1 Sarwar G, et al. BMJ Open 2020;10:e037371. doi:10.1136/bmjopen-2020-037371 Open access Developing and testing community- based tuberculosis (TB) screening intervention to increase TB referral, case detection and knowledge among sexual minority people in urban Bangladesh: a mixed-method study protocol Golam Sarwar, 1 Masud Reza, 1 Mohammad Niaz Morshed Khan, 1 Gorkey Gourab, 1 Mahbubur Rahman, 1 A K M Masud Rana, 1 Shaan Muberra Khan, 1 Samira Dishti Irfan, 1 Shahriar Ahmed , 1 Rupali Sisir Banu, 2 Sayera Banu, 1 Sharful Islam Khan 1 To cite: Sarwar G, Reza M, Khan MNM, et al. Developing and testing community-based tuberculosis (TB) screening intervention to increase TB referral, case detection and knowledge among sexual minority people in urban Bangladesh: a mixed-method study protocol. BMJ Open 2020;10:e037371. doi:10.1136/ bmjopen-2020-037371 ► Prepublication history for this paper is available online. To view these fles, please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2020- 037371). Received 02 February 2020 Revised 01 August 2020 Accepted 03 August 2020 For numbered affliations see end of article. Correspondence to Dr Sharful Islam Khan; sharful@icddrb.org Protocol © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Introduction Although Bangladesh is a country of generalised tuberculosis (TB) epidemic, the HIV prevalence is low among general populations, and 3.9% among key populations. Despite the high possibility of HIV–TB coinfection, scientifcally tested approaches for increasing TB case detection among sexual minority people are yet to be developed and implemented in Bangladesh. Such approaches could foster service delivery linkages between communities and the government health system. Findings of this experimental research are likely to provide new insights for programme managers and policy planners for adopting a similar approach in order to enhance TB referral, thus ultimately increasing TB case detections and reducing the likelihood of TB-related mortalities and morbidities, irrespective of HIV status. Methods and analysis This operational research will follow a quasi-experimental design, applying both qualitative and quantitative methods, in two drop- in centres in three phases. Phase 1 will encompass baseline data collection and development of a community-based TB screening approach. In phase 2, the newly developed intervention will be implemented, followed by end-line data collection in phase 3. Qualitative data collection will be continued throughout the frst and second phases. The baseline and end- line data will be compared both in the intervention and comparison areas to measure the impact of the intervention. Ethics and dissemination Ethical approval was obtained from the Institutional Review Board of International Centre for Diarrhoeal Disease Research, Bangladesh. The fndings will be disseminated through diverse scientifc forums including peer-reviewed journals, presentation at conferences and among the policy-makers for policy implication. The study started in January 2019 and will continue until June 2020. INTRODUCTION HIV epidemic poses as an impediment to the effective control of tuberculosis (TB) worldwide. 1 Clinical evidence has alluded to a causal relationship between TB and HIV. 2 HIV is considered as the most predomi- nant risk factor for the development of Mycobacterium tuberculosis infection to TB disease. 2 3 Likewise, TB infection accel- erates the progression of HIV infection, reduces survival and even predisposes the infected individual to premature death. 4 On the global scale, an estimated 10.0 million Strengths and limitations of this study ► The study adopts a mixed-method design, which will validate results from quantitative and qualita- tive strands in order to explicitly understand the re- search problem. ► The study will use a community-based approach, thus ensuring the involvement of the sexual minority population at all phases of the study to ensure the internal validity of the fndings. ► This study will develop an approach of detecting tuberculosis cases for the frst time among sexual minority people through an integrated model, which will harness service delivery linkages with the gov- ernment health system for achieving sustainability. ► This study will follow a quasi-experimental design rather than a randomised controlled trial. ► The study will be conducted in two service centres only; therefore, the fndings generated from this study may not be generalised for the whole sexual minority people; nonetheless, the approach is ex- pected to help in informing the policy makers. on February 23, 2022 by guest. Protected by copyright. http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2020-037371 on 22 September 2020. Downloaded from