 1 1.00[0.24- 4.12] 5.75[1.52-21.73] 5.75[1.62- 20.43] Ever tested for TB No Yes 0.000 7.56[3.21-17.81] 1 0.000 1 23.17[5.92-90.69] Test for TB yearly No Yes 0.000 9.75[3.16-30.04] 0.000 1 21.69[4.06-115.95] Discussion The study was conducted to investigate the epidemiology of TB screening among adults aged 18–64 years in South Africa. Notably, barely less than half of the participants reported to have been screened for TB. The following factors were found to be positively associated with TB screening age, gender, having had ever been screened for TB, having been tested for TB in the past year. However, having information on TB screening, and seeking healthcare were negatively associated with TB screening. This study found a lower prevalence of TB screening among people aged 18–64 in South Africa. These findings are consistent with findings from a study conducted among agricultural workers in South Africa which reported a TB screening prevalence of 56%( 3 ) which is far below the 90% target of the end TB strategy by WHO( 16 ). When TB screening is low, there is reduced case finding, which has implications in reducing transmission, morbidity, and mortality( 17 ). Accurate and scalable tuberculosis screening is also important to exclude tuberculosis before initiating tuberculosis preventive therapy ( 3 ). The TB program in South Africa need to ensure to plan for services that will ensure increased uptake of TB screening to meet the WHO 90% target. Providing information on TB screening did not improve participants uptake of TB screening services in this study. This long-established link did not hold in this study. Previous studies reported that knowledge increases the likelihood of screening uptake ( 3 , 18 , 19 ). The reasons for this varied; it may be due to lack of awareness as the information provided in our study as it was targeted to men, not all people may have accessed such information as it was provided in selected settings. This study findings revealed that there was low utilization of healthcare services as less participants visited health facilities, although they are accessible. This indicates that there is great need of TB sensitization to ensure uptake of TB services as TB screening is crucial for early detection and treatment ( 17 , 20 ). A study conducted in Bangladesh reported that fear and stigma in healthcare facilities is one of the main barriers to TB screening uptake ( 21 ). Having been ever tested for TB in the past increased the likelihood of screening for TB. Participants from different provinces might have different knowledge on TB screening and its importance. Having been tested for TB is secondary to testing, as people are screened before they can test ( 20 ). This signifies a gap in service. Findings from this study is the same as findings from a study conducted in Tanzania found that some healthcare facilities had varied numbers of patients screened for TB, not all patients seen were screened( 22 ). There is lack of consistency in service delivery within the system. There is a need to provide person-centredness services ( 23 ). There is a need for comprehensive TB screening in healthcare facilities, there was a noticeable gap in screening among people who attended healthcare facilities, some would be attending monthly but not screened this truly signifies a gap in service delivery. Which is against the goals in the South African strategic plan for TB, HIV and STI’s that aims at achieving objective 2.5 (strengthen TB prevention interventions for key and other priority populations and implement airborne infection prevention and control in health facilities and high-risk indoor places where people congregate) of goal 2 maximizing equitable and equal access to HIV, TB and STI services and solutions( 7 , 24 ). It has been previously reported that gender has influence on TB screening uptake ( 2 , 5 , 8 ), with females being likely to screen than males( 25 ). However, it was not the case in this study. Screening uptake was not associated with gender. Such findings have been reported in South Africa in a study that was conducted by Mlangeni and colleagues among agricultural workers( 3 ). This finding suggests that structural rather than individual factors are the main barriers to TB screening among this population. Recommendations There is a need to understand the low utilization of health services among the population of South Africa. Capacity building for healthcare providers to ensure that all clients seeking healthcare facility should be screened for TB might be either they are a symptomatic or not. Increase awareness of the significance of TB symptoms to prompt early care seeking. Increase and sustain heightened vigilance by healthcare professionals in assessing TB symptoms among those who attend health care facilities to promote early identification of presumptive TB and elicit diagnosis. Undertake research to better understand the holistic WHO pillars of TB screening among all population, this only focused on men’s interventions not on general population. In the 2019 Global TB report, the HIV co-infection rate among notified TB cases in South Africa was 59%, which highlights the continued importance of