Consolidated Guidelines

Several clinical characteristics, conditions and comorbidities can indicate an increased risk for developing TB disease or suffering worse outcomes from the disease, or both. Individuals identified as having untreated fibrotic lesions on CXR and who are not diagnosed with TB disease are at increased risk of developing TB disease (34–37). These individuals are often identified through TB screening or clinical evaluation or during a clinical evaluation done for other reasons.

The GDG considered that all three approaches – symptom screening, CXR and mWRD – may have roles in screening for TB disease in the general population. The ranking of the tools according to accuracy proposed by the GDG is: first, CXR; second, mWRDs; third, screening for any TB symptom (higher sensitivity and lower specificity); and fourth, screening for any cough or cough lasting 2 weeks or longer (lower sensitivity and higher specificity).

A prisoner is anyone held in a criminal justice facility or correctional facility during the investigation of a crime, anyone awaiting trial and anyone who has been sentenced. In addition, people residing in a correctional facility are almost always in close contact with several other inmates; thus, whenever a person residing in a prison is diagnosed with TB, prisoners who have been in close contact with that person should be investigated (see Recommendation 4).

TB is the main cause of hospitalization and mortality among people living with HIV. The assessment of the performance of an mWRD used as a combined TB screening and diagnostic strategy for medical ward patients with HIV included 4 studies in Ghana, Myanmar and South Africa with a total of 639 participants (see Web Annex B, Table 15, and Web Annex C, Table 8).