TB KaSPar
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3. People living with HIV should be systematically screened for TB disease at each visit to a health facility
(existing recommendation: strong recommendation, very low certainty of evidence).
2. Systematic screening for TB disease may be conducted among subpopulations with structural risk factors for TB. These include urban poor communities, homeless communities, communities in remote or isolated areas, indigenous populations, migrants, refugees, internally displaced persons and other vulnerable or marginalized groups with limited access to health care
(existing recommendation: conditional recommendation, very low certainty of evidence).
1. Systematic screening for TB disease may be conducted among the general population in areas with an estimated TB prevalence of 0.5% or higher
(updated recommendation: conditional recommendation, low certainty of evidence).
Fig.1 summarizes the potential contribution of TB screening to standard TB care practices based on the above frameworks for TB screening and shows the conceptual framework that guided the 2021 update to the TB screening guidelines.
Fig. 1. Conceptual framework for the 2021 WHO update to guidelines for systematic screening for TB. Numbers in parentheses refer to the PICO (population, intervention, comparator and outcome) questions that guided the evidence gathering
The definitions below apply to terms as used in these guidelines, and they may have different meanings elsewhere.
Active (tuberculosis) case-finding (ACF): Provider-initiated screening and testing in communities by mobile teams, often using mobile X-ray and rapid molecular tests. The term is sometimes used synonymously with “systematic screening”.
ART
antiretroviral treatment
CAD
computer-aided detection of TB-related abnormalities on chest radiography
CI
confidence interval
CRP
C-reactive protein
People in prisons and other penitentiary institutions are at an increased risk for TB compared with the general population, and they often have limited access to health care services. The estimated incidence of TB among people residing in prisons is 23 times higher than that among the general population (24). Data reviewed for the GDG meeting suggest that screening in prisons may improve early case detection, increase overall case detection and reduce TB prevalence.
Children and adolescents are of particular importance in contact screening, given the high prevalence found in the youngest age groups and the importance of rapid diagnosis and treatment owing to the risk of rapid disease progression in children younger than 5 years(23), as well as the importance of initiating preventive treatment if TB disease has been ruled out (see Section 2.4.2).