HIV to the TB epidemic( 6 ) It was noted that this study did not consider HIV/AIDS which is a critical factor to consider when dealing with issues of TB. In future studies there is a need to understand the epidemiology of TB screening even among PLHIV. ABBREVIATIONS Term/Abbreviation Definition AIDS Acquired immunodeficiency syndrome HIV Human immunodeficiency virus TB Tuberculosis PLHIV People living with HIV Declarations Ethics approval and consent to participate Ethical approval was obtained from University of Johannesburg Research Ethics Committee, Faculty of Health Sciences with the approval number REC-1541-2022, NHREC Registration: REC 241112-035 for the Process Evaluation of the Community Response System in South Africa. Participants offered consent for participation prior to participation in the study. Availability of data and materials The data for this study is available on reasonable request from the corresponding author. Competing interests The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Authors contribution The conceptualisation of this study was done by N.T, M.M, M.M, X.S, D.E, S.M, N.M, C.M, S.D, T.M.N, M.C, N.M. Data analysis was done by X.S, S.D, D.E. Methodology was done by N.T, X.S, S.D,D.E Literature review was done by N.T, X.S, S.D,D.E. Writing of the original draft was done by N.T, X.S, S.D,D.E. Writing, review and editing was done by and all authors have read and approved the final version of the article. Disclaimer The views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings, and content. References Tuberculosis in the WHO African Region: 2023 progress update. https://www.afro.who.int/publications/tuberculosis-who-african-region-2023-progress-update Global Tuberculosis report 2022 [Internet]. 2022. 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Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 29 Oct, 2024 Editor assigned by journal 29 Oct, 2024 Submission checks completed at journal 27 Oct, 2024 First submitted to journal 17 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Solutions","correspondingAuthor":false,"prefix":"","firstName":"Clinton","middleName":"","lastName":"Moyo","suffix":""},{"id":371607599,"identity":"9456daf3-3759-48cf-aea3-a47779e10f14","order_by":8,"name":"Elakpa Daniel Ngbede","email":"","orcid":"","institution":"The Best Health Solutions","correspondingAuthor":false,"prefix":"","firstName":"Elakpa","middleName":"Daniel","lastName":"Ngbede","suffix":""},{"id":371607600,"identity":"05cc1b0f-d1e9-48f0-aa1e-b1a57ffd9d48","order_by":9,"name":"Sinothando Dlamini","email":"","orcid":"","institution":"The Best Health Solutions","correspondingAuthor":false,"prefix":"","firstName":"Sinothando","middleName":"","lastName":"Dlamini","suffix":""},{"id":371607601,"identity":"c0c9a9c5-716c-45fb-96ce-52e9ca090511","order_by":10,"name":"Tshepo M Ndhlovu","email":"","orcid":"","institution":"The Best Health Solutions","correspondingAuthor":false,"prefix":"","firstName":"Tshepo","middleName":"M","lastName":"Ndhlovu","suffix":""},{"id":371607602,"identity":"4f59164b-a2b0-49ef-aca9-c23f38ac104e","order_by":11,"name":"Phumlani Ximiya","email":"","orcid":"","institution":"National TB Unit","correspondingAuthor":false,"prefix":"","firstName":"Phumlani","middleName":"","lastName":"Ximiya","suffix":""},{"id":371607603,"identity":"90dc85a0-add9-4f2a-93a8-24d5e0ec4756","order_by":12,"name":"Martha Chadyiwa","email":"","orcid":"","institution":"University of Johannesburg","correspondingAuthor":false,"prefix":"","firstName":"Martha","middleName":"","lastName":"Chadyiwa","suffix":""},{"id":371607604,"identity":"fc7e8522-9a8d-475c-ae6a-d706b093b9fb","order_by":13,"name":"Ntsieni Mashau","email":"","orcid":"","institution":"University of Venda","correspondingAuthor":false,"prefix":"","firstName":"Ntsieni","middleName":"","lastName":"Mashau","suffix":""}],"badges":[],"createdAt":"2024-10-17 19:38:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5284940/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5284940/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68375343,"identity":"d0f12625-e92d-45ba-8db8-f6402c5c4345","added_by":"auto","created_at":"2024-11-06 15:10:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":495370,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5284940/v1/1f931724-4a5a-419e-9f92-0d53c361d175.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiology of TB screening among adults aged 18-64 years in South Africa in 2020","fulltext":[{"header":"INTRODUCTION","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eTB globally\u003c/h2\u003e \u003cp\u003eTuberculosis (TB) has remained a global health emergency, despite being preventable and curable (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Before the advent of the coronavirus (COVID-19) pandemic, TB was the leading cause of death from a singular infectious agent, ranking above HIV/AIDS (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In 2020 the global TB incidence rate was 127/100 000 population, and 9.9\u0026nbsp;million people were reported to have been ill with TB the same year (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The African region suffer the greatest burden of TB (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) which account for 28% of all the cases globally (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Low- and middle-income countries accounted for more than 95% of all TB deaths(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In 2022 the region had about 2.5\u0026nbsp;million individuals with TB, equating to one person every second (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). From 2015 to 2022, the region saw a 23% reduction in new TB cases, exceeding the initial End TB Strategy target of 20% by 2020 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, while the reduction in TB deaths is commendable, it still falls short of the 2025 End TB Strategy target of a 75% reduction. Similarly, the 23% decline in TB incidence mises the mark of the 50% reduction target for 2025. This highlights the need for continued and intensified efforts to meet these ambitious goals(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Challenges such as delayed diagnosis, limited access to new tools and technologies, and the ongoing threat of multi-drug-resistant TB require continued vigilance and sustained efforts within the region.\u003c/p\u003e \u003cp\u003eSouth Africa is one of the countries that carry high burden of TB accounts for 3% of cases globally (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The high rates of TB have been fuelled from the early 1990s by the HIV epidemic that negatively impacted TB control in the country (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Although South Africa has a well-established TB control program (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe identified factors driving TB morbidity and mortality in South Africa are poverty, socio-economic inequalities, delayed or limited access to screening, overcrowding and occupational risks (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e7\u003c/span\u003e). HIV infection increases the likelihood of reactivation of latent tuberculous infection (LTBI) and the pace of disease progression. Of all demographic groups, young women face the highest risk of HIV. The disproportionate vulnerability of female-headed households to poverty, sex-based violence and HIV puts women at further risk for TB (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e8\u003c/span\u003e),which is a current problem in South Africa due to its high HIV prevalence. The recent South African TB Prevalence Survey found that TB was particularly under-detected among people without HIV and suggested this is a group that needs more testing (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In the 2021 Guidelines for Systematic Screening for Tuberculosis Disease, WHO recommended Systematic screening for TB disease in the general population and among people with risk factors, household and close contacts, inmates, PLHIV, people exposed to silica in workplaces in areas with a high TB prevalence (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Emphasis made on screening of general population where the estimated prevalence of undiagnosed TB is above 0.5% (500 per 100,000) adults (10). The country has commitment itself in meeting the 90-90-90 WHO TB strategy through its National Strategic Plan for HIV, TB and STI 2023–2028 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The target aims to have at least 90% of the population screened for TB and placed on therapy; 90% of the vulnerable populations screened for TB and give access to appropriate therapy and achieved 90% of treatment success in all people diagnosed with TB (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 2021, the TB incidence in South Africa was 554 per 100 000 (328 000) among general population and 394 per 100 000 among people living with HIV (PLHIV). With a recorded mortality of 42 per 100 000 and 61 per 100 000 respectively (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). TB incidence still poses a threat within the country’s health system. The findings will inform policy and practice, guiding the optimization of the TB screening programs to better serve the broader community, ultimately reduce the burden of TB at population level, and thus contribute toward the WHO 90-90-90 TB targets (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e7\u003c/span\u003e)Therefore, this study is a need to comprehensively investigate the epidemiology of TB screening among people aged 18–64 years.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e\n\n\n\n "},{"header":"METHODS","content":"\u003ch2\u003eStudy design and setting\u003c/h2\u003e\u003cp\u003eThis was a Cross-Sectional study utilizing a Network-Based Digital Recruitment Technique(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) in preparation for South Africa’s World TB Day Commemoration in Sedibeng District. This approach utilizes various digital platforms and the inherent social connections within these platforms, employing network-based sampling techniques where initial participants (seeds) recruit peers from their social networks, thereby creating a chain-referral system (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003ch3\u003eStudy population\u003c/h3\u003e\u003cp\u003eThe study population comprised of132 adults aged 18–64 years. The inclusion criteria included Residing in Sedibeng District, willing to provide an informed consent. Pregnant women were excluded in the study.