Identifying and Prioritizing Barriers to TB Prevention and Care in High-Burden Countries: A Community-Engaged Approach Using Best-Worst Scaling

Objective: To comprehensively identify the multi-level barriers to tuberculosis prevention and care in high-burden settings, and prioritize them according to their perceived harm and modifiability. Methods: We conducted a multi-phase stakeholder-engaged study, synthesized barriers from two scoping reviews, and then convened regional workshops in Hyderabad, India, and Nairobi, Kenya, prioritizing TB survivors, community advocates, and frontline healthcare workers (HCWs). Participants refined existing barriers and added new ones. They then completed a Best-Worst Scaling (BWS) exercise to assess the perceived impact (harm) of each barrier, and Likert-based questions to assess perceived modifiab