Factors associated with persistent low internal active tuberculosis screening in tuberculosis treatment centers: An exploratory qualitative study in the Koshibanda Health Zone, Democratic Republic of the Congo

Introduction Internal active screening (IAS) for tuberculosis (TB) constitutes a critical strategy for improving case detection within healthcare facilities. Despite its integration into certain Tuberculosis Screening and Treatment Centers (TSTCs), the detection rate remains low in the Koshibanda Health Zone. Purpose To identify the factors explaining the persistence of low implementation of internal active tuberculosis screening in Tuberculosis Screening and Treatment Centers. Methods An exploratory qualitative study was conducted among 43 healthcare providers, including seven in-depth interviews and five focus group discussions. Four focus groups comprised seven participants each, while one included eight participants. Purposive sampling was employed until data saturation was achieved. Deductive thematic analysis was performed using ATLAS.ti version 9 software, based on an analytical framework inspired by the World Health Organization (WHO) health system building blocks. Methodological rigor was ensured through data source triangulation and independent coding procedures. Results The study, conducted in two TSTCs in the Koshibanda Health Zone among seven key informants and 36 healthcare providers, revealed varying levels of knowledge regarding internal active tuberculosis screening and its still-limited implementation. The major barriers identified included structural deficiencies, low prioritization of internal active screening due to excessive workload, and a persistent gap between knowledge and practice, resulting in predominantly opportunistic rather than systematic screening practices. Furthermore, dysfunctions in the referral and counter-referral system significantly limited patient follow-up and continuity of care. Conclusion Despite generally adequate knowledge of internal active tuberculosis screening among healthcare providers, its implementation in the TSTCs of the Koshibanda Health Zone remains constrained by structural limitations, insufficient prioritization of screening activities, and discrepancies between knowledge and practice. Strengthening diagnostic capacity, ensuring the availability of essential supplies, improving human resources, and reinforcing supportive supervision could substantially enhance early case detection and support tuberculosis control programs.