Operational Handbooks

High-quality services for TB diagnosis, treatment and management and support services for patients should be in place before or scaled up at the same time as systematic screening for TB disease.

The acceptability and feasibility of screening for those who will be screened and those who will provide screening should be assessed. Whether screening is accepted depends on how the programme is designed and implemented. Acceptability is therefore difficult to predict from evidence for other sites or for other subgroups. The acceptability of screening may be assessed in advance by organizing focus groups of target populations, preferably with a risk profile and an age and sex distribution that matches that of the populations at highest risk.

The provider-initiated screening pathway to TB diagnosis entails systematic identification of people with possible TB disease in a predetermined target group with tests, examinations or other procedures that can be applied rapidly. In those with a positive screening test result, the diagnosis must be established by one or several diagnostic tests and additional clinical assessments, which together are highly accurate.

The patient-initiated pathway to TB diagnosis can be enhanced by:

The operational handbook is intended for personnel in national TB programmes and national HIV/ AIDS programmes, or their equivalents, and other relevant national health programmes in ministries of health; other relevant ministries working in public health and screening; other health policy-makers, implementing partners including technical and funding agencies, civil society and representatives of affected communities, clinicians and public health practitioners working on TB and HIV and infectious diseases in the public and private sectors.

Systematic screening for TB fulfils the classic screening criteria (8). The following key principles are to be considered in planning a TB screening initiative:

Note: Unless otherwise specified, the definitions listed below apply to the terms as used in this handbook. They may have different meanings in other contexts.

Active (TB) 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”. It is referred to as “intensified case-finding” when conducted in health-care facilities and as “enhanced case-finding” when conducted in communities.

This operational handbook was prepared by Saskia den Boon and Cecily Miller, with input from Dennis Falzon and Matteo Zignol, under the overall direction of Tereza Kasaeva, Director, WHO Global Tuberculosis Programme. The WHO Global Tuberculosis Programme gratefully acknowledges the contributions of all experts and reviewers involved in the production of the latest update of the WHO guidelines on systematic screening for TB disease, on which this handbook is based, as well as other contributors listed below.