\u003c/p\u003e\u003ch3\u003eData collection\u003c/h3\u003e\u003cp\u003eThe data collection tool was developed by the SANAC Civil Society Forum Research Sector in close consultation with its members. A structured questionnaire was designed using Google Forms to assess various TB community interventions targeting engagement in TB screening and awareness, while also incorporating demographic characteristics and health-seeking behaviours. Key variables included:(Community TB awareness campaigns targeting men, deployment of mobile TB screening units in areas frequented by men, the role of community leaders as TB ambassadors, effectiveness of incentives for TB screening and distribution of Information, Education, and Communication (IEC) materials in male-dominated areas, partnerships with local sports teams to promote TB events, hosting TB screening events alongside other health services, conducting door-to-door outreach emphasizing the importance of TB screening, peer-to-peer outreach activities encouraging TB screening and community events centred around TB screening. The questionnaire was piloted among Civil Society Forum Research Sector and Men’s Sector leaders to ensure its relevance and clarity (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData were captured in Microsoft Excel and analysed using Stata software version 18. Participants were categorized by sex assigned at birth and age was categorized into three age groups: 18–25, 26–45 and 49\u0026amp;above. Educational levels were categorized into two groups: matric and below, and post-matric. The outcome variable was self-reported TB screening, determined by asking participants if they had been screened for TB in the past 12 months. Data were summarized using frequency distributions and descriptive statistics. Unadjusted logistic regression was employed to assess the association between TB screening and individual variables. Variables with a p-value \u0026lt; 0.20 were included in the multivariate logistic regression model. Results are presented as odds ratios (OR) with 95% confidence intervals (CI), providing a robust analysis of the factors influencing TB screening behaviours among the participants (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) .\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 132 participants were included in the study. About a quarter of participants 37(28%) reported to have been screening for TB. 21(29.2%) males and 16(26.7%) were females screened. Less than half 12(33.3%) of participants aged 46 and above had screened. Of note, 9(100%) participants from the Northwest province had been screened. Only a quarter 22(25.2%) of those who utilize healthcare services had been screened for tuberculosis. Half of participants 12(50.0%) who visited healthcare facilities monthly reported being screened for tuberculosis. Over a third 23(85.2%) of those who visit healthcare facilities more than once a month were not screened for TB in the past year. Almost a third 13(72.2%) of participants who underwent TB testing annually were screened for the disease see table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e: study participants characteristics\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"719\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTB screening\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN=95(72%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN=37(38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN=132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e51(70.8)\u003c/p\u003e\n \u003cp\u003e44(73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e21(29.2)\u003c/p\u003e\n \u003cp\u003e16(26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eAge group\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e18-25\u003c/p\u003e\n \u003cp\u003e26-35\u003c/p\u003e\n \u003cp\u003e46 \u0026amp; above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e31(75.6)\u003c/p\u003e\n \u003cp\u003e40(72.7)\u003c/p\u003e\n \u003cp\u003e24(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e10(24.4)\u003c/p\u003e\n \u003cp\u003e15(27.3)\u003c/p\u003e\n \u003cp\u003e12(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eMarital status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eComplicated\u003c/p\u003e\n \u003cp\u003eDivorced\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e5(100.0)\u003c/p\u003e\n \u003cp\u003e38(82.6)\u003c/p\u003e\n \u003cp\u003e52(68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e5(100.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e8(17.4)\u003c/p\u003e\n \u003cp\u003e24(31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTertiary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e60(75.0)\u003c/p\u003e\n \u003cp\u003e35(67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e20(25.0)\u003c/p\u003e\n \u003cp\u003e17(32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eProvince\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eEastern Cape\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGauteng\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eKZN\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLimpopo\u003c/p\u003e\n \u003cp\u003eNorthwest\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNorthern Cape\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e5 (55.6)\u003c/p\u003e\n \u003cp\u003e74(78.7)\u003c/p\u003e\n \u003cp\u003e6(60.0)\u003c/p\u003e\n \u003cp\u003e6(100.