Populations with structural risk factors for TB are those that are at increased risks of TB and of poor health outcomes from TB due to structural determinants in their environment, defined as the conditions that generate or reinforce social stratification (e.g. socioeconomic inequalities, population growth, urbanization), and therefore give rise to an unequal distribution of key social determinants of TB epidemiology, such as poor housing, poverty and malnutrition, which in turn influence exposure to risk, vulnerability and ability to recover after developing the disease (16,17). Structural risk factors for TB include poverty; malnutrition; overcrowded and poorly ventilated living, working and gathering conditions; and limited or no access to health care. These risk factors are not mutually exclusive nor do they exclude the clinical risk factors described in other recommendations, and they often compound one another.
This recommendation has not been changed from the 2013 guidelines as, since the last GDG meeting, no new evidence was found to inform the question of the impact of systematic screening for TB disease compared with passive case-finding practices in these risk groups. Observational studies during 2013–2020 suggest that TB screening conducted among populations affected by structural risk factors may initially increase TB case notifications and decrease TB prevalence; however, all studies had a major risk of bias.