Family first: integrating principles of family-centered care to improve the tuberculosis care cascade - BMC Global and Public HealthTuberculosis (TB) remains a leading cause of morbidity and mortality worldwide, with persistent losses across the care cascade from screening and diagnosis to treatment completion and prevention. While TB programs have largely focused on disease control and individual patients, many barriers to care arise at the household level, including stigma, financial strain, caregiving demands, and limited access to information and support. Family-centered care (FCC), which engages families as active partners through shared decision-making, respect, and tailored support, has improved outcomes in other health areas but has not been systematically applied to TB. Here, we argue that integrating FCC into TB care can reduce losses across the cascade and improve outcomes for individuals and households. FCC offers a unifying framework to strengthen engagement, equity, and continuity of care. It can address key barriers by promoting tailored education, shared treatment planning, household involvement, and coordinated social, economic, and clinical supports across prevention, diagnosis, treatment, and follow-up. Drawing on existing evidence and case vignettes, we outline practical strategies to align FCC principles with TB program activities. We also highlight key considerations for implementation, including workforce training, community partnerships, resource needs, and potential trade-offs such as caregiver burden or unintended stigma, underscoring the importance of context-specific adaptation. Adopting a family-centered approach provides a pragmatic pathway to strengthen TB programs, enhance patient and household experiences, and accelerate progress toward TB elimination. Effectiveness of a novel midwifery preceptor program on midwives’ competence and confidence in Sierra Leone: A prospective pilot studySub-Saharan Africa faces some of the highest maternal mortality rates globally and the greatest shortage of midwives. Strengthening midwifery education and clinical training is one of the most impactful interventions to reduce maternal mortality. Global reports cite lack of investment in educators, limited skills and knowledge in contemporary teaching methods, and limited clinical experience for students as key barriers. To address these gaps, a six-month, low-dose, high frequency midwifery preceptor course was developed and piloted in Sierra Leone. This study aims to evaluate the program’s effectiveness in strengthening preceptors’ clinical and precepting competence and confidence. Between 2023 and 2024 two midwifery schools in Sierra Leone participated in this novel intervention, each with n = 10 midwife preceptors (N = 20). A pre-post-test design was used to evaluate participants at the end of the intervention (6-months). Twenty-five assessments were used to evaluate participants including: written competency test, objective structured clinical examinations (OSCEs), self-assessments of competence and confidence, direct clinical observation, and student evaluations. Written competency tests had significant statistical improvement from pre- to post-assessment (p < 0.0001). All OSCEs had significant statistical improvement from pre- to post-test. The largest mean difference was for incomplete abortion/manual vacuum aspiration (mean: 45.76, SD: 15.47) while the smallest mean difference was in repair of perineal tears (mean: 9.26, SD: 11.91). Self-assessed clinical confidence and competence were also significant with average median scores increasing 1.42 points (IQR: 0.86, p = 0.002) and 0.75 points (IQR: 0.77, p = 0.0005) respectively. Self-assessed precepting competence significantly improved with average median scores increasing 1.32 points (IQR 0.80, p = 0.0002). Direct clinical observations had no change and student evaluations improved slightly pre- to post-test. Participants showed statistically significant improvements in clinical and precepting competence and confidence. This midwifery precepting program may be a useful intervention in strengthening midwifery education and maternal healthcare in a region with the highest burden of maternal mortality. Systems analysis and improvement approach to optimize tuberculosis (SAIA-TB) screening, treatment, and prevention in South Africa: a stepped-wedge cluster randomized trial - Implementation Science CommunicationsBackground The use of systems engineering tools, including the development and use of care cascades using routinely collected data, process mapping, and continuous quality improvement, is used for frontline healthcare workers to devise systems level change. South Africa experiences high rates of tuberculosis (TB) infection and disease as well as HIV co-infection. The Department of Health has made significant gains in HIV services over the last two decades, reaching their set “90–90-90” targets for HIV. However, TB services, although robust, have lagged in comparison for both disease and infection. The Systems Analysis and Improvement Approach (SAIA) is a five-step implementation science method, drawn from systems engineering, to identify, define, and implement workflow modifications using cascade analysis, process mapping, and repeated quality improvement cycles within healthcare facilities. Methods This stepped-wedge cluster randomized trial will evaluate the effectiveness of SAIA on TB (SAIA-TB) cascade optimization for patients with TB and high-risk contacts across 16 clinics in four local municipalities in the Sarah Baartman district, Eastern Cape, South Africa. We hypothesize that SAIA-TB implementation will lead to a 20% increase in each of: TB screening, TB preventive treatment initiation, and TB disease treatment initiation during the 18-month intervention period. Focus group discussions and key informant interviews with clinic staff will also be conducted to determine drivers of implementation variability across clinics. Discussion This study has the potential to improve TB screening, treatment initiation, and completion for both active disease and preventive measures among individuals with and without HIV in a high burden setting. SAIA-TB provides frontline health care workers with a systems-level view of their care delivery system with the aim of sustainable systems-level improvements. Trial registration Clinicaltrials.gov, NCT06314386. Registered 18 March 2024, https://clinicaltrials.gov/study/NCT06314386 . NCT06314386.