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e4(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4(44.4)\u003c/p\u003e\n \u003cp\u003e20(21.3)\u003c/p\u003e\n \u003cp\u003e4(40.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e9(100.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eEmployment\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEmployed\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e62(73.8)\u003c/p\u003e\n \u003cp\u003e25(62.5)\u003c/p\u003e\n \u003cp\u003e8(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e22(26.2)\u003c/p\u003e\n \u003cp\u003e15(40.5)\u003c/p\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eHealth access\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e95(74.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e5(100.0)\u003c/p\u003e\n \u003cp\u003e32(25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eSeek healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e35(70.0)\u003c/p\u003e\n \u003cp\u003e60(73.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e15(30.0)\u003c/p\u003e\n \u003cp\u003e22(26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eHealthcare visits\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eMore than once monthly\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOnce monthly\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOnce in 3 months\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOnce yearly\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOnce in 6 months \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e23(85.2)\u003c/p\u003e\n \u003cp\u003e29(85.3)\u003c/p\u003e\n \u003cp\u003e12(50.0)\u003c/p\u003e\n \u003cp\u003e15(100.0)\u003c/p\u003e\n \u003cp\u003e16(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4(14.8)\u003c/p\u003e\n \u003cp\u003e5(14.7)\u003c/p\u003e\n \u003cp\u003e12(50.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e16(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eEver tested for TB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e70(87.5)\u003c/p\u003e\n \u003cp\u003e25(48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e10(12.5)\u003c/p\u003e\n \u003cp\u003e27(51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eTest for TB yearly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e90(78.9)\u003c/p\u003e\n \u003cp\u003e5(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e24(21.0)\u003c/p\u003e\n \u003cp\u003e13(72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMales had a higher likelihood of undergoing TB screening compared to females, though this association was not statistically significant (AOR: 1.54, 95% CI: 0.45-5.29, p=0.490). Age was a significant factor, with participants aged 46 and above being much more likely to undergo TB screening compared to those aged 17-25 (AOR: 7.80, 95% CI: 1.63-37.24, p=0.010). Those aged 26-45 also had a higher, though not statistically significant, likelihood of TB screening (AOR: 6.27, 95% CI: 0.89-44.15, p=0.065). Having information was associated with a significantly lower likelihood of undergoing TB screening (AOR: 0.20, 95% CI: 0.05-0.86, p=0.031). Seeking healthcare was significantly associated with a lower likelihood of TB screening (AOR: 0.28, 95% CI: 0.09-0.91, p=0.035). The frequency of healthcare visits was significant, with participants who visited healthcare facilities once in three months (AOR: 5.75, 95% CI: 1.52-21.73, p=0.010) and those who visited once yearly (AOR: 5.75, 95% CI: 1.62-20.43, p=0.007) having a significantly higher likelihood of TB screening compared to those who visited more than once monthly. Participants who had ever been tested for TB were significantly more likely to undergo TB screening (AOR: 23.17, 95% CI: 5.92-90.69, p\u0026lt;0.0001), and those who tested for TB yearly had a similarly high likelihood of undergoing TB screening (AOR: 21.69, 95% CI: 4.06-115.95, p\u0026lt;0.0001) (Table 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e: Factors associated with TB screening in South Africa (N=132)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"671\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevels\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate regression\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Multivariate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eC0R [95% CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003ep-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAOR [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.750\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.13[0.53-2.43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003cp\u003e1.54[0.45-5.29]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eAge