# Active screening of presumptive tuberculosis cases in rural communities through youth club members in India: logic model development and feasibility study

## TL;DR

A youth volunteer-driven model for early TB detection in rural India was developed and found to be feasible, with community acceptance and suggestions for improvement.

## Contribution

A novel logic model for active TB screening through youth volunteers in rural India, validated through feasibility and acceptability studies.

## Key findings

- The logic model was accepted by participants due to community alignment and trust in volunteers.
- Key barriers included lack of financial incentives and logistical challenges.
- Improvement strategies focused on training, gender diversity, and intersectoral coordination.

## Abstract

The majority of presumptive TB cases report late. Early detection of tuberculosis (TB) cases is crucial for its control. We developed a logic model program involving members of a governmental and community-driven youth club of Nehru Yuva Kendra Sangathan (NYKS) volunteers and explored its feasibility.

The study defined the purpose, scope, and program domains. The domains were input, process, output, and outcome. These domains were drafted, refined, and finalized using standard techniques. A qualitative study, including in-depth interviews and focus group discussions, was undertaken with community members, healthcare staff, and NYKS volunteers across diverse settings. Acceptability, feasibility, effectiveness, barriers, and improvement strategies of the developed model were synthesized through thematic analysis.

The developed “Logic Model” aims to actively screen and motivate individuals with TB-suggestive symptoms for early detection of active TB, using various domains and corresponding activities. Information, education, communication (IEC), screening, referral, and case detection activities have been monitored using 36 indicators. Most participants expressed acceptance of the model, owing to its alignment with community values, trust among volunteers, and perceived benefits. Key motivators included the proximity of services, improved awareness, and civic responsibility. Barriers included a lack of financial incentives, logistical challenges, and overlapping stakeholder roles. Suggestions for improvement included enhancing gender diversity, confidentiality, volunteer training, and intersectoral coordination.

The developed logic model provides a visual display of the input, process, output, and outcome domains, their activities, and relationships. The model links resources, activities, and outcomes for the screening and referral of diagnosed cases. It was broadly accepted, despite some reported challenges. Addressing barriers is essential for program sustainability. Tailored strategies to improve volunteer support, training, and trust-building can enhance the model’s effectiveness and contribute to India’s TB elimination program.