Consolidated Guidelines

Definitions

Unless otherwise specified, the terms defined here apply as used in this document. They may have different meanings in other contexts.

Active (tuberculosis) case-finding: 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".

Acknowledgements

The production and writing of the WHO consolidated guidelines on tuberculosis. Module 5: management of tuberculosis in children and adolescents, 2022 was coordinated by Sabine Verkuijl, Annemieke Brands, Kerri Viney and Tiziana Masini, under the guidance of Farai Mavhunga, head of the TB Vulnerable Populations, Communities and Comorbidities unit and the overall direction of Tereza Kasaeva, Director of the World Health Organization (WHO) Global Tuberculosis (TB) Programme.

Executive summary

Tuberculosis (TB) is a leading cause of death from a single infectious agent, despite being largely curable and preventable. In 2019 an estimated 2.9 million of the 10 million people who fell ill with TB were not diagnosed or reported to the World Health Organization (WHO). The Political Declaration adopted by the United Nations General Assembly in September 2018 at the High-Level Meeting on the Fight Against Tuberculosis commits to, among other goals, diagnosing and treating 40 million people with TB by 2022.

2.1.1 Summary of the evidence and rationale

Systematic screening in the general population is conducted on the premise that it bears dual benefit: to the persons diagnosed with TB and to the community in which screening is conducted. Individuals found to have TB may benefit from less diagnostic delay, improved treatment outcomes, and lower costs and financial losses associated with the disease. It also benefits public health by reducing the population prevalence of TB, thereby reducing further transmission of TB.

3.2.1 Summary of the evidence and rationale

The use of CXR to screen for TB is a practice that goes back several decades. CXRs are also routinely used for triage of patients presenting to care who are displaying signs, symptoms or risk factors for TB to determine the most appropriate clinical pathway for proper evaluation. However, in many settings, the use of CXR for TB screening and triage for TB disease is limited by the unavailability of trained health personnel to interpret radiography images and by substantial intra- and inter-reader variability in its accuracy to detect abnormalities associated with TB (70–72).

3.1.1 Summary of the evidence and rationale

The data used to inform this recommendation came from a systematic review of the diagnostic accuracy of using symptoms and chest radiography to detect TB disease among individuals aged 15 years and older with negative or unknown HIV status. The review included studies of screening conducted in the general population (including several prevalence surveys conducted in African and Asian countries), as well as screening conducted in high-risk groups (including contacts of TB patients, prisoners and others).