group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e18-25\u003c/p\u003e\n \u003cp\u003e26-45\u003c/p\u003e\n \u003cp\u003e46\u0026amp; above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.750\u003c/p\u003e\n \u003cp\u003e0.388\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.65[0.24-1.74]\u003c/p\u003e\n \u003cp\u003e0.75[0.30-1.87]\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6.27[0.89-44.15]\u003c/p\u003e\n \u003cp\u003e7.80[1.63-37.24]\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eInformation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003cp\u003e1.43[0.58-3.54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.20[0.05-0.86]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTertiary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003cp\u003e1.46[.68- 3.14]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eProvince\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNon-coastal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCoastal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.47[0.56-3.83]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eSeek healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.86[0.39-1.86]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.28[0.09-0.91]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eHealthcare visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMore than once monthly\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOnce monthly\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOnce in 3 months\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOnce in 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.990\u003c/p\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.00[0.24- 4.12]\u003c/p\u003e\n \u003cp\u003e5.75[1.52-21.73]\u003c/p\u003e\n \u003cp\u003e5.75[1.62- 20.43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eEver tested for TB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.56[3.21-17.81]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e23.17[5.92-90.69]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eTest for TB yearly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9.75[3.16-30.04]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e21.69[4.06-115.95]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study was conducted to investigate the epidemiology of TB screening among adults aged 18\u0026ndash;64 years in South Africa. Notably, barely less than half of the participants reported to have been screened for TB. The following factors were found to be positively associated with TB screening age, gender, having had ever been screened for TB, having been tested for TB in the past year. However, having information on TB screening, and seeking healthcare were negatively associated with TB screening.\u003c/p\u003e \u003cp\u003eThis study found a lower prevalence of TB screening among people aged 18\u0026ndash;64 in South Africa. These findings are consistent with findings from a study conducted among agricultural workers in South Africa which reported a TB screening prevalence of 56%(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) which is far below the 90% target of the end TB strategy by WHO(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). When TB screening is low, there is reduced case finding, which has implications in reducing transmission, morbidity, and mortality(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Accurate and scalable tuberculosis screening is also important to exclude tuberculosis before initiating tuberculosis preventive therapy (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The TB program in South Africa need to ensure to plan for services that will ensure increased uptake of TB screening to meet the WHO 90% target.\u003c/p\u003e \u003cp\u003eProviding information on TB screening did not improve participants uptake of TB screening services in this study. This long-established link did not hold in this study. Previous studies reported that knowledge increases the likelihood of screening uptake (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The reasons for this varied; it may be due to lack of awareness as the information provided in our study as it was targeted to men, not all people may have accessed such information as it was provided in selected settings.\u003c/p\u003e \u003cp\u003eThis study findings revealed that there was low utilization of healthcare services as less participants visited health facilities, although they are accessible. This indicates that there is great need of TB sensitization to ensure uptake of TB services as TB screening is crucial for early detection and treatment (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). A study conducted in Bangladesh reported that fear and stigma in healthcare facilities is one of the main barriers to TB screening uptake (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHaving been ever tested for TB in the past increased the likelihood of screening for TB. Participants from different provinces might have different knowledge on TB screening and its importance. Having been tested for TB is secondary to testing, as people are screened before they can test (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This signifies a gap in service. Findings from this study is the same as findings from a study conducted in Tanzania found that some healthcare facilities had varied numbers of patients screened for TB, not all patients seen were screened(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). There is lack of consistency in service delivery within the system. There is a need to provide person-centredness services (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). There is a need for comprehensive TB screening in healthcare facilities, there was a noticeable gap in screening among people who attended healthcare facilities, some would be attending monthly but not screened this truly signifies a gap in service delivery. Which is against the goals in the South African strategic plan for TB, HIV and STI\u0026rsquo;s that aims at achieving objective 2.5 (strengthen TB prevention interventions for key and other priority populations and implement airborne infection prevention and control in health facilities and high-risk indoor places where people congregate) of goal 2 maximizing equitable and equal access to HIV, TB and STI services and solutions(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt has been previously reported that gender has influence on TB screening uptake (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e8\u003c/span\u003e), with females being likely to screen than males(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). However, it was not the case in this study. Screening uptake was not associated with gender. Such findings have been reported in South Africa in a study that was conducted by Mlangeni and colleagues among agricultural workers(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This finding suggests that structural rather than individual factors are the main barriers to TB screening among this population.\u003c/p\u003e\n\u003ch3\u003eRecommendations\u003c/h3\u003e\n\u003cp\u003eThere is a need to understand the low utilization of health services among the population of South Africa. Capacity building for healthcare providers to ensure that all clients seeking healthcare facility should be screened for TB might be either they are a symptomatic or not. Increase awareness of the significance of TB symptoms to prompt early care seeking. Increase and sustain heightened vigilance by healthcare professionals in assessing TB symptoms among those who attend health care facilities to promote early identification of presumptive TB and elicit diagnosis. Undertake research to better understand the holistic WHO pillars of TB screening among all population, this only focused on men\u0026rsquo;s interventions not on general population. In the 2019 Global TB report, the HIV co-infection rate among notified TB cases in South Africa was 59%, which highlights the continued importance of HIV to the TB epidemic(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e6\u003c/span\u003e) It was noted that this study did not consider HIV/AIDS which is a critical factor to consider when dealing with issues of TB. In future studies there is a need to understand the epidemiology of TB screening even among PLHIV.\u003c/p\u003e"},{"header":"ABBREVIATIONS","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTerm/Abbreviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDefinition\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAIDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAcquired immunodeficiency syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHuman immunodeficiency virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTuberculosis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePLHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePeople living with HIV\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from University of Johannesburg Research Ethics Committee, Faculty of Health Sciences with the approval number REC-1541-2022, NHREC Registration: REC 241112-035 for the Process Evaluation of the Community Response System in South Africa. Participants offered consent for participation prior to participation in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data for this study is available on reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe conceptualisation of this study was done by N.T, M.M, M.M, X.S, D.E, S.M, N.M, C.M, S.D, T.M.N, M.C, N.M. Data analysis was done by X.S, S.D, D.E. Methodology was done by N.T, X.S, S.D,D.E Literature review was done by N.T, X.S, S.D,D.E. Writing of the original draft was done by N.T, X.S, S.D,D.E. Writing, review and editing was done by \u0026nbsp;and all authors have read and approved the final version of the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimer\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings, and content.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eTuberculosis in the WHO African Region: 2023 progress update. https://www.afro.who.int/publications/tuberculosis-who-african-region-2023-progress-update\u003c/li\u003e\n \u003cli\u003eGlobal Tuberculosis report 2022 [Internet]. 2022. Available from: http://apps.who.int/bookorders.\u003c/li\u003e\n \u003cli\u003eMlangeni N, Malotle M, Made F, Ramodike J, Sikweyiya Y, Du Preez C, Thompson NS, Zungu M. Factors associated with TB screening among agricultural workers in Limpopo Province, South Africa. Glob Health Action. 2023 Dec 31;16(1):2162227. doi: 10.1080/16549716.2022.2162227.\u003c/li\u003e\n \u003cli\u003eOsman M, Karat AS, Khan M, Meehan SA, von Delft A, Brey Z, Charalambous S, Hesseling AC, Naidoo P, Loveday M. Health system determinants of tuberculosis mortality in South Africa: a causal loop model. 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BMC Public Health. 2017 Oct 10;17(1):795. doi: 10.1186/s12889-017-4825-3.\u003c/li\u003e\n \u003cli\u003eAerts C, Revilla M, Duval L, Paaijmans K, Chandrabose J, Cox H, Sicuri E. Understanding the role of disease knowledge and risk perception in shaping preventive behavior for selected vector-borne diseases in Guyana. PLoS Negl Trop Dis. 2020 Apr 6;14(4):e0008149. doi: 10.1371/journal.pntd.0008149.\u003c/li\u003e\n \u003cli\u003eWHO consolidated guidelines on tuberculosis. Module 2: Screening. Systematic screening for active tuberculosis (2020 update).\u003c/li\u003e\n \u003cli\u003eSarwar G, Khan SM, Irfan SD, Khan MNM, Reza MM, Rana AKMM, Banu RS, Ahmed S, Banu S, Khan SI. 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 Serv Res. 2023 Jul 29;23(1):810. doi: 10.1186/s12913-023-09737-5.\u003c/li\u003e\n \u003cli\u003eMaokola W, Ngowi B, Lawson L, Mahande M, Todd J, Msuya SE. Performance of and Factors Associated With Tuberculosis Screening and Diagnosis Among People Living With HIV: Analysis of 2012\u0026ndash;2016 Routine HIV Data in Tanzania. Front Public Health. 2020 Feb 6;7. doi.org/10.3389/fpubh.2019.00404\u003c/li\u003e\n \u003cli\u003eHealth service delivery 1. https://cdn.who.int/media/docs/default-source/service-availability-and-readinessassessment\u003c/li\u003e\n \u003cli\u003eTB Prevalence Survey SA_2022_SML (003)- march 2002.\u003c/li\u003e\n \u003cli\u003eShapiro AN, Scott L, Moultrie H, Jacobson KR, Bor J, Fofana AM, Dor G, Ndjeka NO, da Silva P, Mlisana K, Jenkins HE, Stevens WS. Tuberculosis testing patterns in South Africa to identify groups that would benefit from increased investigation. Sci Rep. 2023 Nov 27;13(1):20875. doi: 10.1038/s41598-023-47148-y.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Epidemiology, Tuberculosis, screening, adults, South Africa ","lastPublishedDoi":"10.21203/rs.3.rs-5284940/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5284940/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTuberculosis (TB) continues to be a public health issue of concern in South Africa. The study aims to investigate the epidemiology of TB screening among people aged 18-64 years in South Africa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a cross-sectional study with a study population of 132 adults in 6 provinces in South Africa. Data was collected through an online questionnaire. Outcome variable was self-reported TB screening within the past year. Descriptive statistics, multivariate logistic regression analysis were performed to determine prevalence and factors associated with TB screening, p-value \u0026lt;0.05 considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA third 37(38%) participants reported to have been screened for TB. Factors such as gender (AOR 1.54; p=0.490), participants in the age group 26-45 (AOR 7.80; p=0.010), Ever been tested for TB (AOR 23.17; p=0.000), and TB testing yearly (AOR 21.69; p=0.000) were positively associated with TB screening. Participants that had information on TB (AOR 0.20, p=0.031), and those who seek healthcare services (AOR 0.28, p=0.035) were significantly less likely to report TB screening.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnly a quarter of adults aged 18-64 in South Africa had been screened for TB, with significant associations observed for age, gender, previous TB screening, and recent TB testing. The structural barriers and the need for comprehensive, person-centered screening strategies to meet the WHO's 90% target are needed. The study recommends understanding the low utilization of health services, capacity building for healthcare providers, increasing awareness of TB symptoms, and conducting research on comprehensive TB screening approaches.\u003c/p\u003e","manuscriptTitle":"Epidemiology of TB screening among adults aged 18-64 years in South Africa in 2020","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-06 15:02:08","doi":"10.21203/rs.3.rs-5284940/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-29T07:22:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-29T07:09:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-28T03:08:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-10-17T19:22:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4df60d76-a878-44e9-b37d-9ca99426c6ea","owner":[],"postedDate":"November 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-24T06:40:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-06 15:02:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5284940","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5284940","identity":"rs-5284940","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}